originally posted on SportsRehabExpert.com
This article was originally written for physical therapists and other clinicians dealing with shoulder pain and loss of motion so excuse some of the medical terminology. I know a number of them read this blog so I’m leaving the article as is.
The jist of this article is as follows: most of us have too much extension (arch) in our lower spines, and we go into even more extension any time we try to raise our arms overhead. Over time this can lead to shoulder pain and low back pain. The article below describes a great warm-up exercise to improve shoulder mobility while controlling spinal posture.
As always if you have any questions feel free to email me: firstname.lastname@example.org
Joe Heiler PT, CSCS
This is a great correction for the shoulder mobility movement patterns and also for the shoulder flexion component of the MS Extension pattern. The lumbar spine frequently contributes excessive extension to the shoulder patterns when the shoulder itself is limited. Mobility work is required to free up the shoulder, but this pattern will continue if motor control is not imparted to lock in the new range of motion.
The ‘wall posture’ as I describe it to the patient is an attempt to get the entire spine to touch the wall. By having the feet out in front and knees slightly flexed it makes it easier to get the lumbar spine flat onto the wall which is really just a less extended, and probably more neutral position, for most folks. If you’re concerned that it is too much flexion, or if it is not well tolerated due to back pain, and towel roll/lumbar support could be used but contact must be kept at all times.
The cervical spine is a little trickier when it comes to proper positioning. I will cue to get the spine to the wall, but to a point. That cue will usually bring the chin down and back (into cervical retraction) which again will bring most folks to a more neutral posture. Too ‘straight’ is not a normal position either and could affect the shoulder mobility component of this corrective so don’t force it. If their forward head posture is so severe that their head won’t touch the wall without going into extension, then place a towel roll behind the head and require them to hold the towel in place as the arms go overhead.
Maintaining the proper positioning throughout the movement is the most important factor here. The shoulder motions in the video are a challenge to that positioning. When posture is lost, the movement is done.
Breathing is critical here as well. My preferred way of cuing the breathing is to inhale at the bottom and slowly exhale during the overhead motion. The more the ribs stay down in the front the better. This can be incredibly hard for many people, and especially so for many overhead athletes, weight lifters, dancers, and gymnasts.
The order in which the motions are presented in the video go from easier to most challenging:
1) Shoulder Flexion
2) Shoulder Abduction (snow angels)
3) Shoulder Abduction with External Rotation
If following the SFMA’s 4×4 matrix, this would be considered a level 4 posture, unloaded but with assistance (the wall as the positional cue) so 4:1. Competency must be attained in each of the previous postural levels: 1) supine/prone, 2) quadruped, 3) tall or half kneeling.
Progressions per the matrix:
4:2 – shoulder mobility work without the postural cuing or any activation
4:3 – loaded with cuing or activation. Shoulder Flexion/Extension (reciprocal patterning) or pressing overhead with the spine against the wall or a corner (I prefer a corner to allow the shoulders to move more freely).
4:4 – loaded without cuing or activation – Shoulder Flexion/Extension in standing, any type of pressing.