The role of the scapula - PubMed (original) (raw)

The role of the scapula

Russ Paine et al. Int J Sports Phys Ther. 2013 Oct.

Abstract

Previously, the scapular musculature was often neglected in designing a rehabilitation protocol for the shoulder. In the past two decades a significant amount of research has been performed in order to help identify the role of the scapula in upper extremity function. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased shoulder complex neuromuscular performance. This clinical commentary presents facts about the anatomy and biomechanics of the scapula and surrounding musculature, and describes the pathomechanics of scapular dysfunction. The focus is upon the assessment of dysfunction and retraining of the scapular musculature.

Level of evidence: 5.

Keywords: scapular biomechanics; scapular musculature; scapular strengthening; shoulder rehabilitation.

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Figures

Figure 1.

Figure 1.

(a) Wall push – press into wall using fingertips. Avoid leaning into wall with body. Observe backward winging of the scapula. (b) Lift 3–5# dumbbell and lower to position shown (45 degrees). Observe backward winging of scapula.

Figure 2.

Figure 2.

Notice prominence of the medial border of the right scapula during only a fingertip press into wall.

Figure 3.

Figure 3.

Genie Stretch – Begin stretch in “Genie Position” with involved arm below normal. Limit external rotation using top arm as the control arm. Lift the elbow slightly then pull across chest in a diagonal movement. Make sure that subject perceives stretch on top and or posterior aspect of shoulder. Coracoid impingement will occur if subject feels pinching in front. This can be avoided by lowering angle towards opposite hip.

Figure 4.

Figure 4.

Dynamic Hug – using cable column, can also be performed using Theraband. Instruct the patient to reach forward as if “hugging a tree”. Target muscle, serratus anterior.

Figure 5.

Figure 5.

Cheerleader Exercise – Using Theraband, perform alternating diagonal patterns with one bilateral horizontal abduction motion between each diagonal. Target muscles, lower trapezius, rhomboids.

Figure 6.

Figure 6.

Swiss Ball “Robbery” – Prone on a Swiss Ball, assume “robbery” position, cuing patient to point elbows to back pockets. Target muscle, lower trapezius.

Figure 7.

Figure 7.

Cocking Cable Column – Perform D2 diagonal pattern pulling into a cocked position, then slowly lower to decelerate. Target muscles, lower trap, rhomboid, posterior cuff.

Figure 8.

Figure 8.

(a) Manual Resisted protraction/retraction – Manual resistance applied to anterior shoulder and spine of scapula while patient performs protraction, retraction. Target muscles, serratus anterior and rhomboids. (b) Bilateral PNF – Manual resisted D2 bilateral PNF pattern. Target muscles, lower trap, rhomboid, posterior cuff.

Figure 9.

Figure 9.

(Super 6 Scapular Routine (a‐f) Series of reciprocal scapular exercises that target scapular, rotator cuff, and trunk musculature. a. Upright Row, b. Dynamic Hug, c. Cocking/Deceleration, d. Cocking/Acceleration, e. Bilateral D2, f. Bilateral Pullover

Figure 10.

Figure 10.

Bear Crawl – Walk out on hands while in a plank position on swiss ball, then perform push‐up with a plus. Target muscles, serratus anterior, pectoralis major.

Figure 11.

Figure 11.

Seated Pike Lift – Using large dumbbells or blocks, lift buttocks off table and hold for 20 seconds. Target muscle, lower trapezius.

Figure 12.

Figure 12.

Standing “snow angels” – Stand with back against wall, keeping scapula, back of hands, and forearms touching wall. Move hands to overhead pressing motion then return with arms to side. Light cuff weights are used to provide additional resistance.

Figure 13.

Figure 13.

Scapular shirt – Scapular shirt used to help maintain proper posture and scapular positioning.

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