Home Training What Should be Included in a Comprehensive ‘Shoulder Health’ Training Program
What Should be Included in a Comprehensive ‘Shoulder Health’ Training Program

What Should be Included in a Comprehensive ‘Shoulder Health’ Training Program

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Scapular stability is one of the most popular things you will hear about when you walk into a strength and conditioning facility, especially if that facility deals with the overhead athlete population (ie. baseball, volleyball, swimming, tennis etc). But does it have merit? Let’s dive into the background and the evidence.

What is it? 

The concept of scapular stability is based on the premise that the shoulder blade needs to sit stable on the rib cage, and be able to resist change in movement. It’s long been believed that those with winged shoulder blades (and any of the other issues that fall into the ‘scapular dyskinesis’ category) is a ‘faulty’ movement pattern that needs to be addressed in order to reduce risk of injury in the future. As such, promoting things such as serratus anterior work, lower trap work, thoracic mobility, and scapular stability has become a common trend in training.

The Truth

Despite the perceived beliefs mentioned above, the evidence simply doesn’t hold up once we put it under a microscope. That doesn’t mean scapular stability work doesn’t have its place in a training program. Allow me to explain.

The Background – where did it ever originate from, and why?

There are a few different principles from which this belief probably originated from:

  1. Joint by Joint Approach
    Popularized by Gray Cook and Mike Boyle, the Joint-by-Joint approach is a theory that describes how the body is designed to optimally function, and how the joints work in a reciprocal fashion in terms of mobility and stability demands (ie. mobility at the ankle, stability at the knee, mobility at the hip, stability at the lumbar spine, and so on). The basic premise revolves around the concept that movement is more important than individual muscles, which I can certainly get behind. However, it’s also important to understand that athletes move in different ways, and certain joints require a demand for stability AND mobility.
  2. Kinesiopathological Model
    A common model found in the health and wellness industry that believes in ‘ideal’ alignments, posture and/or movements – anything that deviates from this said ‘ideal’ position is ASSUMED to be a risk factor for future injury risk. Certain ‘structural faults’ of the shoulder (ie. scapular winging etc., and a myriad of others that fall into the ‘scapular dyskinesis’ category), are believed to be ‘abnormal’, and as such, should be ‘corrected’ and taught to be ‘stable’ within a training program (scapular stability).

The Facts – does the evidence stack-up? 

In a 2014 follow-up study, it was found that scapular dyskinesis and dynamic scapular control (ie. scapular stability) were NOT correlated with future injury. For those who did experience injury at the time of follow-up, lack of full scapular upward rotation at both 45 and 90 degrees of abduction was noted (Struyf et al, 2014), but the classified ‘faulty’ scapular movement had no bearing on the pain. In a separate but related 2015 study, a group of researchers found that there was no statistical significance between performing an exercise only program versus performing an exercise program plus manual therapy for treating shoulder impingement, and that NEITHER group altered the kinematics/movements of the shoulder blade (despite reductions in pain). Still struggling with the concept that a winged shoulder blade has to be ‘abnormal’ and a predictor of injury? That’s fine, I too enjoy a good debate. Try arguing with this one – a 2014 review study, which analyzed and compiled findings from 10 different studies, concluded that ‘there is insufficient evidence to support a clinical belief that the scapula adopts a common and consistent posture in shoulder impingement syndrome (SIS)…deviation from a ‘normal’ scapular position may not be contributory to SIS but part of normal variations” (Ratcliffe et al, 2014).

The Shoulder Training Program: train it the right way.

If scapular position, posture, and movement doesn’t matter for predicting pain, then how should I go about training the shoulders properly?

  • Get the most amount of ROM from the scapular and shoulder that you can.
  • There is no ‘ideal’ scapular movement – improve every function of the shoulder and associated structures as possible.
  • Maximize the following:
    – Thoracic flexion/extension/rotation mobility and ROM
    – Glenohumeral and scapular mobility and ROM 
    – End range scapular strength, power and endurance (instead of just middle-range strength so often seen with upside down KB variations and other scapular stability tasks).

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By: Ian Schnarr (CSCS)
Director of Performance, Redline Conditioning (Kitchener ON)

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Sources Cited:

  1. Does Scapular Positioning Predict Shoulder Pain in Recreational Overhead Athletes?
    F. Struyf-J. Nijs-M. Meeus-N. Roussel-S. Mottram-S. Truijen-R. Meeusen – International Journal of Sports Medicine – 2013

  2. Effects of Stretching and Strengthening Exercises, With and Without Manual Therapy, on Scapular Kinematics, Function, and Pain in Individuals With Shoulder Impingement: A Randomized Controlled Trial. Paula Camargo-Francisco Alburquerque-Sendín-Mariana Avila-Melina Haik-Amilton Vieira-Tania Salvini – Journal of Orthopaedic & Sports Physical Therapy – 2015

  3. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Elizabeth Ratcliffe-Sharon Pickering-Sionnadh Mclean-Jeremy Lewis – British Journal of Sports Medicine – 2013

 

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