Compared to some of the other information on this site, this is going to be a nerdy post. For anyone reading this who has shoulder pain there are definitely some important pieces of information. However, there is a lot of anatomy talk in this that I realize not everyone is familiar with (or wants to be familiar with). Therefore, you may want to skip around and find what is most pertinent to you.
With that said, reading the entire thing will give some insight as to just how much thought process should go into selecting some of the exercises you do, as well as the exercises I select for my clients.
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The basis for this post is a study I found titled,
–Subscapularis muscle activity during selected rehabilitation exercises.
First off, what is the subscapularis?
The subscapularis is one of the rotator cuff muscles. You know, that thing your doctor told you is messed up? And he/she said just pull on an elastic band to make your shoulder feel better…yet you can still barely move your arm.
There are four muscles that make up the cuff, and the subscapularis is one of them.
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Why you care about it:
This muscle internally rotates the humerus (upper arm) and depresses the humeral head. In other words, when you move your arm the subscapularis helps keep the shoulder nice and snug in its socket.
One of the more common causes of shoulder pain I see with new clients is an overstretched and weak subscapularis. This is often visible to the eye: Ever see people where the front of their shoulders look really boney?
Or feel your own shoulder. There should be a little give when you touch the front portion of the joint. it shouldn’t be protruding, and it shouldn’t be tender. If it is, there is a good chance your subscapularis could use some strengthening, which will help with your shoulder pain. Or prevent it.
So what exercises best strengthen it? Based on the paper above, for the exercises they looked at, they ranked the exercises they used as follows (for a detailed look at the exercises check out the paper; click for a clearer image):
While the author’s chart makes things seem pretty straight forward, there is more to what exercise one should select. It’s actually not as simple as this exercise has greater activity than that exercise, so pick that one.
As mentioned, often times the subscapularis becomes long and weak. When one muscle becomes long and weak, typically another muscle, or muscles, becomes tight and or overactive.
When it comes to muscular imbalances (and pain) we regularly want to strengthen the long and weak muscle(s) and get the tight and or overactive one(s) to calm down. So not only do we want to pick exercises that wake up the long and weak muscle, but we want to pick exercises that, if not simultaneously, calm down the tight/overactive one.
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What becomes tight/overactive when the subscapularis is long/weak?
Often times the tight/overactive muscles in this case are pectoralis major and latissimus dorsi. This is because the subscap isn’t internally rotating the humerus like it should be. So, other internal rotators, like pec major and the lat, pick up the slack. Infraspinatus and teres minor pick up the slack as humeral head depressors.
Therefore, when strengthening the subscap we want to pick exercises that elicit great activity in the subscap, but don’t elicit much activity in pec major, lat, infraspinatus, and teres minor.
That’s where this chart from the paper comes in:
In comparing the activity of the muscles I’m going to only look at the upper subscapularis in relation to the other muscles we’re looking at. This is because I’m really not sure how important the distinction between the two is. The authors go out of their way to talk about the importance of the subscap being separately innervated. However, they mention the upper subscap has been found to be dysfunctional in those with shoulder pain, but make no such mention of the lower subscap. I’ve also seen other authors make no distinction when it comes to the shoulder issues and simply stick with, “strengthen the subscap.”
Furthermore, the upper subscap is the portion of the muscle that consistently had the highest activity, and the exercises were ranked nearly identical in terms of effectiveness between the two sections. So again, while there may be a better approach, I’m just going to look at the upper.
All right, so from looking at the chart we can see exercises such as the diagonal would be a poor choice due to the fact that pec major is more active than the subscap. This is important as simply taking the authors data at face value could lead one to suggest the diagonal is a great exercise as it was ranked as the second best.
And we can tell an exercise such as IR High is a good exercise due to the fact the subscap is more active than pec major, infraspinatus, and the lat, which are all barely active at all.
So, changing the author’s original order in terms of best exercises for the subscap based strictly on activity to best exercises based on activity in relation to the other muscles, I’d do something more along the lines of:
1) IR High
2) Push-up plus
3) Dynamic Hug
4) IR Mid
5) Forward Punch
6) IR Low
7) Diagonal
I put the IR High first because it had the biggest difference between subscap activity and other muscles with at least a 38% difference. The push-up plus and dynamic hug are next as there was still a good sized difference between the subscap and other muscles, 16 and 12% respectively. These exercises get the serratus anterior involved too, which is often overstretched and weak also.
