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6-2006

Scapula Stabilization Rehab Exercise PrescriptionJason BrumittGeorge Fox University, jbrumitt@georgefox.edu

Erik Meira

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Recommended CitationPublished in Strength and Conditioning Journal, 2006; 28(3): 62-65 http://journals.lww.com/nsca-scj/Pages/collectiondetails.aspx?TopicalCollectionId=17

© National Strength and Conditioning AssociationVolume 28, Number 3, pages 62-65

R e h a b T i p s

Scapula Stabilization RehabExercise PrescriptionJason Brumitt,MSPT,SCS,ATC.C5C5,*DWillamette Falls Hospital,Oregon City,Oregon

ErikMeira,PT,CSCSElite PhysicalTherapy and Sports Medicine, Portland,Oregon

s u m m a r y

The athletic shoulder is susceptible

to repetitive overuse injuries in

sports. No shoulder rehabilitation

program is complete without the

prescription of exercises to enhance

5capular function. An athlete should

progress from basic rehabilitation ex-

ercises identified by electromyo-

graphic studies to dynamic, sport-spe-

cific positions before returning to sport.

T he athletic shoulder is susceptibleto repetitive overuse injuries insuch sports as baseball, golf, and

tennis {1, 5, 6). Athletes who have SLIS-

tained shoulder injuries present to reha-bilitation professionals with such diag-noses as rotator cuff strain, impinge-ment, labral tears, and instability (6),Although many of these diagnoses re-quire rotator cuff strengthening, a com-prehensive rehabilitation program mustalso include the prescription of scapularstabilization exercises.

Kibler (3) has identified several roles ofthe scapula for athletic performance('I'able I). The gienoid fossa oi thescapula articulates with the humeralhead, providing a stable base for nor-mal upper-extremity movement. For anathlete to achieve full shoulder eleva-tion, normal scapulobumeral rhythmmust occur. I'or every 2° of elevationmotion contributedby the glenohumer-al joint, 1° of mo-tion must occurfrom the scapulo-thoracic articula-tion. The scapularmuscles facilitate up-per-extremity move-ment via the scapu-lar motions oi pro-traction, retraction,tipward (lateral) ro-tation, and down-ward (medial) rota-

The main muscles providing scapularstabilization are the rhomboids, trapez-ius, and serratus anterior. Weakness ofthe scapular muscles will lead to dys-function of the scapulohumeral rhythm,which may cause or lead to shoulder in-jury. Scapular dysfunction is found in as

June 2006 • Strength and Conditioning Journal

many as 68% of rotator cuff problemsand 100% of glenohumeral instabilitydiagnoses (4, 6, 8),

Sports medicine researchers have identi-fied the best exercises to train or rehabil-itate the muscles of the scapula. Table 2lists the top exercises for some keyscapula muscles as determined from

elect roniyographicresearch (2, 7),

Elevation ofScapula[he combined ac-lion of the upperand lower fibers ofthe trapezius and the,scrratus anterior ele-vate and laterally ro-tate the scapula.This action helps toposition the upperextrem 1 ty f o r m o-

tions required during overhead throw-ing or tennis ball serving. We typicallyfind that the injured athlete does notpresent with upper trapezius weakness.If deemed necessary, the top exercise forthe upper trapezius is rowing (Figure I)or a unilateral shoulder shrug (2, 7). Onthe other hand, the lower trapezitis doesoften present with weakness. Shoulder

Table 1Roles of the Scapula inThrowing and Serving

1. Stable part of glenohumeralarticulation

2. Retraction and protraction tofacilitate cocking,throwing,andserving motions

3. Elevation of tbe acromion

4. Base for muscle attachment

5. Link in proximal to distalsequencing

abduction and rowing (Figure 1) are thetop exercises identified by Moseley et al.(7). Ekstrotn's electromyograpbic studyfound the overhead arm raise in linewith the lower trapezius to be the bestexercise (Figure 2) (2).

Retraction and ProtractionScapular retraction provides a stablebase from which the arm elevates and ex-ternally rotates during the cocking phas-es of overhead throwing and during thetakeaway phase of the golf swing. I herhomboids and middle trapezius are themain scapular retractors. From our clin-ical experience, these muscle groups aregrossly weak. We recommend an imme-diate correction of any compensationpatterns when instructing horizontal ab-duction (neutral) or horizontal exten-sion with external rotation (Figure 3).(Note, although Ekstrom et al. |2] andMoseley et al. [7] use different terms fortheir respective horizontal exercises, tbeexercises in fact are performed in thesame prone position, with the exceptionof Fkstroms performed with gleno-humeral external rotation.)

