Addressing Our Scapular Stabilizers

Addressing Our Scapular Stabilizers

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.



Poor Posture and Pressure on your Spine

Poor Posture and Pressure on your Spine

Freddie Mercury was right: we’re under pressure. Nothing can be truer when it comes to your spine. It’s because of simple physics: the pressure or load on your back increases as you move away from a neutral posture. Here are the numbers: Standing straight puts 100mm of pressure on the intervertebral discs of your spine; add a forward bend while flexing or rounding your back and you’ve more than double the pressure, or 220mm. Can you see now why reaching your toes in Uttanasana or any standing forward bend before you’re ready isn’t worth the potential harm to your back?

What poor posture means to the ongoing health of your back?

Over time, poor posture causes the discs between the vertebrae to wear down and lose their ability to cushion and act as shock absorbers. The discs are pushed out towards the back from their normal position which causes bulging or herniated discs. These bulging and worn out discs can cause a more serious problem by increasing the pressure on the spinal nerves and the spinal cord itself. The result is pain in the legs, including sciatica, arms, shoulders, and neck, and problems with muscle innervations, movement patterns and the sensation of temperature, pressure and pain.

These same problems can be worsened when sitting, believe it or not. Sitting, in contrast to standing, actually increases the intradiscal load compared to standing; spinal pressure “sits’ around 140mm pressure. If you slouch (I’m talking to you desk slouchers!), spinal pressure increases to 190mm; add some weight and you’ve put a whopping 275 pounds of pressure on your spine. This is why in certain methods of yoga like Iyengar students learn standing poses before sitting ones as a general rule as they’re considered more advanced.

Sitting for long periods of time can definitely cause back pain or worsen an existing back problem. Sitting is a static posture that increases stress on the entire back, shoulders, arms, and legs, and especially the muscles of the spine. Slouching overstretches spinal ligaments and surrounding structures of the spine and nerves, blood supply is interrupted and the back muscles are overstretched.

The Solution

If you’re not a yogi yet but find yourself slouching or sitting for long periods of time during the day, your yoga can be as simple as doing the following:

  1. Getting up periodically to stand up and take the pressure off your spine

  2. Sit back into your chair so your back is supported. In yoga postures, ground evenly into your support and allow your spine to straighten up

  3. Use a lumbar roll between your lumbar or lower back and your chair. To judge the proper size of the roll, sit back in your chair, place your forearm behind your lower back between it and your chair and lean back. Your forearm is approximately the size of a lumbar roll. This works when driving too.

  4. Move! Joints don’t have much blood flow. Joints get nutrition in and waste out by physical movement. Move freely in your chair instead of sitting still for hours at a time.

For you yogis, body awareness is key to minimizing the pressure on your back. I’m not saying never practice a forward bend or a seated pose but rather know how to practice them safely. Even a seemingly friendly pose like Savasana can do harm. Sure, while lying down you’re at the lowest end of the spinal load spectrum at 25mm. As a teacher, I ask my students to roll to the side before sitting up not simply to avoid feeling dizzy and lightheaded but also to reduce the pressures on the spine. For the record, resting on your side applies 75mm pressure on your back, which is quite a bit less than pulling yourself straight up from lying flat on your back.

So, the take home message is: do the work in other poses which don’t load the spine first to lengthen your leg muscles and hamstrings, and strengthen your back before you throw yourself into a forward bend. Realize which types of poses are right for you. Gentle flexion of the spine isn’t for everybody and that’s ok. Once your body is ready, you’ll be reaping the benefits of practicing Uttanasana instead of causing harm to our back.

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