Scapular (shoulder blade) movement should work synergistically with our arm movement to ensure our rotator cuff (supraspinatus, teres minor, subscapularis and infraspinatus) does not become overworked (Larsen et al. 2014). When we perform a push up this is not always the case, therefore, this needs to be addressed.

Scapular movements

• Protraction
• Retraction
• Upward rotation
• Downward rotation
• Elevation
• Depression

The correct coordination of the scapular and humerus (arm bone (scapulohumeral rhythm)) will allow pain-free shoulder movement and increase shoulder joint stability which is needed when performing a push-up (Paine et al. 2013).

During a push-up, your shoulder blades should glide smoothly on the lowering phase, then retract quickly and strongly when you push away from the floor. A common misconception when it comes to performing a push-up is using the cue “pin your shoulders back and down”. By doing this, you can increase your chance of suffering a shoulder injury as the shoulder blade is not moving through the most efficient pathway for this exercise.

You are probably wondering – are my shoulder blades collapsing when I’m performing a push-up?

Well, let’s find out…

Why does this happen? Poor scapular control?

This happens when scapular protraction (anterior movement) is missed out and glenohumeral (shoulder) movement is just happening with no scapular movement. It often happens at the bottom of the push-up when a collapse of the shoulder blades occurs.

This is normally due to not having the control/strength in our shoulder blades to maintain a good position. When this happens, we can clearly see our shoulder blades collapse like this…

This person is performing protraction in a wall push-up, the first picture shows collapsed shoulder blades and the second one shows the true movement which should occur in a push-up in the protraction phase. When someone is performing a push-up and their shoulder blades collapse (picture 1), this means the sole movement is coming through the shoulder joint itself, thus increasing the risk of a shoulder injury as this can be an overload of the joint and tissues surrounding it, especially if carried out repetitively (Brooks & Cressey, 2013).

As well as the shoulder joint, the shoulder blades also work alongside and on the rib cage. Shoulder protraction and retraction should take place against the rib cage and is vital during a push-up and this de-loads the shoulder joint. This further explains the importance of not forcing the shoulder blades into the downward rotation as this stops their natural movement pattern of protraction and retraction.

A great video below by Eric Cressey shows someone who thinks they are performing a push-up properly but really, they are missing out on the two key points of a push-up, PROTRACTION AND RETRACTION.

Furthermore, in our video below, we used this test to see if the subject could control the shoulder blade in a pulling sequence. What you can clearly see here is too much collapsing of the shoulder blades at the final pull and also how they lose control in the eccentric portion (left shoulder blade) on the way back.

A stable scapular allows for a stable shoulder

A stable scapular aids the stability of the shoulder as this encourages the rotator cuff muscles, as mentioned above, to work efficiently and effectively. This works in reverse also – if the scapular is unstable, this could lead to an unstable shoulder and the potential risk of injury.

Imagine building a house, you need your foundations first to make a stable house. Imagine our shoulder blades are the foundations and our shoulder is the house. If the foundations fail, how do you expect the house to stay standing?

Scapular stabilisers

To keep our shoulder blades stable, we have a multitude of muscles that act as stabilisers to keep this floating bone in place.

The stabilisers

• Serratus anterior
• Rhomboid major & minor
• Levator scapulae
• Trapezii

When suffering from weak or dysfunctional scapular control, the two most common muscles to switch off are:

• Serratus anterior
• Lower trapezius

This causes scapular instability which is estimated to be seen in 100% of shoulder instability problems (Kibler et al., 2013) therefore, showing a clear link between scapular stability and shoulder stability.

Weakness of scapular stabilisers?

Weakness of scapular stabilisers is equal to increased stress on the anterior (front) aspect of the shoulder leading to increased chances of rotator cuff impingement (Brooks & Cressey, 2013). Due to the weakness of scapular stabilisers, this alters the shoulder biomechanics affecting the following

• Abnormal stress to anterior capsular structures
• Increased rotator cuff compression
• Decreased neuromuscular activity of the shoulder (Paine et al., 2013)

Due to this weakness in the scapular stabilisers, the shoulder complex is at greater risk of becoming dysfunctional which can lead to pain.

Have you got poor motor control?

Poor motor control has been linked with changes in the activity of certain scapular stabilisers such as trapezius middle and lower and serratus anterior which are related to many shoulder injuries. When performing a push-up, poor motor control can affect muscle activation and deactivation (Phadke & Ludewig, 2013). If this occurs, in the serratus anterior for example, the scapular protraction phase of the push-up won’t be as efficient which can therefore result in excessive loading through the rest of the shoulder joint.

What happens when we collapse the shoulder blades?

When our shoulder blades collapse this increases our chance of rotator cuff problems (Larsen et al. 2014). Some people think the reason why rotator cuff injury occurs is due to weakness of the rotator cuff, most of the time during a pushing exercise such as the push up it is due to poor scapular movement which we have previously spoken about.

Using our previous analogy, when our shoulder blades collapse due to poor scapular control, this means that our house is collapsing and the objects inside are being crushed. This, in more scientific terms, means that an area within our shoulder known as the subacromial space where our rotator cuff muscles and their tendons pass through, is being crushed (Suprak et al., 2013). This results in irritation to these structures, potentially causing rotator cuff tears, tendinosis, and even damage to the labrum within our shoulder joint.

This is supported by multiple studies showing that many shoulder injuries and altered shoulder biomechanics are not to do with just the weakness of the rotator cuff, but more so the dysfunctional movement of the scapular (Kibler et al. 2013).

In conclusion

When you are next doing a push-up, consider whether are you allowing your shoulder blades to move through their natural pathway. Remember, the shoulder complex cannot function if the glenohumeral joint and shoulder blades don’t work as a pair. Don’t put yourself at risk of injury. Let them work as a pair and keep a happy shoulder and a happy you!

Any questions? Feel free to get in touch.

If you’d like any help with your injury, you can subscribe to our ACTIVE Training Programme.

Jessica Woodhouse & Emma Benton

BSc Sports Therapy

References

Larsen, C. M., Juul-Kristensen, B., Lund, H., & Søgaard, K. (2014). Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review. Physiotherapy theory and practice, 30(7), 453-482.

Paine, R., & Voight, M. L. (2013). The role of the scapula. International journal of sports physical therapy, 8(5), 617.

Brooks, T., & Cressey, E. (2013). Mobility training for the young athlete. Strength & Conditioning Journal, 35(3), 27-33.

Kibler, W. B., Ludewig, P. M., McClure, P. W., Michener, L. A., Bak, K., & Sciascia, A. D. (2013). Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. British journal of sports medicine, 47(14), 877-885.

Phadke, V., & Ludewig, P. M. (2013). Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement. Journal of Electromyography and Kinesiology, 23(2), 469-475.

Suprak, D. N., Bohannon, J., Morales, G., Stroschein, J., & San Juan, J. G. (2013). Scapular kinematics and shoulder elevation in a traditional push-up. Journal of athletic training, 48(6), 826-835.