Tbe serratus anterior protracts tbescapula along the thorax to provide astable base as the shoulder transitionsfrom a cocked position to either throwor strike a ball. Dysfunctional scapularprotraction leads to increased decelera-tion forces on the shoulder duringthrowing (3). A patient with a dysfunc-

Table 2Top Exercises for Scapular Stabilization

Moseley(1992}

Upper trapezius

Middle trapezius Horizontal abduction(neutral)

Lower trapezius Abduction or rowing

Rbomboids Horizontal abduction(neutral)

Serratus anterior Push up with a plus

Ekstrom (2003)

Unilateral shoulder shrug

Shoulder horizontal extensionwitb external rotation andoverhead arm raise in line withlower trapezius (proneposition)

Overhead arm raise in line withlower trapezius (prone position)

Not tested

Shoulder abduction plane ofscapula above 120°

Overhead arm raise in line with lower trapezius exercise.

June 2006 • Strength and Conditioning Journal

Figure 3. Shoulder horizontal extension with external rotation.

Figure 4. Stepping alternating punch exercise.

tional serratus anterior muscle may pre-sent to the clinician with winging of themedial scapular border (3). To strength-en the serratus anterior, we recommendbeginning with a push-up and a plus ex-

ercise. Most patients can safely performthis exercise during the initial phase ofrehahilitation. As symptoms improve,the athlete may progress to a scaptionabove 120° (2).

Proprioceptive neuromuscu-lar facilitation diagonal 2pattern exercise with pulley.

Sport-Specific TrainingAs an athlete's symptoms improve withthe aforementioned exercises, we recom-mend that exercises that reproduce ormimic functional positions he per-formed. Examples of sport-specifictraining include plyometric hall throwsagainst a rehounder, alternating serratusanterior punches (Figure 4), and propri-oceptive neuromuscular facilitation di-agonal 2 patterns (Figure 5).

Exercise DosingThe athlete should initially perform eachexercise with low weight, performing 1to 3 sets of 25 to 30 repetitions. Whenthe athlete can successfully complete 25to 30 repetitions at a weight with nojoint pain, he or she should gradually in-crease the weight by l4b increments.

ConclusionA comprehensive shoulder rehabilita-tion program should include exercises

June 2006 • Strength and Conditioning Journal

for the scapular muscles. We recom-mend that exercises identified by eitherMoseley or Ekstrom be prescribed ini-tially. As the athlete's condition im-proves, we suggest a progression to dy-namic exercise positions. •

References1. BVLAK, J., AND M.R. HUTCHINSON.

Common sports injuries in young ten-nis players. Sports Med. 26(2):119-132. 1998.

2. EKSTROM, R.A., R.A. DONAIIXLI, AND

G.L. ScuiFRBFRC. Surface eiectromyo-graphic analysis of exercises for thetrapezius and serratus anterior muscles.

/ , Orthop. Sports Phys. Ther. 33(5):247-258. 2003.

3. KIBLER, W . B . The role of the scapula in

athletic shoulder function. Am. J.SportsMed 26(2):525-337. 1998.

4. KUHN,J.E., K.D. PlJ\NCHER, ANDR.J.HAWKINS. Scapular winging . / Am.

Acad. Orthop. Surg. 3:319-325. 1995.5. MCCARROLL, J.R. The frequency of

golf injuries. Clin. Sports Med. 15(1):1-7. 1996.

6. MEISTER, K. Injuries to the shoulder in

the throwing athlete. Part one: Biome-chanics/pathophysiology/classification.Am.J. SportsMed 28(2):265-275.2000.

7. MostLEY, J.B., Jr.. E.W. JOBE. M ,

PINK, AND J.TiBONE. EMG analysis of

the scapular muscles during a shoulderrehabilitation program. AmJ. SportsMed 20(2): 128-134, 1992.

8. WARNER. j.J., LJ. MICHELI, L E . AR-

SEAN IAN. J. KENNniV, AND R,KENNEDY. Scapulothoracic motion in

normal shoulders and shoulders withglenohumeral msrability and impinge-ment syndrome: A study using moiretopographic analysis. Clin. Orthop.Relat. Res. 285:191-199. 1992.

Jason Brumitt is an APTA board-certifiedsports clinical specialist. He is employedat Willamette Falls Hospital,

Erik Meira is the director and lead pbysi-cal therapist for Elite Pbysical Tberapyand Sports Medicine.

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June 2006 • Strengtb and Conditioning Journal