IR High is also ranked above these as preventing the head of the humerus from moving is much easier to do than with other exercises, like the push-up plus or dynamic hug. I’ll show an example of this later.
The IR Mid and Forward Punch both favored the subscap as well, but with very small differences. The IR Mid, similar to IR High, is a better choice in my mind though because of the ability to prevent the head of the humerus moving forward.
IR Low and the Diagonal both favored the overactive muscles, thus would be contraindicated for people looking to strengthen their subscapularis.
This means if you are trying to strengthen your rotator cuff and keep your shoulder healthy, performing internal rotation with your arm by your side (IR Low) could cause you to spin your wheels, if not make things worse. This is because you are strengthening pec major just as much, if not more, than the subscap. In other words, get rid of this exercise:
And switch to this one:
You’ll notice the opposite hand is pressed down on the shoulder joint. This is to make sure the humerus does not glide anteriorly during the movement. This is crucial because the whole point of doing this exercise to get the shoulder to stop protruding.
Performing IR High already helps a lot to make sure this doesn’t happen since the muscles that cause anterior glide are primarily dormant, however, it can still happen. Therefore, putting the hand on the humerus and pushing it down and back only helps. Also, it gives the client a better understanding of why we are doing this particular exercise, as well as how we are going about ceasing their shoulder pain. This can be hard as hell to do with an exercise where a lot more is going on e.g. push-up plus.
Lastly, the IR High can be performed in the prone position as well. I’m not sure why this wasn’t examined in the study, but people who really know their stuff, such as Shirley Sahrmann and Mike Reinold, are advocates of this.
I’ll say getting people to perform the exercise prone has proven to be more difficult for me, so I tend to go with the standing version first. If you go with the prone variation make sure 1) You can see your elbow to make sure it’s not moving forward and backward (sign you are using the deltoid/lat instead of the subscap) and 2) That the humerus is not moving anteriorly.
If you look closely at the humerus here you can see how it glides toward the mat:
Again, this is exactly what we want to avoid. Putting something under the humerus can help get rid of this movement:
Just make sure whatever is put under the shoulder does not block the person’s ability to see their elbow.
Again, I tend to go with the standing variation first. It’s a bit easier to learn and there is a much greater range of motion involved. Both seem to get the job done though.
Check out some information on the law of repetitive motion for a related post.
Matt Douglas
August 17, 2012
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??
reddyb
August 17, 2012
Hey Matt,
This is an interesting idea. Give me a couple days. I’m going to write something up on this.
Thanks for the idea!
reddyb
September 9, 2012
Sorry this took me so long, but here you go: http://b-reddy.org/2012/09/09/another-exercise-for-the-subscapularis/
Mark Jamieson
September 25, 2012
I find with IR low , if the weight is to great you cant help bring in the major muscles like pecs but using a lower weight and ONLY activating you subcap does the trick, ad I know it does because the lesser weight performed strictly result in my being able to perform far less reps and i can feel the subscap working in isolation. I’ve started doing IR high though on my back, seems to be making more of an improvement with my shoulder, not sure if I’m doing it right though, no idea what my humerus is doing, I’ll give this one a shot., when my shoulder was at its w3orst I’d get half way though a set of tricep extension and my subscap would completely tired out and my humerois would start rattling round , not good
reddyb
September 25, 2012
Sounds like you’re on the right track. Let me know if you need help with anything. Best of luck.
Jwhite
June 6, 2013
I realize I may be resurrecting an old thread, but I found this article helpful and had a couple of questions. I’ve recently noticed some pain in my anterior deltoid when benching and performing overhead pressing. I’m aware of proper form (and try to practice it), but when I use heavy weights, sometimes I feel my left shoulder moving upward, despite my efforts to keep my shoulder blades pulled back. This is making me wonder if my subscapularis is failing to fire properly and keep the humerus in place.
