Assessing shoulder motion / pain (an illustration of humeral anterior glide)

Posted on June 23, 2012

6


I recently had this exchange and thought others could potentially benefit it from as well:

From Tyler (in italics; I’m always in bold):

“I’ve been reading a few of your articles and discussions on T-Nation and I was wondering if I could ask you a few things regarding my shoulder issue. I’m a pitcher and I’ve been having issues throwing for the last 6 years. Recently I had a huge scare while pitching. I heard a huge click/pop in my shoulder when pitching. I have all my strength and have been working with a very good chiro in my error and it seems to be slowly getting better.

I have subscap firing problems and a very tight posterior capsule and external rotators along with some winging, tight rhomboids and pec minor and a little weak of weakness in my lower traps.

I was wondering if I could shoot a video going through some motions and see if you can pick out whats going on.

Thanks alot”

.
Hey Tyler,
 
Nice to meet you. Shoot me some videos and I’ll be glad to take a look.
 
-Brian
 .
Ok will do after workout. It definitely feels like the upper trap is weak and lengthened and rhomboid takes over when trying to elevate. I have held my right shoulder in the back and down for years and its in a pulled down state. 
.
.
.
Here’s video. It definitely looks and feels like my right side is more retracted then left and upper trap isn’t allowing proper upward rotation due to tight rhomboids. also have issues with GIRD although it has gotten better
 .

You are a bit too retracted. And your right shoulder is pretty depressed. However, in anyone with a throwing history it’s common to have a depressed shoulder. 

 
Your upward rotation is actually good. You’ll notice with throwers often times their shoulder is depressed in a resting position (like yours), but once you begin to elevate the shoulder it will actually catch up to the other side causing things to pretty much even out. You can see this pretty easily with your shoulders. Your right starts lower but then catches up as you fully upwardly rotate. 
 
Your biggest issue I can see in the videos is your humerus is excessively gliding anteriorly. Look at the 32 second mark when you perform internal rotation. You can see the humeral head become quite prominent as you internally rotate compared to the left. AND you SHOULD have less internal rotation on the right side than your left. (Because of your throwing history.) However, you’re accomplishing extra internal rotation by excessive anterior glide. 
 
If you look at the posterior cuff muscles when you perform internal rotation at 1:01 you can see your right cuff muscles are wayyy hypertrophied. One because this is your throwing arm, two is likely because the posterior cuff muscles are compensating for a weak subscapularis. (The muscle responsible for your excessive anterior glide). 
 
Then at 1:10 you can see how much more extension you are getting on your right arm compared to your left. I.e. your right elbow goes much further back than your left. Again, this is indicative of excessive anterior glide. 
 
Let me know if that makes sense. 
 
-Brian
 .
Oh it makes perfect sense. I’m seeing a chiropractor who is taking care of the subscapularis as we speak as it was neglected from the very start from other doctors. I was told to continue doing external rotation and stretch right chest and strengthen back. I have zero issues reaching overhead on my right side especially. I get issues during the cocking phase and release when throwing. Obviously due to faulty subscapularis firing. It has come along way in the last month since I’ve started seeing my new Chiro. I started doing the overhead shrugs you posted online an it’s been helping a lot. (Note to readers, see this link 3 common weak musclesMy right trap is definitely weaker then the rest of the muscles. When I have it propped up in its proper position I can do all of my exercises and stretches a lot easier with no pain.
 
So by your findings, what would you suggest me start/continue doing?
Also, with my right side it always feels like it is being pulled externally and away from my body and my palm faces forward. When I keep it closer to my body and slightly internally rotates, it feels like a lot of stress is being taken off of my external rotators
Also when going over my rhomboids with a lacrosse ball it is so beat up and feels so lumpy and knotted. Could this be a reason for my shoulder issues?
 .

Glad to hear the shrugs are helping. Definitely keep doing them.  

As far as the rhomboids, are you sure you are rolling the rhomboids and not the posterior cuff? Because your posterior cuff looks like it’s what’s knotted up. I don’t see too much going on with your rhomboids. 
 
Why are you doing external rotations? I’d have trouble keeping those in if I were you. You already have a hypertrophied posterior cuff, which is responsible for external rotation. And you have pain during the cocking phase, which is external rotation. I’m just not sure you need it and I have a feeling you may be overdoing this motion. You ESPECIALLY need to make sure when you perform external rotation you have ZERO anterior glide from the humeral head. However, I’d be much more concerned with working this during internal rotation. 
 
Be very, very careful about how you stretch your pecs. If you do it wrong you may be stretching the anterior capsule. Obviously, you now know this is a huge no-no for you. Your anterior capsule is already too flexible. 
 
You want to make sure you are stretching the pecs with a posterior glide on the humerus. This way the subscap is not excessively stretched, nor the humeral head. 
 
Have you read my article on the subscapularis? (Note to readers, see this link: Best exercises for the subscapularis ) It has a lot of info in there that would be applicable to you. 
.
The overhead shrugs have helped a lot. I’ve been keep a slight contraction in them and everything feels a lot more symmetrical. Yesterday I threw and everything felt a lot better. I’ve been loosening up the pec minor, rhomboid and posterior capsule with a lacrosse ball. I had no pain throwing and once it loosened up I had a lot of power. Very minimal soreness today.
 
It really feels like the upper trap was the biggest thing along with the posterior capsule. My lower trap feels really strong compared to my left one. The right side just feels depressed and no hunched forward like my left one.
 
I have read the article on the subscapularis and I’ve really started to focus on those exercises and they’ve helped a lot.
 
I haven’t been doing external rotations. I meant it felt like my shoulder was being pulled into external rotation even in resting phase.
 
Also the rhomboidal are very beat up with regards to their tissue quality. Very knotted and bumpy as are the posterior capsule and pec minor.
Although when I keep my shoulder from going into anterior glide, all of the trap exercises feel much easier to do and I feel the muscles working more. Also doing posterior capsule stretches feel better as I feel I am keepin it from gliding anteriorly which was causing my joint pain
 .
Great to hear! It sounds like you’re heading in the right direction. 
 .
Ya big improvement within the last few weeks. Yesterday was a huge eye opener and I’m really exciting. I was throwing 87-90 pretty much all arm and in tons of pain so I want to see where I can go from here. Thanks a lot for your input my friend. I really appreciate it.
 .
Glad I could help! 

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Advertisements
Posted in: Shoulder Pain