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Video Tutorial-Scapular Depression with Shoulder Extension

Filed under: Uncategorized — Shon @ 1:30 pm December 15, 2011

One of my favorite exercises for upper quarter (shoulder, cervical spine and thoracic spine) dysfunction is scapular depression with shoulder (glenohumeral) extension.  In cases of shoulder impingement, there is almost always a component of scapular dyskinesia, or poor scapular positioning.  Ben Kibler, M.D., one of the pioneering researchers in the area of the scapula, stated here that the prevalence of scapular dyskinesia is 100% in cases of shoulder instability and 94% in instances of labral tears.

Why is my bias toward scapular depression?  First, it is generally non-provocative, as you aren't moving toward glenohumeral elevation.  In cases of impingement, I want to establish exercises and activities that don't provoke symptoms while giving the patient something constructive to do as well.  "Getting back" scapular control with this exercise allows both things to happen pretty seamlessly. 

Second, scapular depression fosters thoracic extension more so than the other scapular exercises.  Thoracic extension goes hand in hand with scapular mobility, and I don't feel you can optimize one without the other. 

Third, with scapular depression, upper trapezius activation/ compensation is limited.  Yes, some upper trapezius is needed in normal shoulder function, but if we are dealing with "abnormal", then upper traps need to be subdued a bit.  Most shoulder and neck patients I see have a difficult time disassociating upper trapezius from middle and lower trapezius activity; this exercise sets the stage for the upper traps to "step off" a bit.

Fourth, as you see in the video, the exercise is easily scaled.  The arm serves as the "weight" the scapular depressors lift; if the demand is too high on the depressors, then the position of the arm can be accommodated until they can meet the demand.

Does this mean I don't work on other scapular exercises?  No way!  I just feel this exercise sets the stage for patient comfort, success in an important movement pattern, as well as disassociation between upper trapezius and middle/ lower trapezius activity.  It is just one activity in a "parts to a whole" approach to upper quarter dysfunction.  Enjoy the video!