I’ve tried the high internal rotation exercise on both sides. I can feel it working on my right side, but my left side (the troublesome side), I don’t feel fatigue in my subscapular area, but rather in the anterior delt region (along with some discomfort there). I just had an MRI, and the doctor said that the rotator cuff’s not torn, so I’m thinking it may be an issue with poor motor control.
Anyway, my question was this: Rather than internally rotating the arm, what do you think about an isometric exercise — such as by abducting and externally rotating the arm while holding a high pulley (like the start position in the high IR exercise), and then walking forward while keeping the arm in place? I’m trying to take the anterior deltoid out of the movement as much as possible, while avoiding anterior humeral glide.
Thanks for your help!
reddyb
June 6, 2013
Hey JWhite,
Your shoulder moving upward during the lowering portion of a bench press is likely more scapular related than humeral.
As the arm comes down the serratus anterior is lengthening. If the timing of its lengthening doesn’t coincide with the other muscles, the scapula is prone to wing. Often times when a scapula wings it hikes up.
Other factors here are the rhomboids may be retracting the scapula more powerfully than the lower trapezius. The rhomboids have a line up of pull upwards, the lower trap downwards. Rhomboids dominant = scapula / shoulder hiked upwards.
Trying to simply strengthen one particular muscle is unlikely to be enough. What you need to do is work on this movement (arm lowering / coming down / however you want to say it) and make sure it happens properly.
Wall Slides are one form of doing this: http://www.youtube.com/watch?v=MNtKWvkICoM
Where you’d be extra careful to make sure no hiking occurred during the lowering portion.
Here’s an example showing how a winging scapula can cause the shoulder to hike (watch the whole video; it gets progressively worse on the right side): http://www.youtube.com/watch?v=ak7xd4M7Nqo
And then I talk about corrective strategies for the above person here: http://b-reddy.org/2011/06/02/example-of-impaired-movement-causing-pain/
More on winging here: http://b-reddy.org/2013/02/12/the-rotator-cuff-is-not-a-muscle/
I harp on the scapula because winging so often accompanies anterior glide. Also, if your humerus is truly moving upward (and not the scapula), then that’s a different issue (humeral superior glide). Again, talked about here: http://b-reddy.org/2013/02/20/another-example-of-a-postural-evaluation/
Not sure if you meant this or not, but you also shouldn’t be trying to keep your shoulder blades back / down during an overhead press. Let them upwardly rotate.
Finally, I harp on the scapula because if you have a scapular issue, you almost always have to address that first. All the humeral work won’t correct a dysfunctional scapula. This is where so many PT programs go wrong: They obsess over the rotator cuff. Why is the rotator cuff having issues though? Often because of the scapula.
Hope this helps.
Tony Ricci
April 30, 2015
Excellent information! I’m kind of a shoulder nerd myself and do a lot of TrP to get folks moving pain-free again. My general approach for “upper crossed” type folks is to release the pec minor, short head of the biceps, and subclavious. Relaxing that anterior pull which so often dominates helps a lot, and unloading the coracoid process helps reduce the tendency to tilting. There’s more that goes into it, but as you’ve made very clear–scapular control (and clavicular control via that sleeper the subclavius and clavicular head of the pec) is paramount. Obviously, weak non-diaphragmatic breathing, T-spine curving or stiffness and OFTEN, head position are culprits. Keep up the good info feed!
reddyb
May 1, 2015
Nice comment Tony! Thank you for the kind words too.
kierfinnegan
September 19, 2013
I’m really glad to have found this article. I have only been weight training for a few months but recently my overhead pressing has started to fail and I’ve noticed my humerus is really far forward at the moment. I’ve also noticed a bulge in my posterior capsule. I couldn’t figure out why because I’d been conscientious to include loads of rows, external rotations and stretch my upper traps (from every training website out there).
Also been getting impingement type pain in shoulder flexion. So will try to work on my subscapularis and see how I get on.
I have posted on this site about my hip. Currently waiting to see a specialist but am wondering if you think it could be similar – I’ve been told to do hip external rotation exercises til the end of time and stretch my adductors. I’ve told them i’m not stretching my hip flexors any more. Maybe some internal rotation strengthening could help? Just a thought
reddyb
September 21, 2013
There are similarities between the hip and shoulder, especially in the sense that the humerus and femur both tend to glide anteriorly too often. However, you wouldn’t really want the same corrective strategy.
