My post Best exercises for the subscapularis is still one of the most popular articles I’ve written. Read it first, otherwise this post won’t make as much sense.
Matt left a comment on that post:
“I know this was posted a while back, however I am wondering if this could also be done laying on your back, the resistance would be greatest at the beginning and least at the end of the movement, and it seems like it would be fairly easy to keep from using pecs while laying down? I am no kinesiologist but good idea or bad??”
This is an interesting idea; something I didn’t consider. Here’s how I envision Matt’s thought:
First, this resistance is still isotonic. Meaning the resistance doesn’t change. The tension is the same at the beginning as it is as the end.
If you used a band for resistance, the tension would actually be least at the beginning and greatest at the end.
Feel free to chime in Matt, but I’m not sure I see any advantage or reason for concern over varying the resistance throughout the movement. Sticking with the cable seems easiest to me.
One of the aspects I like about this variation is it could be easier for the person to make sure the humerus does not glide anteriorly. Being on your back allows the opposite hand greater leverage to push the humerus down. This is in contrast to the standing variation I proposed, where there isn’t as great of leverage.
Next, I would plop the elbow up, again, increasing the amount of help available to keep the humerus down. This is crucial. That humerus can’t be gliding forward in order for this to be effective.
Without having experimented this exercise with anyone but myself, a few potential issues do come to my head though.
1) This variation has less ROM.
The range of motion is cut down some with the ground variation. (Because you can only externally rotate as far as the ground will let you.) In contrast to the standing version where you can achieve greater than 90 degrees external rotation.
2) People completely butcher this WITHOUT weight.
The position of the shoulder here is very similar to a sleeper stretch.
I’ve had so much trouble coaching people properly on this I no longer bother with it. Last I checked guys like Eric Cressey and Mike Reinold, guys who see A LOT of baseball shoulders, have pretty much canned this stretch as well. It just doesn’t go well.
People have a tendency to let the shoulder shrug into the ear:
This allows them to achieve way more internal rotation than they otherwise would. This:
Compared to:
Really though, any exercise where you are focusing on glenohumeral rotation presents these issues. And in the year since I wrote the original post on the subscapularis I’ve gone more and more away from worrying about working directly on rotation.
Any dysfunction having to do with the humerus, like lack of internal rotation (GIRD), humeral anterior glide, humeral superior glide, etc. seems to more often than not be a symptom of an issue with the scapula.
Treating issues with the scapula, like downard rotation syndrome, is 1) Much easier than working on pure humeral rotation and 2) Often fixes the humeral issue at the same time. Working on the humeral issue does not guarantee fixing the scapular issue though.
That’s a bit of a tangent to Matt’s original question. I suppose my short answer would be, “This is a fair alternative, but you have to pay special attention to the form. Such close attention is needed that I probably wouldn’t bother with exercises specifically for the subscapularis. I’d focus much more on the movement at the scapula first.”
Mike
December 24, 2012
It’s interesting that you promote working on the scapular issues rather than the humoral issues. I’ll be the first to admit that I don’t have the greatest posture. My shoulders round forward a lot and my overhead flexibility is bad. My shoulders are also loose. I can pull my left shoulder out of its socket just by trying, and both shoulders click and snap a lot when I move them (such as when I try the subscapularis exercises). I’ve been trying to actively pull my shoulders down and back throughout the day by pulling my shoulder blades together – will this eventually fix anything?
My primary sport is rock climbing, and I’ve been having a lot of pain in the shoulder as well as the biceps (especially the origin tendon, but also the muscle body). I think this is because of a movement deficiency when I climb. Do you know of any problems that could be causing work to be referred to the biceps or the wrong parts of the shoulder during overhead pulling activities such as climbing?
reddyb
December 26, 2012
Hey Mike,
I’m actually not a fan of that cue re: “Shoulders back and down.”
If you have trouble with overhead flexibility that cue could actually make things worse. You’re having trouble reaching overhead, right? By actively pulling your arms down, you’re not helping your cause in trying to get your arms up, if that makes sense.
And by pulling the shoulder blades too far together you’re likely recruiting the rhomboids, which, again, pull the shoulder / scapula down.
