A common debate in physical therapy is whether we should cue people to “pinch their scapulas” together during exercises.
I don’t really think there should be a debate…
Here’s why we don’t use that cue and what we do instead.
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#AskMikeReinold Episode 332: Should You Cue to Pinch Your Shoulder Blades Back?
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Show Notes
• How to Cue the Scapula During Shoulder Exercises
Transcript
Brenna Hanna:
Okay. Alyssa from New Hampshire asks, “As a new PT, I find myself struggling with shoulder injuries. I learned the classic pinch the shoulder back to cue scapular retraction to prepare for basically all shoulder exercises. And I’m realizing this isn’t ideal. I’m now wondering how to best explain the importance of scapular retraction and when it actually should be cued. If we don’t cue anything during shoulder exercises, how are we encouraging more lower middle trap rhomboid serratus activation and less upper trap compensation, which I also see a lot of and have a hard time correcting?”
Mike Reinold:
Awesome. Good question. Thanks Brenna. Alyssa, that’s a really good question. Classic, right? The pinch the shoulders back, and I’ll let others kind of start it off, but it was kind of funny you said, “how do you decrease upper trap?” I always feel like, when people pinch their shoulders back, they end up using upper traps more, right? They look like those weird robots that just pinch their arms back and are lifting up. It’s tough, but who wants to start this one off with pinch the shoulders back? Do we do it? Why don’t we? What do we do instead? I don’t know. I feel like we haven’t heard Dan Pope in a few weeks. Maybe we start off with Dan. What do you think, Dan?
Dan Pope:
Yeah, this is a huge can of worms. Basically with the history of the shoulder blade, I would say maybe 5, 10 years ago we thought the shoulder blade was everything. And then in more recent years, some of the recent research has shown that dyskinesia is not really as important as maybe once thought. And then I also feel like from a research perspective, we stopped studying the shoulder blade, right? I also feel like we don’t have all the answers. One of the things I see pretty frequently is when someone has a shrug sign and they have a rotator cuff related issue, the muscles around the shoulder blade are going to help you bring your arm overhead. And if the rotator cuff isn’t functioning well, you’re going to see the shoulder blade try to help more. And I think the theory is that when you bring your arm overhead, one third of that motion comes from the shoulder blade and two thirds comes from the shoulder joint.
If we don’t have the shoulder blade doing its job, then maybe the shoulder needs to work a little… Sorry, I lost my train of thought there. So if the shoulder blade is not working as well as it could be, it’s putting a little more stress on the shoulder or the rotator cuff. So I think when you’re seeing these compensations, you have to think about why… Because you can have abnormal shoulder blade movement for a variety of reasons. If your cuff isn’t working properly and you’re noticing that you’re getting more motion from the shoulder blade, then maybe you have to train the shoulder itself, try to train that rotator cuff a little more so. In terms of bringing the shoulder blades together with every single movement, that’s probably not accurate. And again, on social media, it’s like the pendulum just swings back in the day, pinch the shoulder blades back, pack the shoulders.
Now everyone’s like, free the scapula, let it protract, let it do what it’s supposed to do. And I imagine there’s probably a happy medium. So you probably need to train the shoulder blade to do a variety of different things. I think a lot of research shows if someone has pain within their shoulder, if you train mid trap, low trap in general, it seems to be helpful. Whether or not you retract probably is going to be specific to the individual. But I don’t know that you need to cue pinch the shoulder blades back in every single person. So at least for the listener, I would say that you probably don’t have to have so much emphasis on pinching the shoulder blades back, but in some individuals, I think you can probably make a case for it.
Mike Reinold:
Awesome. Great stuff Dan. And I couldn’t help but think while you were talking, we haven’t capitalized like a lot of other podcast people have with T-shirts with catchphrases and stuff, but “free the scapula,” that’s a good one.
Dave Tilley:
I was about to make a sign and hold it up like a protester.
Mike Reinold:
That’s a good T-shirt. For me, Dan, I think you nailed a lot of the good reasons why you don’t, but what else? I want to hear a couple other thoughts and opinions, and I want to get the strength and conditioning coach’s concept too because you guys use big movements sometimes too. A lot of times, I don’t want to say in PT, we just do isolated movements, but oftentimes we’re working on specific things. You guys are working on bigger things, but who wants to jump in? I want to hear a few more opinions on this. Diwesh?
Diwesh Poudyal:
Yeah, my big thought is I feel like we as an industry, including PT and fitness by the way, I feel like we’re so locked in on just spitting out a cue because we know that it’s a decent cue or a good cue for a certain joint or whatever, but we don’t really look at the person in front of us when they’re actually doing the exercise. If someone is clearly just jamming their humerus forward in their joint because they’re not getting any scap retraction as they come back until, let’s say like a row, then yeah, it probably should do scaps back a little bit. You know what I mean? But if someone’s already moving their scap well, me doing more and more of that is not going to give me what I want. It’s probably going to lead to what you said, Mike, earlier of getting a little bit more up trap than you like because you’re overemphasizing something that doesn’t really keep the movement organic.