If nothing else, in this specific instance, barring someone with insane flexibility, the femur can’t abduct to 90 degrees like the humerus can.
While working on the subscapularis can always help, you’re likely to need other intervention as well. There’s quite a bit here: http://b-reddy.org/category/pain-2/shoulder-pain/
kierfinnegan
September 21, 2013
That was great info thanks. It’s weird I’ve started to think recently that I need to work on my upward rotation. I think I’ve kinda got to a bad place through reading all these articles on the Internet. Stretch psoas, upper traps. Only focus on external rotation etc. Rows, rows and more rows. I think I’m in worse shape than when I started. It’s all a learning curve I guess.
I have had ‘tight upper traps’ for ages and suddenly thought I should maybe strengthen them. Came across your 3 common weak muscles article and it all makes sense. Just wondering, have you ever seen anyone where their scalenes take over for their weak traps?
I have a slightly lower shoulder left side and I notice that when I try overhead shrugs for example, and i start to get a bit tired, I notice my neck trying to do the work and I get weird facial spasms. On my left side.
Also, with overhead shrugs should I focus on the scapulae moving upwards or getting that squeeze of the traps at the top?
Thanks for your speedy reply
reddyb
September 23, 2013
Unfortunately, the internet seems to have a good 15 years or so of, “Stretch the hip flexors; row, row, row” and such as you’ve mentioned. Interestingly enough, it seems many are starting to change their tune on this. Why it’s taken over a decade for many to realize what they were saying made no sense? I don’t know. It’s pissed me off in many circumstances because this stuff has made a lot of people worse, and the first rule is never make someone worse.
Regarding tight upper traps, this may be helpful too: http://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/
Check out this video regarding the relationship between arm elevation and neck movement: http://www.youtube.com/watch?v=oZbOagjHHw4
As far as anatomy, I believe the sternocleidomastoid is the biggest issue here. This is something I’ve been thinking about quite a bit recently, and will write something on it eventually.
My initial thoughts on the scalenes here is I’m sure they are likely overactive. However, I’m not sure it’s because they’re compensating for the upper traps. You have people who are more prone to “chest” breathing than “stomach” breathing. Part of this is using the scalenes during breathing more often than desired. So, I have a feeling if the scalenes are dominant here, it’s more because they’re dominant in general life, opposed to dominant in arm elevation. This is one reason to emphasize a nice big stomach breath at terminal arm flexion. Example here: http://www.youtube.com/watch?v=Z1ljCjAAFwk
I will say I rarely get to the terminal breath stage with people. 1) It’s rarely needed to see the results the person wants and 2) It’s hard to get right. You’re adding another thing to think about.
For overhead shrugs and whatnot, I focus on “Getting the shoulders into the ears.” I rarely tell the person to focus on a muscle or anatomical landmark. I tell them, in layman’s terms, where to move their body. Rather than “Extend your knee” I say “Move your foot out.” The goal is more to attain a certain movement, and look of that movement, rather than a certain muscle working or burning.
Tony Ricci
September 26, 2013
Great article and I like how you differentiated the exercises far better than simply taking a “most active” approach. I wanted to comment about the hip side because two client/patients of mine have had phenomenal results from addressing the iliacus (negligently and typically lumped in with the psoas, i.e. the iliopsoas). The iliacus is kind of the hip’s anatomical counterpart to the subscapularis, and its innervation is different than that of the psoas major. In each of the athletes I’ve worked on (complaining of anterior hip/groin/impingement issues, one with gait disturbance secondary to this) I found trigger points in the iliacus, accessed over the top of the ilium by hand. Secondary TrPs were found on the corresponding external obliques and along the inferior margin of the rib cage. One treatment for one, and two treatments for the second, resolved the hip pain completely. I have worked the subscap as well though it is a bit trick to access. I appreciate I’ve underappreciated the role of the subscap until I read the study (pasted below) where the most significant muscle thickness of the most capable powerlifters was, you guessed it, the subscap!
http://www.strengthandconditioningresearch.com/2013/09/04/muscle-mass-powerlifting/
kierfinnegan
September 27, 2013
Ah yes I actually meant the SCM. I’m struggling a little bit to figure out what’s going on as the left side I have problems with my neck/upper traps and the right side I have anterior shoulder pain and humeral glide. Will try out your recommendations anyway and see how I get on.
