The scapula is an important piece of many shoulder conditions. A common shoulder condition that focuses on the scapula is shoulder impingement, where there is pain with overhead movements. The idea is that the scapula doesn’t rotate upwards enough and the humerus bumps into the acromion. This has led to finding the “ideal” position for the scapula during movements. This blog post will discuss the function of the scapula and its position during movement.
The function of the scapula is to move the shoulder so that forces can be transferred to perform a given task. The muscles around the scapula will constantly readjust to put the shoulder in the best position (traditionally, rehab focused on the three main muscles used to rotate the scapula: upper trapezius, lower trapezius, and serratus anterior. However, there are 17 different muscles that attach to the scapula and help control movement). This has a couple implications for the scapula.
One implication is the scapula needs to be mobile. If the scapula is restricted, it wont be able to adjust to the demands placed upon the shoulder. Soft tissue restrictions in the pectoralis minor, levator scapulae, or rhomboids can all alter the movement of the scapula. Environmental factors can also cause restricted motion of the scapula. An example would be the bench press, where the scapula is pinned to the bench.
The other implication is that there is not an “ideal” position for the scapula. Since the muscles around the scapula are constantly readjusting to demands, there is not a fixed “ideal” position for the scapula. The scapula will change positions depending on the task. For example, throwing a baseball, catching a football, or performing a snatch, all require overhead movements. However, each of these tasks place different demands on the scapula and shoulder complex which will change how the scapula moves in each task.
The stability of the scapula is context specific, meaning it depends on the activity. The demands on the scapula will vary as the muscles around the scapula adjust to the movement. A way to think of this as flying a kite during strong winds. As you maneuver the kite in the wind, you will have to change the tension of the strings to the kite to move it around. This is similar with the scapula with different muscles having to activate to move it. Therefore, there is not one muscle that is more important than another. Muscle activation will vary depending on the demands on the task.
The aim of a rehabilitation program for the scapula should focus on having adequate mobility and strength for the demands placed on it. The mobility of the scapula can be addressed in a few different ways. Stretching, IASTM/Graston, and manual therapy such as pin and stretch can all be used to decrease stiffness and allow the scapula to move freely. Many of these therapies will also decrease shoulder pain which will also make loading the shoulder more tolerable.
The training for strength and stability should focus on building a robust shoulder and not individual muscles. There’s nothing wrong with increasing the strength of individual muscles, but the brain thinks in terms of movements, not muscles and our rehab approach should reflect this. Along these lines, the rehab program should focus on the movements that the person will experience. For example, those with movements overhead (ie. baseball players, football players, Olympic lifters) should have a program focused on creating a strong shoulder in the overhead position while those with movements in the lower-mid range (ie. rowers, golfers) should focus on those positions. The rehab program should also include unstable or reactive training, because the tasks will not always be in a predictable environment (for example, catching a ball against an opponent).
It’s not uncommon to hear cues to lock down the scapula (pulling your shoulder blades together or pulling your shoulder blades down and back). However, there doesn’t seem to be an “ideal” position for the scapula. Instead our focus should be to decrease pain and then on increasing the movement variability of the scapula and building a robust shoulder complex.
Mcquade, K. J., J. Borstad, and A. S. De Oliveira. "Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track?" Physical Therapy (2016): 96. 1-8.