Addressing Our Scapular Stabilizers

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Developing Our Scapular Stabilizers to Prevent Shoulder Injury.

What constitutes a shoulder joint that is prone to injury? Could it be weak rotator cuff musculature? Maybe it is joint laxity and instability? What about capsular restrictions or the work we do on a regular basis? Or, is it possible that weak scapular stabilizers could play a role in shoulder injury?

The answer is, all of the above reasons could contribute as the cause of a shoulder injury. Although shoulder injuries are often complex, many do happen to be related to one common problem: weak muscles that support the shoulder blades, otherwise known as scapular stabilizers.

The scapula (shoulder blade) is a very involved structure of the body. Not only does this bone articulate with the humerus (upper arm bone) and clavicle (collar bone), it is also the attachment site for many muscles in the shoulder itself, as well as the back, the chest, the arm, and even the neck. It is therefore easy to comprehend how a weakness in this area could affect many others in the body.

The muscles that attach on the medial (inside) aspect of the scapula are the key muscles for scapular stabilization. These include the middle trapezius and lower trapezius, rhomboid major, and rhomboid minor, and serratus anterior. The middle trapezius and rhomboid muscles function to retract the scapula. Scapular retraction is the action of squeezing your shoulder blades together. The lower trapezius takes care of scapular depression which is drawing the scapula down the thorax. The task of serratus anterior is to hold the scapula’s medial border tight to the thorax.

Many of these weaknesses are actually observable. When the lower trapezius muscle is weak, a flaring of the lower scapula exists. When the serratus anterior is weak, the medial border of the scapula flares. Weakness of the middle trapezius and rhomboid muscles contributes to a separation of the scapulae, also known as protraction.

It is therefore the job of these muscles to hold the scapulae tight to the thorax. If the scapulae are not held firmly by strong muscles, they are left free to flare and flop with arm movements. Without stability at the scapula, how is it possible for the glenohumeral joint (shoulder joint) to remain stable? It isn’t.

Scapular instability leaves the glenohumeral joint (GH joint) at risk of injury as the GH joint requires both strength and endurance of scapular stabilizers for it to be protected. The stability of the GH joint cannot come from the humerus since the arm does not have anything to stabilize from; it has no anchors. However, the scapula attaches to the axial skeleton of the body (a fantastic anchor) and therefore can generate stability from the thorax. Strong scapular stabilizers have been proven to defend the GH joint from injury.

Once these weaknesses are identified via observation of functional movements and muscle testing, exercises must be incorporated into one’s daily schedule in order to prevent or rehabilitate shoulder injuries. Many of the exercises used to target such muscles are very intricate in their movement patterns and look fairly easy. Often, the first time patients see these exercises performed, they expect them to feel simple. However, as soon as they attempt one repetition themselves, they recognize how weak their stabilizers actually are and appreciate the need for such training.

Typical yoga posture focuses heavily on scapular retraction and depression. Yoga brings these movements into everyday life. If you meet a yogi, their scapulae will be retracted and depressed. Their shoulders will not be around their ears like the rest of the population who carry their tension in their upper trapezius muscles and levator scapulae. Simply applying these two movements to your daily activities will prove beneficial. However, to truly protect the GH joint from injury, more intensive exercise is required.

Yoga, single-handedly, can not target each of the scapular stabilizers appropriately, unless modifications are made to poses or practices. For example, by the addition of scapular protraction to plank pose, the serratus anterior muscle could be optimally targeted. Many of the movements designed to pursue the scapular stabilizers are very specific. Feedback from a health care professional or yoga instructor is ideal when attempting to understand these movements.

Bring attention to these muscles in your back. The benefits you will gain from strengthening these muscles are plentiful. Whether you are a parent who is constantly picking up children, a housewife who places the dishes in the top cupboard, or an athlete who is involved in sports with overhead movements such as tennis, volleyball, or climbing, scapular stabilization is essential in preventing shoulder injuries.



Standing Tall: Why Posture Matters

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Remember how your mom used to always lecture you to stand up straight? Well, she might have made some mistakes over the years (that outfit in your 5th grade school picture), but on this one, she’s right. Posture matters more than you may think.

First, let’s talk about your body, starting at the top. Each inch your head is forward of your shoulders doubles the amount of weight it puts on the rest of your body. Although the average head only weighs between 8-10 pounds, your upper back (and then lower back and hips) will become misaligned if your head “lives” in a forward position – all in an attempt to balance your now-too-heavy head.

And, unless you sit in an ergonomically perfect workstation, chances are you round forward over your keyboard or laptop like something straight out of the latest episode of the “Walking Dead.” Most of us, sadly, are in the process of developing this posture. Blame the Internet (we’re talking to you, Mark Zuckerberg) or your boss (for making you work too much).

What happens to our bodies? Back pain, neck pain, hip pain and knee pain. And, let’s not forget your breathing. Collapsing forward compresses your lungs, reducing their capacity by 30 percent or more. Your organs can’t function properly, and neither can your muscles, joints, or connective tissue.

Posture also matters for your mental health. Good posture allows you to breathe more fully, calming your nervous system, which can help with everything from good sleep to good moods. Plus, standing up tall makes you feel more confident. Slouching pulls your energy downward, even making walking and balance more difficult.

What to do? First, analyze your own posture. Do your shoulders slouch? Is your head forward? Do you have back or neck pain? When you walk do you have a tendency to lean forward and feel like you’re lifting your knees towards you?

Since it is vital to have extension in the upper torso in standing posture, the starting place is simply awareness of how you’re standing or sitting. Imagine lifting out of your pelvis, shoulders back, head looking slightly above the horizon.

Don’t spend too much time sitting at your desk, especially in bad posture. Take a walk. Inhale your arms overhead and slightly back. Regularly engage your lower trapezius to draw your shoulders away from your ears, and your rhomboids to draw your shoulders together.

And balance the forward posture with a lot of back bends. Stretch your pecs and anterior shoulder muscles with anahatasana pose (think child’s pose with your hips over your heels, reaching your tailbone and chest away from each other). Camel pose has been called the “antidote to sitting” because it stretches the entire front of your body.

If you have access to a Pilates reformer, you’re in luck. Do seated arm circles to take your shoulders through a weighted stretch, and turn around for chest expansion to, well, expand your chest and your lung capacity. Or just lie down on a mat, extending arms and legs long on the floor, and lift up, fluttering arms and legs in opposition while breathing deeply.

Most importantly, throughout your day, remember to stand up straight. Don’t slouch. Just listen to mom on this one. You can still argue about your clothes, your politics, and what’s for dinner. On posture, she’s right.

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