One more question! Can you point me in the direction of an effective pec major/minor stretch? Any time I try to stretch it irritates my anterior shoulder which I’m guessing is the opposite of what I want.
Thanks again
Jwhite
September 27, 2013
I defer to Brian, as I am not a PT, but I thought I’d chime in here, as I have had the exact same problem. Initially, my PT suggested that I do the doorway stretch, but all it did was irritate my anterior delt and make my hand go numb. Consequently, we searched for other alternatives. The past couple of weeks, we have been doing the corner stretch (Google it) with great success — I can really feel a stretch across the pec and pec minor. I like this in particular because I’m also able to concentrate the stretch on the pec minor by raising my arm a bit more and turning away from the side I’m trying to stretch. I have never been able to do this with the standard doorway stretch.
Best of luck!
reddyb
September 27, 2013
Thanks for the input Jonah.
The thing you need to consider here is the anatomy and action of the pec. We’ll consider the pec minor here. One of it’s actions is to downwardly rotate the scapula. So, in order to fully stretch it, we’d need to get a considerable amount of upward rotation (the opposite motion). Because the corner stretch keeps the arms down by the side, you may generate a stretch in the pec minor, but not as good of a stretch as you could.
The pec major is a little more intricate as it can extend and flex the humerus. The issue normally is the humerus extends too much. With that in mind, we’d want to loosen pec major with an emphasis on humeral flexion (lifting the arm up). Basically, again, in order to really effectively stretch the pecs, the arms need to start coming overhead.
You may have had issues with the doorway stretch due to your elbows being below your shoulders, or trying to stretch too far. What can happen here is the humerus gets put into such extension that the only way the arm can continue to go back is by generating anterior humeral glide. This can pull / push on the nerves around that area, hence, numbness in the hands.
The variation I gave Kier can elicit some unwanted symptoms. However, you can do things such as not elevate the arms as high (hence, varying heights), or, give the elbow some support to really insure the humerus does not glide forward.
Finally, laying the person supine helps the person make sure their lower back does not come off the ground, as well as generate some thoracic extension. That is, the person is unlikely to compensate with lumbar extension.
Hope that all makes sense.
Tony Ricci
September 27, 2013
I don’t know if I’ve missed this in the previous addendums, but I kind of liked Cressey’s variation of the corner stretch where the anterior delt is captured by the door frame (or towel against a firm object). This brings the A/C joint & humeral head back rather than trying to drag it all from the arm itself (when using the elbow or hand). It doesn’t feel as dramatic, but a stretch shouldn’t. Just bringing the arm out at 90 of abduction, then bringing the anterior shoulder against the jam of a door, leaning into and turning 20 or 30 degrees away (pulling away) seems to work wonders for me. As a side, this may well instantly relieve muscle tension in the back (rhomboids?) since they aren’t being tensioned by tight anterior flexors.
reddyb
September 30, 2013
Having something to help push the anterior shoulder posteriorly can definitely be worthwhile.
Some considerations:
-Depending on the person, the pressure on the anterior humeral head may be too much. Some people are so beat up in that region nearly any pressure will cause tenderness / symptom reproduction.
-You want to make sure you don’t push the scapula into retraction, as in many instances when you’re looking to loosen up the pecs, you’re likely not wanting to tighten up the rhomboids / promote scapular retraction.
-You’re still not getting the shoulder into full flexion / upward rotation. You could possibly start with something of this nature, but it needs to be progressed in order to be more effective.
reddyb
September 27, 2013
reddyb
September 27, 2013
Also Kier, see my notes to Jonah about modifying this should any symptoms be felt. You’re right, you do not want to feel any irritation.
Alexis
April 10, 2014
Red, do you think that High Internal rotation should be contraindicated for people that have problems with supraspinatus tendon, tendonitis, or impingement?
reddyb
April 10, 2014
I rarely approach things in those terms. Rather, more in a “shoulder pain” manner. So, if someone has shoulder pain, would I consider this exercise contraindicated? No. I’d consider it a good exercise to implement. Form is crucial though.