So I am just a big proponent of letting the scap do the full range motion that it’s supposed to, depending on what movement you’re doing. If I’m going overhead, I need to have the scapular tilt. I’m going to need it to protract. I’m going to need it to upwardly rotate. So that’s what I’m going to look for. If they’re doing all those things, I’m not going to over-cue it. If I’m doing a row, I need the shoulder to get into extension. I need the scapula to come back into retraction. If I’m not seeing that, I’ll cue it. But if I see that is happening, then there’s no reason for me to cue it. So there’s no standard. Do we cue shoulder blades back for all these exercises, including your I, Ys and Ts? Well, maybe if someone’s not doing a good job of doing what should be happening organically in that movement, yeah. If they’re not demonstrating that, then probably leave it alone and just let them get stronger.
Mike Reinold:
And I like your point too, where you cue it if you need it. But I think this is also a “feel versus real.” What you don’t want somebody to do is just lock the thing into full retraction and do it. It’s cue the movement versus actually locking it in. I think that’s a big one. But who else? Anybody else want to jump in? Kev?
Lenny Macrina:
Yeah, I’ve seen no desire to use that cue in my 20 year career. Who’s shoulder blade needs to be retracted back and held? Try to retract your shoulder blade back and then raise full flexion or even 90 degrees of flexion. It’s not easy. You talk about compensating, it just doesn’t make sense in my head.
Mike Reinold:
It’s like try to dorsiflex your ankle as much as you can, lock it in there and do a squat. It’s really weird. I mean, gross movement patterns require multiple joints to move in coordination, and I think that’s what it comes down to. It’s weird. But anyway, sorry, keep going.
Lenny Macrina:
I think perceptually, we think we can isolate the muscle. The person asked about trying to isolate the mid traps and the low traps and all that, and you can’t isolate the muscle. So just like Pope said, and I think I’ve put a video on Instagram on this about freeing the scapula… Just let it go. And EMG will tell you… And there are studies that say that certain muscles are working and they’re all working in coordination. So let it happen, load it. If there’s something gross going on like a long thoracic nerve issue where you have a serratus issue, well yeah, then you want to cue stuff and maybe use some taping or e-stim and all that. But I don’t think setting and forgetting of the scapula is just not… It’s never been in my repertoire. I just haven’t seen the benefit and the value and it inhibits motion. So it’s just not what I’m looking for.
Mike Reinold:
And setting the scapula and doing an arm elevation, doesn’t isolate… That doesn’t get low trap more, actually, it probably gets less. It would be an isometric movement for the scapula. If you want to work on low trap strength, you just do a different exercise. You pick an exercise that works well on it. But Kevin, what do you think? Do you have anything on that?
Kevin Coughlin:
Yeah, I was just going to say, I feel like what I see sometimes is people with chronic neck or chronic shoulder pain who have really poor motor control of their scapula. And it’s not just retraction, they’re not really sure how to do… They can’t protract, they can’t upwardly rotate. And I think there’s some utility in coaching people on how to move their scaps in just different ways. I feel like a lot of the healthy good movers we see, they have a lot of different movement options and they can do the same task multiple different ways. And I do think there is some utility in coaching that, but not exclusively pinching the shoulders back and explaining to the… I think we do some education on this with patients quite a bit where they’ve heard elsewhere to pinch their shoulders back because it’s safer for their shoulder where they’re not going to get their upper trap involved.
And then I try to draw it back to whatever task that they like to do. So if it’s throwing a baseball, you can’t do that with retracting your shoulder blade or a lot of other sports. It’s just not part of the sport’s task. So if we draw it back to how they have to function with their shoulder or if it’s a regular adult, just when they have to lift their arms overhead to place something above their head, their shoulder blade has to upwardly rotate and move and they can’t achieve that with retraction. So I think it comes back to educating the patient and trying to work on their goals and helping them get there with education.
Mike Reinold:
Awesome. Good stuff. I think I’ll sum it up as this then. I think we answered it pretty well. But not only do we not say let’s pinch the shoulders back, we actually say you need to move the scapula. The scapula moves during normal motion. I want you to take a step back Alyssa, and I want you to think what are you trying to do? Are you trying to work on one specific muscle or are you trying to work on a movement pattern? If you’re trying to work on shoulder elevation for example, or even shoulder retraction, you got to remember it’s not just scapula, it’s glenohumeral, it’s scapular, it’s putting it all together. It’s even a little thorax. So you put that all together. I want you to think of a general gross movement pattern and think about what goes into that and not restrict.
If you want to get isolated strengthening of a muscle, which is hard to impossible to do in general anyway, you can just pick a different exercise that has a higher ratio of low trap to upper trap to perform in them, but then you want to follow it up with something that allows the freedom of the movement of the scapula because that’s normal function.
So yeah, I would say we’re pretty much the opposite. We don’t pinch the shoulders back, we actually cue them to rotate. We cue them to do the motion that we want to do. Even with our prone exercises, right? T’s a little bit easier. It just comes straight back into our traction. But a prone Y, we teach them, we want you to upwardly rotate and posterior tilt that scapula while you’re doing the prone Y. Otherwise, you’re just jamming it. It’s just a weird exercise.
So anyway, hopefully that helps Alyssa. Great question. I think a lot of people probably learned that early in their careers and I think even like yourself, you kind of said in your comment here that you’re starting to find out that maybe that’s not great. I think we would agree. So subtle tweaks, I don’t think this is one of those things that… I wouldn’t go on social media and say you’re hurting people if you pinch the shoulder back. That’s not it. But to me, it’s all about being as optimal as we can. The more optimal we can be the better. And I think they think that’s our job, that our profession is trying to maximize the output we can do. Anyway, great question. Hope that helps.
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