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 sometimes not always the case, therefore, this needs to be addressed.
Scapular movements
- Protraction
- Retraction
- Upwards
- Downwards
- Superiorly
- Inferiorly
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).
When we are talking about a push-up we want your shoulder blades to move smoothly when lowering then when you push up, try to push away from the floor as much as possible. Don’t let someone tell you to pin your shoulders down and back as far as possible as this will increase your chances of a shoulder injury.
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 stay like in the first picture this is showing that all movement is going purely through the shoulder itself. Therefore, increasing their risks of a shoulder injury.
Our shoulder joint is a ball and socket joint, this should glide smoothly, however, if our foundation is affected (our shoulder blades) this will affect the movement of our ball and socket in the joint, therefore, increasing loading through our shoulder (Cressey 2013).
We need to think of the movement of the scapular moving on the rib cage, not just shoulder movement. Shoulder protraction and retraction should take place and remember, we don’t want the scapular to be forced into the downward rotation, we want the natural movement of the scapular to be working.
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 allows the shoulder to become stable as the rotator cuff muscles mentioned above are allowed to work efficiently. Without a stable scapular, the shoulder will become unstable, altering shoulder biomechanics and increasing the 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 be stable? How do you expect the house to not fall down and crush everything in it?
Weakness of scapular stabilisers?
Weakness of scapular stabilisers is equal to increased stress on the anterior aspect of the shoulder leading to increased chances of rotator cuff impingement (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 shoulder complex neuromuscular activity
The weakness of scapular stabilisers affects scapular positioning and movement causing shoulder complex dysfunction.
The stabilisers
- Serratus anterior
- Rhomboid major & minor
- Levator scapulae
- Trapezii
Two stabilisers which are shown to be the weakest in many people and which are the first to switch off when there is a dysfunction:
- Serratus anterior
- Lower trapezius
This causes scapular instability which is estimated to be seen in 100% of shoulder instability problems (Kibler 2013) therefore, showing a clear link between scapular stability and shoulder stability.
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 et al. 2009). If we have poor motor control such as incorrect muscle activation of the serratus anterior in a push-up this will affect the protraction phase of the push-up causing excessive loading of our shoulder.
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.
Scapular movement and control are very important in shoulder stability and this will help aid with maximising subacromial space in the shoulder preventing future injury (Suprak et al 2013). If we have poor scapular movement our foundations are poor which means our house is collapsing, therefore decreasing the subacromial space, crushing objects in our house such as the rotator cuff. When we collapse our shoulder blades we are increasing our risk of the following: glenohumeral instability, impingement, rotator cuff tendinosis, rotator cuff tear, and labrum injuries.
This is supported by many studies showing that many shoulder injuries and altered shoulder biomechanics are not to do with just the weakness of the rotator cuff, the main problem is seen to be scapular dysfunction (Kibler et al. 2013).
In conclusion
Think when you are next doing a push-up, are you allowing your shoulder blades to move their natural movements. Are you letting your wings fly? 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.
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Jessica Woodhouse
BSc Sports Therapy