Dave
July 23, 2014
Awesome post! I’ve seen Eric Cressey do external rotation exercises with his elbow supported on a bench (http://i1.ytimg.com/vi/_EHmq1yPhnU/hqdefault.jpg), would doing this during high IR make the exercise more effective since you could focus on pure rotation or does the subscap work better having to stabilize as well? Thanks.
reddyb
July 23, 2014
That exercise works the external rotators of the cuff, not the internal. You would need a cable to aim it at the subscap. In which case, I always prefer the supine variation. I only go with the standing for some variety.
Declan
November 7, 2014
Hey,
Great article! I discloated my shoulder climbing Mt Fuji in August (I live in Japan) and at rehab he gets me doing all the exercises you mention above. In contrast my friend from the States discloated his shoulder and is doing the IR low exercises.
I wonder why they are still even used?
reddyb
November 9, 2014
Old habits die hard :).
Thomas
April 28, 2015
I strained my shoulder about six months ago and this by far has been the most helpful blog post I’ve read this entire time.
I’ve been spinning my wheels for months with doctors and therapists giving me basic rotator cuff band work but nobody has ever thought about specifically targeting my subscapularis.
I noticed a ” looseness” in the front of my shoulder yet tightness and over an over active feeling in the pec major. Tightness in the lats and teres minor, especially when doing any layt exercises like pull-ups or rows which I have stopped and now I stretch the lats instead which has helped a lot. I remember how interal rotaror band work helped in the beginning but progress stopped as my pec became way to active and took over in the movement.
Now assuming my subscapularis has been the weak link all along, I wonder how long it will take to get it working properly again? What’s a good time frame to expect results,two weeks, four ?
reddyb
April 30, 2015
Hey Thomas,
I think this will be of help: http://b-reddy.org/2013/08/01/how-long-does-it-take-to-get-rid-of-chronic-pain/
Thomas
May 1, 2015
Thanks. That is EXACTLY the kind of information I have been looking for and it will definitely help me gauge my progress and keep me from getting discouraged.
I have been doing these subscapularis exercises I seen on this page for one week now and I’m noticing small improvements already. Wish I would’ve found this site months sooner.
reddyb
May 4, 2015
Happy to help.
Ivan
May 21, 2015
Hey Brian,
You have great articles on your page. I have winged scapulas and I don’t know the cause so I started doing your overhead exercises and standing IR high for subscapularis that you recommend but I am not sure I do standing IR high for subscapularis correct. Am I suppose to feel the subscapularis during the exercise, soreness, pump or something? I feel pectoralis major (I think clavicular part, from clavicle to arm) flexing. Where is arm supposed to be during exercise, in line with the body or in scapular plane (found that in one of your articles)? How hard am I supposed so press the humerus and is it possible to do it without pressing on the humerus?
You also noticed that scapulas are not supposed to wing during the exercises and during the rest of the day, that we have to try to prevent winging. Can you say a few words how to prevent that? I can do that by flexing the lats or by protracting the scapulas (but than my shoulders protrude forward), but if I try to touch opposite scapula with my arm it wings pretty bad and I can’t stop it.
Thanks
reddyb
May 25, 2015
Hey Ivan,
-You won’t feel a pump or soreness in the subscapularis. That’d be very unusual at least. Feeling a little work there may happen, but it’s nothing like one feels when they say, do bicep curls. Overall, one is much more likely to feel a need to concentrate on doing the movement properly than anything else. This movement often requires a lot of mental effort, and it’s pretty rare I have someone doing this motion with more than a few pounds.
-You want to keep the pecs as relaxed as possible.
-Good question about scapular plane vs in line with body. It depends on the shoulder. Sometimes bringing the arm back so it’s in line with the body is too hard. The flexibility isn’t there yet. In that case, I’ll bring the elbow forward as much as needed so no pain is felt. But I’m not actively seeking the scapular plane.
-I discuss winging during the day some in these posts: http://b-reddy.org/2013/12/04/a-quick-way-to-work-on-scapular-winging/
And here: http://b-reddy.org/2013/07/25/musings-on-scapular-winging-anatomy-muscular-and-nerve-causes-and-exercise-considerations/
There are other things one can do, but I haven’t made it that far writing wise yet.
