Shoulder discomfort is a fairly common malady among today’s office workers, and although the scapulae rarely get blamed, they are often the source of the pain. Commonly known as the shoulder blades, the left and right scapulae are the critical links between the spine and the shoulder’s rotator cuffs. Essentially, they and the 17 muscles around them are the foundation of your shoulders and the base of every arm movement, so it pays to keep them positioned properly.
“In almost 100 percent of cases where there is an injury at the shoulder joint, there is also dysfunction at the scapula,” says Mike Robertson, president of Robertson Training Systems in Indianapolis, Ind.
Ordinary lifestyle factors and common exercise patterns can create imbalances in the scapulae that cause them to function improperly. Eventually, this can lead to shoulder problems such as bursitis (sometimes referred to as “swimmer’s shoulder”), arthritis, cartilage damage, rotator-cuff tendonitis (inflammation), tendinosis (degeneration) and rotator-cuff tears.
“But the good news,” Robertson says, “is that if you can get rid of your problems at the scapula, you can get rid of — or prevent — most shoulder injuries.”
The Price of Imbalance
Poor posture, such as the forward rounding of the upper spine common among office workers (see “In a Slump” in the May 2007 archives), inhibits the ability of the scapula to tilt backward and create space for the rotator cuff in the shoulder joint when the arm is lifted overhead. As a result, the rotator cuff gets pinched, causing tissue damage.
Sitting in a hunched position for long periods of time also affects the muscles that move the scapula. “Most commonly, poor scapular positioning causes the lower trapezius, which helps rotate the scapula upward to lift the arm overhead, and the external shoulder rotators to become weak,” says Bill Hartman, PT, CSCS, owner of PR Performance in Carmel, Ind.
These weaknesses reduce the shoulder’s mobility and stability, and certain popular exercises may actually worsen these imbalances — and their consequences. The bench press, for example, strengthens the muscles that rotate the scapula internally and downward, but it leaves the weak external and upward rotators untouched. A good counterbalance to the bench press is the pushup, which activates and strengthens those rotators.
An Ounce of Prevention, a Pound of Cure
Restoring balance and proper function to your scapulae isn’t hard, but it requires some focus and commitment.
“Before anything else, focus on correcting your posture,” says Robertson. Condition yourself to sit with your trunk fully upright and with your deep abdominal muscles engaged. If necessary, reposition your computer screen so you look straight ahead at it instead of downward, and move your keyboard so you can type without reaching forward.
You can further correct a hunched upper back by doing thoracic extension exercises. While sitting in a chair, lace the fingers of both hands together against the back of your head and tilt your head back to look up at the ceiling. Relax and repeat 10 times. Do this exercise at least twice a day.
It’s also important to modify your resistance-training routine to strengthen all of the muscles that act on the shoulder joint. For most of us, the muscles that typically require the most attention are the lower trapezius and the shoulder external rotators. You can strengthen these muscles using the corrective exercises described below.
The site of pain is not always the cause of pain, and the shoulder blades are a prime example of this principle. If you have shoulder pain or dysfunction, your scapulae may be to blame. But don’t get mad at them — get even. Evenly balanced, that is.
Are Your Shoulder Blades Where They Should Be?
Because your scapulae are tenuously attached to the rest of your skeleton (a single, fingerlike bone provides the only link), the muscles attached to them have a dramatic effect on where they sit in relation to your spine and shoulder joints. When these muscles are not well balanced, the scapula is often pulled away from the spine and rib cage, toward the shoulder joint — a phenomenon known as scapular winging. This common scapular-positioning issue reduces the mobility and stability of the shoulder joint, increasing the risk of injury.
To see whether you are affected by scapular winging, stand with your hands on your hips with mirrors in front of and behind you. Your scapulae should sit flush with your upper back. If the inside edges of your shoulder blades are clearly visible, then your scapulae are out of balance.
To correct common scapular imbalances, Bill Hartman of PR Performance recommends that you incorporate these exercises into your workout regimen twice a week.
Prone Y, T and W
Y: Lie facedown on a table or bench (use a towel to cushion your face and keep your cervical spine neutral), your arms hanging down toward the floor, palms facing your body. Start without any weight, and then move to using a very light dumbbell (1 to 3 pounds). Tighten your shoulder blades down against your rib cage. Contract the muscles around your shoulder blades and lift your arms upward at a 45-degree angle to your body (so that your arms and body form a “Y” shape, viewed from above). Lift your arms until your scapular muscles are fully contracted (this is a small movement). Lower your arms back to the starting position and relax your scapular muscles. Do 10 reps.
T: Next, rotate your arms so your palms are facing forward with your pinkies closest to your body. Tighten your scapular muscles and lift your arms straight out to the side. (Your arms and body now form a “T” shape.) Lower your arms to the starting position and relax your scapular muscles. Do 10 reps.
W: Finally, rotate your arms so your thumbs are facing your body. Tighten your scapular muscles and lift your elbows straight upward, allowing your arms to bend 90 degrees. Pause with your upper arms parallel to the floor and your forearms perpendicular to the floor. Now rotate your forearms up and forward 90 degrees. (Your arms and upper body will form a “W” shape, viewed from above.) Lower your arms to the starting position and relax your scapular muscles. Do 10 reps.
For External Rotation
Neutral Position: Stand with your left side close to a cable pulley station. Grasp the handle in your right hand and begin with your right arm bent 90 degrees so that your fist is pointing toward the cable pulley station and your forearm is across your belly. Keeping your elbow tight to your side, rotate your shoulder externally and pull the handle across your body until your shoulder is rotated outward as far as is comfortable. (Keep the weight setting light — no more than 5 to 6 pounds.) Slowly return to the starting position. Complete 10 repetitions and repeat the exercise with your left arm.
Overhead Position: Stand with your upper arms extended out to your sides at shoulder level, your elbows bent 90 degrees, holding small dumbbells (3 to 5 pounds) in your hands, fists pointing toward the ground. Now rotate the weights upward 180 degrees, stopping when your fists are pointing toward the ceiling. Return to the starting position. Complete 10 repetitions.