Shoulder stabilization, brachiation, and maintaining mobility

Recently, I began training a gentleman in his 70s that had done Pilates and Gyrotonics for years. He noticed after his Gyrotonics workouts his shoulder felt sore, until eventually it became a chronic ache. He decided to see me (his wife was already a client), to see if I could provide any guidance. I noticed when he made any sort of shoulder movement, his scapula would collapse. It wasn’t the Gyrotonics that was the issue, it was the fact he lacked the shoulder girdle stability to perform some of the single arm circular movements.

The shoulder girdle is a rather complicated joint. I wrote a really bad blog on it a few years ago when I was trying to put all of the pieces together. The reason I think it is a little more difficult to understand than, say, the hip joint is because the shoulder joint actually consists of several joints to allow for overhead movement to take place. The humerus, the long upper arm bone, inserts into the scapula via the glenohumeral joint (1). This is where the rotator cuff muscle group (supraspinatus, infraspinatus, subscapularis, and teres minor), exist. While the name implies these muscles allow for rotation, their main purpose is to keep the humerus stable as it moves. In order for the humerus to move, the scapula must move as well. The scapula shares a connection point with the clavicle via the acromioclavicular joint and the sternoclavicular joint. The scapula also connects to the thoracic spine at the scapulothoracic joint, implying that thoracic spine position will impact shoulder mechanics (as one client likes to say, “it really is all connected, isn’t it”). When someone lifts his arm overhead, the scapula provides a stable base to allow the arm to move (2). This doesn’t mean the scapula is fixed; in fact, Scibek and Carcia (2012) found that while the scapula moves very little when the arm lifts from 0-30 degrees, from 30-90 degrees, the scapula contributed 20-37% of movement,and from 90-120 degrees, the scapula contributed 57% to the elevation of the arm. This, of course means the scapula must also return to its resting position in a controlled manner, which was one of the components my client was lacking. How stable the scapula is (and how much eccentric control will occur when the arm is being lowered), depends on several stabilizing muscles, including the serratus anterior, trapezius, rhomboids, and levator scapulae. There must be balance in this musculature to support scapular movement, and the ability to protract and retract is important for good quality movement. These muscles work with the rotator cuff muscles to provide scapular control. 

In addition to the muscles that provide support for the shoulder to move through a full range of motion, the joint capsule, labrum, and ligaments provide stability and allow a the humerus to move in a large arc around a center of rotation (1). The joint capsule is twice the size of the humeral head and works with the glenohumeral ligament to alternatively tighten and loosen during rotation. This provides stability and prevents the humeral head from moving too far forward or back as the arm moves.

If you were able to follow that dense anatomy, hopefully it is obvious that the human shoulder joint is a complex joint that allows for a lot of movement, but has the necessary structures in place to provide adequate stability and control during this movement. However, in order for all of to take place, the spine has to be well-organized (to borrow from the mind-body peeps). Researchers suggest that in overhead athletes, for instance, shoulder dysfunction is dependent on cervical rotation and side bending, overall spine function, and hip flexibility (3). When you consider the fact that hip flexibility is related to foot mechanics, you basically have a shoulder that only functions as well as the rest of the body.

The next question is what to do with this knowledge? Based on the anatomy, I think it is pretty evident the arm is designed to go overhead. In fact, some of the activities of daily living, such as back washing, hair combing, and reaching, are all things that require overhead movement (4). Some evolutionary biologists believe our ancestors were tree dwellers before they ended up on the ground, implying that not only was the shoulder designed to reach up for fruit, but to hang from branches and climb as well (5). I am doubtful that nature intended us to sit in front of screens for many hours at a time, or to throw objects at high velocities over, and over, and over again. Modern society has ended up with shoulders that don’t maintain range of motion or stability, leading to a plethora of rotator cuff and impingement issues, laxity problems, and labrum tears.

If you are working with a healthy adult (or are a healthy adult) with no pre-existing shoulder issues that isn’t an overhead athlete, working towards hanging can be an excellent goal. Some of the pre-requisites for hanging include good scapular control, adequate shoulder mobility, a balanced glenohumeral joint, a well-organized spine with proper thoracic mobility, and adequate hip mobility, all of things which will be reinforced by various forms of brachiation. If you have a pre-existing shoulder injury or participate in a sport involving a lot of overhead motion, while hanging might not be the best choice, working on the pre-requisites for hanging can be an excellent way to build balanced strength and mobility in the shoulder. If you don’t regularly use the range of motion available in the shoulder, you will lose that mobility; conversely, if you use the available range of motion a lot and stretch to add more flexibility, but don’t have the supporting structures to provide stability during all parts of the motion, eventually something will give. Strength and mobility are not either/or components; rather, a sense of equanimity between the two is required for efficient, pain free movement.

Yours in health and wellness,
Jenn

*For more information about training overhead athletes, I highly recommend checking out some of Eric Cressey’s work at www.ericcressey.com
**Katy Bowman discusses brachiation and how to do it in more detail in her book, “Move your DNA.”
***I will have a Youtube up in the next two weeks with an example of a shoulder mobility sequence for hanging. If you would like to be notified of when that is up, please sign-up for my mailing list at www.bewellpt.com 

1. Moezy, A., Sepehrifar, S., & Dodaran, M.S., (2014). The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome. Medical Journal of the Islamic Republic of Iran, 28(87). 
2. Terry, G.C., & Chopp, T.M., (2000). Functional anatomy of the shoulder. Journal of Athletic Training, 35(3), 248-255.
3. Scibek, J.S., & Carcia, C.R., (2012). Assessment of scapulohumeral rhythm for scapular place shoulder deviation using a modified digital inclinometer. World Journal of Orthopedics, 3(8), 87-94
4. Young, J.L., Herring, S.A., Press, J.M., & Casazza, B.A., (1996). The influence of the spine on the shoulder in the throwing athlete. Journal of Back and Musculoskeletal Rehabilitation, 7(1), 5-17.
5. Rundquist, P.J., Obrecht, C., & Woodruff, L., (2009). Three-dimensional shoulder kinematics to complete activities of daily living. American Journal of Physical Medicine and Rehabilitation, 88(8), 623-629.
6. Crompton, R.H., Vereecke, E.E., & Thorpe, S.K.S., (2008). Locomotion and posture from the common hominoid ancestor to fully modern hominins, with special reference to the last commong ancestor. Journal of Anatomy, 212(4), 501-543.