Thomas
May 25, 2015
I have had a 100% recovery in my left shoulder that I strained over six months ago, thanks to the info on this web page. And it took exactly four weeks. Incredible.
Now, I have a question. Can a weakness in the subscapularis contribute to neck pain/tension?
I had only been working my left side but my right side of my neck always feels tensed down to the back of the shoulder blade. I stretch the lats and it helps some but not nearly enough.
It also gets worse if I were to do external rotation work.
Tony Ricci
May 25, 2015
Hi Thomas–my answer is uninvited, but I am getting these feed questions so here goes: I have worked on dozens of acute and chronic shoulder and neck problems, and one thing I have consistently noted: they are interlinked. Your head and upper neck provide major anchors to the clavicle and scapula via the traps, scalenes and levator scapularis muscles. If you have a forward-head posture: If you lift weights pushing reps out looking like a chicken with your head bobbing forward on every strained rep (this includes pushups, shrugs, curls, lat raises, et al.,): if your breathing is faulty and / or your torso stability is crummy (aka “core”) then you will be prone to persistent tension in the upper back (that nagging “I need a massage” feeling), overloading of the neck muscles that keep your head and neck from falling into your lap, and because the scapulae and clavicles are being “dragged” upward, you will experience a range of dysfunction due to tired, spastic or weakened/lengthened muscles. Solutions to almost everyone: 1) stand tall, chin pulled back like a drawer–in a horizontal plane so that the back of the neck feels a slight stretch. This does NOT mean arch your neck and look up–it means “tall” as if you were a mannequin suspended from a hook at the top of your skull 2) stretch your pecs a good minute or two. Visit Eric Cressey to see excellent examples on how to stretch your pecs without straining your shoulder capsule. 3) Get some manual therapy to knock out the trigger points (TrPs) you will almost certainly have in your scalenes, traps and levator scaps. You can do your own therapy pretty easily for the scalenes (top of collar bone and around top of your sternum, and ridge of your skull from behind your ears to jawline) but for the levator and traps you’ll need a ball and a floor or wall to work those. Google those muscles for insertion and origins and look up how to release trigger points. I doubt your subscaps are big players with neck pain due to their function, but yours might be jacked up anyhow due to their needing to compensate. Good luck!
Thomas
May 26, 2015
Thanks Tony.
I have been working on the scalenes after reading your reply and I have to say I’m already experiencing such a relief in the amount of tension I get in the neck.
I’ve been doing some self massage throughout the day when I can. I hope the progress continues.
I’ve been working on my forward head posture for a very long time now but the scalenes are muscles I’ve forgetten about.
I really appreciate the helpful response.
Tony Ricci
May 29, 2015
Brian (?): thanks for clarifying the clavicular elevation…I did not specify well, namely because I was typing it all out in a rush. The clavicle does move a lot, but this varies with the arc of movement increasing as you move away from its pivot point at the sternum. Interestingly, I find that it (or the 1st rib?) is often superiorly displaced at the sternal junction, and I use a move learned from Kelly Starret to help reset the 1st rib/proximal clavicular joint, often with really good results. This link here is really neat at showing just how much the clavicle moves at its juncture with the scapula, aka acromion. (https://www.youtube.com/watch?v=ecffbyeBFXU)
You made another excellent point regarding the sensation of tightness, and I believe the sensation can result from the lesser known reason you elaborate so well on (it’s actually too stretched). This seems to be the reason why you see guys at the gym constantly stretching their posterior shoulder when, in fact, it is already stretched and they’re in an upper-crossed type position. The other two sides I see are a) the stretched, contracted tired side from being pulled or over-powered, an example of which is how shortened pecs, rounded-forward shoulders overpower or fatigue the scapular retractors, e.g. the rhomboids, lower traps. Evidence of this can be shown by the dramatic relief in soreness and “tightness” of those middle back muscles that results once the pecs are allowed to lengthen, and b) the shortened, often TrP riddled muscles that result from some sort of instability. The worst case scenario is as with a dislocated joint. The muscles absolutely clamp down, causing excruciating pain. As a medic it is dramatic to see how much pain a strongly muscled person experiences due to the magnitude of force those spastic muscles can generate, versus the much more moderate pain someone who is very weak experiences. More subtly core instability seems to lead to compensatory tension, and in the most extreme sense, I’ve had shoulder pain resolve after working on the contralateral foot muscles…a situation that frankly stunned me because until then it had been largely theoretical for me. The best analogy I can develop is that of standing on the deck of a ship. When the ship is perfectly still, people walk about and are relaxed. If the ship starts to rock (i.e., an unstable base) people start to widen their stance, tense up, and generally settle down into a more flexed “ready” stance. If the ship starts to move too much, people will clutch onto something and hold on…the worse the movement, the tighter and more still they become. I believe this explains what Karel Lewitt believed regarding a possible cause for TrPs…..a compensation for proximal instability. I keep learning more and more about this, but will probably die of old age before I figure it all out 🙂 Keep up the awesome work on your site. You already know far more than any PT or MD I’ve ever met.