I’m not saying it’s not important to stand up straight; I’m saying people almost always take that cue too far.
A better cue in my mind is “stand up straight with your chest out.”
It really depends on the person and the movement dysfunction. Keep in my mind a lot of this is generalizing.
As far the biceps: If you have insufficient overhead flexibility, say the scapulae aren’t sufficiently upwardly rotating (this is likely you), then the scapula and humerus are going to almost “clunk” into one another. And what’s between them? The biceps.
This is why upward rotation is so important. Without it, the tendons between the bones get beat up.
Give number 1) a read in each of these.
http://b-reddy.org/2011/08/04/3-common-tight-muscles/
http://b-reddy.org/2011/09/12/3-common-weak-muscles/
Hope this helps.
Rob
April 10, 2013
Hey Brian,
So, I’ve been working on those wall slides in upward rotation since I’ve last spoken to you… needless to say it’s definitely helped a bit. There’s a certain feeling of relief after performing them. Something, still isn’t quite right and I wanted to see if I can get your input.
When I was diagnosed with my rhomboid tear, the MRI also showed a slight subscap tear. At the time, it was considered insignificant and no real cause for concern. However, I’ve been noticing that it feels as if the positioning of my biceps tendon determines my ability to fully retract my scapula and even get into comfortable external rotation. I have intermittent clicking and feel “blocky,” if that makes any sense, on the anterior aspect of my humeral head. I’ve been looking around online and I appear to have all of the symptoms of a medial biceps tendon sublux/dislocation. There is a tightness right up in my coracoid and I can’t seem to get out of protraction, regardless of trigger point release and stretching of my pec minor and major. I’ve come a long way in releasing my lats, pec major and minor, and my overhead flexibility is the best it’s been in some time… but something just doesn’t feel right.
Man, I wish I was still at UC San Diego so you could visually see what I’m talking about. Do any of these symptoms make sense with a medially subluxation? I just want to make sure that I’m not caught up in a catch twenty-two… because it just seems as if the wheels are spinning, but I’m going nowhere, FAST.
Rob
April 10, 2013
Would you consider those OH wall slides to be a contributing problem to an already subluxing first rib? Sorry, my dude. This is just incredibly frustrating.
reddyb
April 11, 2013
Rob,
If upward rotation was something you were really working on, why are you now focusing so much on scapular retraction? The primary scapular retractors (rhomboids) are the muscles that would inhibit upward rotation. It seems you’re trying to accomplish opposite things here?
Perhaps you have your terms mixed up? Not trying to be an ass, I understand not everyone is fluent in anatomy.
Overall though, when it comes to a specific person and an issue that sounds as intricate as yours, if I can’t see you, it’s very, very hard for me to help you. Just the assumption you’re doing the overhead exercise properly is a BIG assumption.
For what it’s worth, I don’t view things in terms of what’s clicking and whatnot. I view things as “What’s the aberrant movement?”
Because you can’t see your own shoulder blades when you lift your arms, it’s damn near impossible to diagnose yourself with something like this.
And going based off how you feel is a potentially dangerous rabbit hole: http://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/
This is my long way of saying just send a video of you moving your arms and I can tell you if I see something.
Rob
April 11, 2013
Hey Brian,
First and foremost, thank you for the opportunity to send you something. Upward rotation is something that I’m definitely working on. When I mentioned retraction, I guess I should have mentioned just normal movement, day-in and day-out, not that I’m actively trying to focus on my downward rotators; horizontal abduction, along with scapular retraction is generally just a huge challenge.
Any specific movements you’d prefer to see?
reddyb
April 16, 2013
Lift your arms a bunch of times from your side as high up as you can.
Then do the same thing, but with the arms in front of you.
So, a bunch of lateral raises then a bunch of front raises.
Uri Gottlieb
August 21, 2013
I must admit I haven’t read this thoroughly, but my comment about doing “high IR” while supine, is that it might cause anterior tilt of the scapula, while when doing this exercise in prone, the scapula is stabilized by the bed.
reddyb
August 22, 2013
Well, I discuss that above…
The link at the top of this page discusses the prone variation. Found here: http://b-reddy.org/2011/06/19/best-exercises-for-the-subscapularis/
A bed / table does not stabilize the scapula by itself. It’s not that simple.
