How to Assess and Improve Shoulder Overhead Mobility

There are 4 main components of getting full overhead shoulder mobility with optimal mechanics. These include:
1. Lumbo-pelvic control: poor motor control here will result in excessive extension of the Lumbar spine & Rib flare, which will give you a false sense of achieving full shoulder elevation.
2. Thoracic extension: THIS IS WHERE YOU WANT SPINE EXTENSION, the thoracic spine is responsible for 20 degrees of arm elevation, without extension here the scapula will not move properly.

3. Scapula (shoulder blade): movement of this bone should consist of elevation, upward rotation, and posterior tilting.
4. Shoulder: Most of the motion will come from this Gleno-humeral joint. Soft tissue weakness & lack of mobility as well as capsular hypomobility will lead to limited motion overhead can lead to many shoulder pathologies such as rotator cuff tear, labral tear, & impingement.
-Ideally you will be able to see the face in front of your arm in pure elevation, WITHOUT a forward head posture.

Latissimus Dorsi Stretch

This stretch is designed to specifically target the Latissimus Dorsi. The Lat’s limited flexibility is often the culprit of excessive lumbar extension with overhead movement. This lumbar extension can be noticed with a rib flare & can cause Lower Back pain.


Additionally, tight Lat’s often manifest in an internally rotated/rounded shoulders position, this is due to its action of internal rotation at the shoulder joint. This internal rotated position decreases subacromial space, which may result in SHOULDER IMPINGEMENT.
Hopefully that shows the importance of flexibility in this muscle!
To maximally stretch the Lat’s:
1. Grab with your shoulder in External Rotation
2. Posterior tilt your pelvic & rotate away it AWAY (opening up your hips toward the arm being stretched). This is pulling the Lat’s from the distal insertion point.

Option 2: If it is difficult for you to posteriorly tilt your pelvic, stepping on an elevated surface will excessively flex your hip, resulting in a posterior pelvic tilt.

Movement With Mobilization of the Shoulder Joint

 

If limited shoulder elevation (Abduction or Flexion) is due to a hypomobile shoulder, a movement with mobilization is a great way to IMPROVE MOBILTY. The arthrokinematics of the Glenohumeral joint that occur with arm elevation consists of the Head of the Humerus rolling superiorly while gliding inferiorly. Therefore, if the inferior capsule is restricted the arm will not elevate to it’s ideal range of motion. When the head of the humerus rises high with elevation, this leads to impingement.

To perform this exercise- step back allowing your shoulder to get into full flexion, with the band wrapped around the head of your humerus pull inferiorly towards the ground & hold for a couple seconds (this will stretch the inferior Glenohumeral joint capsule).
-Another option is to oscillate at end-range of shoulder flexion demonstrated by the last repetition in the video.
Note- find the restriction in YOUR capsule, this is done by pulling in slightly different angles in the inferior direction, until you find a pocket where the capsule feels tight.
*See a local skilled physical therapist confirm that limited shoulder mobility is due to a hypomobile shoulder joint before you crank on it with a band.

Pec Stretch

 

The Pectoralis Major & Minor make up the entire chest region of your body. Pec tightness is notorious for leading to rounded shoulders/hunched position/stooped posture. Rounded shoulders=Internal Rotation of the shoulder, protracted scapula & thoracic flexion/kyphosis.
1st stretch- Pectoralis major stretch- abduct and externally rotate your shoulder onto a stable surface. Rotate until you feel a good stretch in the chest and hold, then contract the chest (by pushing against wall) for a couple seconds followed by rotating your body further away from the doorway to hold again. Then repeat.
*you should not feel the stretch going down into your forearm/hand. If this occurs, you are getting neural tension and should modify the stretch.
2nd stretch- Pectoralis minor- will anterior tilt and downwardly rotate your scapula which will reduce it’s ability for proper scapulohumeral rhythm! You can use the same contract relax technique here as well.
Additionally opening up your chest will allow you to feel much more confident and allowing more oxygen intake!!
This contract relax technique is a type of PNF (proprioceptive Neuromuscular Re-Education) pattern.

Posterior Cuff Eccentric Control

The posterior rotator cuff consist of three of the four rotator cuff muscles; Infraspinatus, Supraspinatus & Teres Minor (which are External Rotators of the Shoulder). Now that you have learned how to give this area some flexibility (from the previous episode) here is a great way to strengthen these muscles eccentrically.
WHY eccentrically you ask?
Regarding rotator cuff strength, it is generally recognized that overhead athletes often exhibit sport-specific adaptations leading to a relative decrease in the strength of the external rotators, and thus muscular imbalance in the rotator cuff. With overhead athletes the recent focus has shifted from isometric or concentric to ECCENTRIC muscle strengthening of the rotator cuff (particularly the External rotators). Reason being that these muscles are used as a decelerator during powerful throwing, serving, or smashing movements.

Posterior Capsule Stretch

As previously mentioned stiffness of the posterior shoulder capsule is a common adaptation seen with overhead athletes. This adaptation is common in more than just athletes. With the amount of time humans spend with their arms at the front of the shoulder capsule during activities such as using a computer, writing, playing video games, & driving chances are your posterior capsule is restricted.
The first stretch is an example of a common fault during a posterior shoulder capsule stretch. This is due to allowing the entire shoulder girdle including the scapula to be pulled with the stretch. What this targets is the scapula retractors instead, such as the rhomboids and mid-lower trap’s.
The next stretch you can see is performed WITHOUT the scapula protraction. Set your shoulder in a good stable position before pulling across your body will allow for a good stretch of the posterior capsule of the shoulder.
The reverse sleeper stretch is also another option of stretching your posterior shoulder capsule. The more you pull your elbow forward the more you will stretch the shoulder into Internal rotation.

Wall Angels

Wall angels are a great way to improve postural awareness as well as recruit the shoulder & spine stabilizers in a controlled & coordinated manner.
For Proper Execution:
-Keep your Lower Back, Elbow, & hands against the wall. (if you can’t get your hand against the wall, get as close as your shoulder allows)
-Allow for initial 90 degrees of elbow flexion
-Tuck your chin in
-After having done the previous movement with mobilizations, stretches, & soft-tissue mobilizations that this series talked about, this exercise is also great way to check if your shoulder range of motion is IMPROVING or not.
-Adding resistance to this exercise may help by giving a resistance cue of your external rotators (rotator cuff) to work harder. These rotator cuff muscles depress the head of the Humerus, which in turn will allow further elevation of the arm.

The resistance may also be used as a way to strengthen the rotator cuff & scapula stabilizing muscles. *DON’T let your lower back arch during this!

In Conclusion: there are a couple things to consider for a healthy shoulder in an overhead athlete:
Mobility of your Lat’s, Pec Major, Pec Minor, Glenohumeral joint, & Posterior Cuff
Strength of your Rotator Cuff and Scapula Stabilizing Muscles.

 

Citation:

“Prevention of shoulder injuries in overhead athletes: a science-based approach” by: Ann Cools et al.

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