reddyb
June 1, 2015
Nice video link!
I haven’t gotten to talk much about “rounded forward shoulders” yet. You bring up some points I’d like to hit on in a post. It’s on the list of posts to come.
That’s interesting to hear about the difference you’ve experienced as a medic between stronger and weaker individuals with the shoulder. I haven’t heard that type of experience before.
Thanks for the thoughtful and nice comment Tony. I appreciate it.
reddyb
May 27, 2015
The subscapularis is unlikely to have any direct impact on neck issues. A constant feeling of neck tension can be due to a shoulder that hangs too much, or some of the neck positioning Tony mentioned.
A point I’ll disagree with Tony on is a “dragged up” clavicle (if we’re talking the entire clavicle, there is potential to differentiate between medial and lateral) is very, very rare. While one portion of the scapula *may* be pulled up, that often means the scapula is still excessively downwardly rotated. Also, as the shoulders anteriorly tilt -which often coincides with the head bobbing Tony is describing- the scapula may elevate but the clavicles depress. These are nuances that are critical. I bring this up because you commonly see people hear anything about their scapula being up and automatically assume they need to pull it down. That’s what you want to be careful of, and this is all too common to do.
The only time you really see someone hike their entire shoulder up like that is during arm flexion, and if they have a significant tear or very painful history.
Some more here: http://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/
Ivan
May 26, 2015
Thanks for reply Brian, I tried this exercise laying on my back and pecs are more relaxed than in standing version. I focus on my shoulder so it stays down so I don’t have to press on my humerus with another arm. I will try all variations to see what suits me best at the moment.
Have you tried prone variation of this exercise with the cable. It could increase range of motion like in the standing version, compared to the prone variation with no weight (just arm).
reddyb
May 27, 2015
I like to bring the other hand on the moving humerus anyways, to help give a sense of where the arm is. I rarely cue to push the arm down compared to nearly always cueing of “make sure you feel the shoulder not come up.” This way the person can feel from below (floor) and above (hand).
I haven’t done a prone version of this with a cable. I don’t think it’d be bad, but I do think the set-up could be cumbersome when you have the context of a gym with other people around. Getting a bench and pulley station near one another is often difficult in itself.
For weight in the prone version, I go with a DB.
shoulderraise
June 29, 2016
Regarding the pushup-plus, does it still target the subscapularis if the pushup is done with a decline?
ExRx lists a similar exercise, the Barbell Incline Shoulder Raise (http://www.exrx.net/WeightExercises/SerratusAnterior/BBInclineShoulderRaise.html). However it doesn’t list the subscapularis as one of the muscles being used, which made me wonder if the “incline” aspect of it (or in the case of a pushup, and decline version) prevents the subscapularis from being targeted?
reddyb
July 1, 2016
My guess is those would be pretty similar to the regular push-up plus.
The push-up plus / scapular protractions with a barbell are not typically used for targeting the subscapularis. They are much, much more aimed at the serratus anterior. That would be my guess as to why ExRx doesn’t list the subscapularis in that movement. They’re only listing the big players / common reasons for the exercise. For instance, they don’t list the forearm musculature even though they forearms are clearly working in helping grip the bar.