Food for thought: What’s more likely to hold the scapula in place? The fully supine version, where a person’s entire bodyweight is pushing the ribcage down against their scapula. Or, the prone variation, where gravity is pushing the scapulae down against the rib cage?
Next, feeling the scapulae can give a nice feedback mechanism. Which variation gives more feedback? The supine version, where the scapula is against the ground, thus, you know when it moves. (Because it’ll rub against the ground.) Or, the prone variation, where the scapula is touching air?
Also, which version has a greater range of motion against gravity for the subscapularis? (Hence, a greater resistance / workload.) The supine version, where the arm fights gravity for 90 degrees? Or, the prone variation, where the subscapularis fights gravity for maybe 45 degrees?
(Supine: Arm internally rotates (uses subscapularis) against gravity for 90 degrees. Prone: Arm internally rotates for maybe 45 degrees against gravity.)
Lastly, supine and side lying are not the same. Something I probably could have delineated better in this post. Anyways, keeping the scapulae in place during a side lying rotation is much, much harder than a fully supine version.
There’s quite a bit to consider here…
BurritoMan
October 28, 2014
Brian, thank you for your research and videos, truly. If I have serratus anterior issues, slightly rounded shoulders and pain/weakness underneath the shoulder blade (likely subscapularis & neighboring muscles that ache after long car driving, desk work, or pressing exercises AND rowing exercises), and you no longer would recommend this standing internal rotation exercise above, what would you recommend as the single best exercise to strengthen the scapula/serrautus anterior/subscapularis, etc? I have been reading your other posts, but I’m not entirely clear on what you prefer to treat these areas most effectively. Overhead press? Front shoulder raises? Supine cobra on floor? I’m searching thru comments in other posts, and I want to make sure I’m being efficient and effective with my exercises. Thanks very much, sir.
BurritoMan
reddyb
October 31, 2014
The internal rotation with the arm at 90 degrees in this post is a good one. I would also give this a look: http://b-reddy.org/2013/09/05/a-progression-to-lifting-your-arms-overhead-pain-free/
-California burrito, or no burrito
Jeff
November 6, 2017
Great articles. I think I’ve read everything you wrote regarding shoulder, but I’m still a bit confused as to the way to correct some of these issues.
I have all the conditions you mentioned at the end of article: GIRD, anterior/superior humeral glide, scapular winging, right lats, and it’s all so bad on my right shoulder that if I don’t pull my humerus and shoulder blade just right, I can’t abduct my arm past 30 degrees to the side and the pinch on top hits hard. Both shoulders are a problem though, but the right (worse) one doesn’t hang low like the other one. I can also feel the tendons rolling over the bones in both shoulders when I pull my shoulders straight back, lots of popping going on.
6 weeks of regular physical therapy didn’t do anything at all for me. All they had me do was the typical external rotations, rows, etc. I saw a chiropractor who helped a great deal. He suggested the serratus wall slides. 2 months ago, unless I turned my thumb up I couldn’t lift my arm at all to the side so I’ve made a little progress but am now stuck again.
I’ve been doing the wall slides for a few weeks and have added high internal rotations just last week, and today am adding in overhead shrugs/slides on the wall and that lat stretch with back/head against wall and arms straight in front. That article showed me how tight my lats are. As I type this, I think I’ve been missing my serratus completely because the overhead shrugs really have my sides feeling it. Am I missing anything? Thank you in advance. I’ve been dealing with all of this for a year and it’s getting old.
b-reddy
November 7, 2017
Hey Jeff,
Thanks for the nice words. Glad you’re finding the site worthwhile.
If you haven’t seen this already, this is part of what I’d be working on: https://b-reddy.org/2013/09/05/a-progression-to-lifting-your-arms-overhead-pain-free/
You may want to entertain this too, to help take the guesswork out: https://b-reddy.org/2013/06/20/the-remote-client-process/