Evidence Based Shoulder Exercises For Muscle Imbalances

Evidence Based Shoulder Exercises For Muscle Imbalances

This isn’t your average rotator cuff and scapula article. We will be demonstrating and explaining seven evidence based shoulder exercises. Principles of biomechanics, kinesiology, and electromyography will be explained and you’ll learn how to increase targeted muscle activation, improve scapular muscle activation sequencing, and challenge shoulder stability. We are taking broscience to the next level, providing research and evidence based shoulder exercises to prehab the shoulders for longevity.

ย Evidence Based Shoulder Exercises

Shoulder and neck pain and dysfunction are among some of the most common complaints of the overhead athlete and desk-bound worker alike. Recent research has shed light on the importance of the scapular muscles in shoulder and neck pain and dysfunction. The scapula serves as our shoulder’s stable base. We need a strong and stabilized scapula in order for our shoulder joint to move properly. Proximal stability promotes distal mobility, folks! Based on research, overhead athletes are more likely to recruit the upper traps prior to lower or middle trap. This can lead to a timing issue in terms of muscle recruitment. Because of this, lower and middle trapezius and serratus anterior activity may decrease, while upper trapezius, pec minor, and levator scapula activity may increase. This group of dysfunctions can lead to a decrease in scapular upward rotation, external rotation, and posterior tilt – all specific scapular motions that are imperative to try and prevent things like subacromial pain syndrome and rotator cuff tendinopathy.

 

Selective Muscle Activation

The glenohumeral joint, aka the shoulder, is so fascinating to the anatomist because it demands chronologic, selective muscle recruitment. The trapezius muscle is made up of three primary fibers: upper, middle, and lower. As a unit, these muscle fibers should activate at specific times with balanced force couples to help move the arm in various directions. Work, hobbies, sports, and performing repeated movements will reinforce movement patterns in the brain, regardless of whether those movements are good or bad. Altered muscle activity and recruitment patterns may increase stress on structures, which may cause mechanical pain or injury.

How do we fix this? By training the brain to learn a new movement pattern. Learning and performing selective muscle activation sequences during specific movements is a way to tap into the nervous system. Here we show one way to train the brain via biofeedback. This is an electromyography device that uses surface electrodes placed on the upper trapezius. Listen to the different cues Mike provides Craig and listen to the change in muscle activity measured by the biofeedback device. We understand that not everyone has this machine at their disposal, however, visual and tactile cues can be used to accomplish the same goal. A legit evidence based shoulder exercise!

 

Sharapovas

Maria Sharapova (@mariasharapova), the former world #1 womenโ€™s tennis player has had quite the remarkable career. But before she reached that #1 spot, she had to battle through a host of well-documented shoulder injuries that hampered her career early on. Rumor has it that this exercise in particular helped REHAB and [P]REHAB her shoulder back to health, hence the aptly named โ€œSharapova” exercise. Itโ€™s an absolute rotator cuff killer that hits the infraspinatus and teres minor isometrically, concentrically, and eccentrically.

HOW TO PERFORM:

  • Keep your elbows and hands against the wall. Maintain tension in the theraband the ENTIRE TIME.
  • As you move one arm up (right hand for example), ensure that your left hand is anchored and doesn’t move, this will isometrically challenge your left rotator cuff.
  • As you move your right hand up, make sure to move in a curved โ€œCโ€ pattern. This allows you to eccentrically and then concentrically challenge the right rotator cuff.
  • I like to shoot for 3 โ€œin and outsโ€ per side on the way up, and then 3 more on the way down. Thatโ€™s 1 rep. I shoot for 5 reps before taking a break and boy, will you feel the burn!
  • Note: A similar exercise (Castelein et al 2015) was found to decrease upper trapezius and pectoralis minor activation, while increasing middle trapezius, lower trapezius, and rhomboid activation.

Sherapovas are part of the Ultimate Shoulder Warm-up that includes other evidence based shoulder exercises. Click here to access it FREE and share it with friends, workout partners, patients, and clients!

 

90/90 Scapular Stabilization

The upper trapezius becomes can overpower the middle and lower traps when it is too strong and hyperactive. The middle and lower trapezius are just as important during overhead exercises to promote optimal mechanics. More importantly, we have to learn how to activate the trapezius as a stabilizer, rather than a mobilizer, during certain glenohumeral joint motions.

Here is a great evidence based shoulder exercise to increase mid and lower trap muscle activation. According to Maenhout et al 2016, the highest middle trapezius and lower trapezius muscle activation was found in prone exercises. Why is training the scapular stabilizers at a 90/90 degree shoulder abduction and external rotation so important? Well look how familiar this position is; think of a pitcher throwing or a CrossFit athlete performing an overhead movement. The shoulder is vulnerable in this position due to the risk of instability of the anterior/inferior glenohumeral joint capsule. Also, the labrum is speculated to be weak in this position. Therefore, we have to train our scapular stabilizers and rotator cuff to be strong in this position!

ย Be sure to avoid hiking your shoulders into your ears and keep your elbow relatively stable with as little movement as possible during this exercise. Note: I tried to exaggerate excessive upper trap use in the first rep!

 

Shoulder [P]Rehab Program

The Shoulder [P]Rehab Program is on our very own [P]Rehab app that is a 16-week long program to maximize your shoulder health for life. The program is for anyone looking to bulletproof their shoulders for life! Whether youโ€™re an average Joe, fit Fiona, weekend warrior, athlete, or superhero parent, you can benefit from this program. We make it easy and teach you how to strengthen your shoulders and keep them healthy for anything life throws at you. Learn more here

 

Overhead Carries

Any form of a loaded carry is always a go-to exercise. This is especially true for overhead carries, which are a great way to train proper shoulder muscle recruitment under heavy load. You need good lower trapezius, serratus anterior, and upper trapezius muscle activation to maintain a stable, upwardly rotated scapula. Not only that, but the ability to maintain a stable humerus in the overhead position places a huge demand on the rotator cuff.

In this first overhead carry sequence, I demonstrate a passive vs active overhead carry position. The goal here is to maximally activate the scapular upward rotators to provide a stable base when under an overhead load. In the video, I point to the bottom part of my scapula, known as the inferior angle, to provide a cue to get maximal lower trapezius and serratus anterior activation (relative to the upper trapezius). The cue I like to use with my patients is to โ€œpoint the bottom of your scapula forward.โ€ I find this helps promote scapular posterior tilt and external rotation (in addition to proper scapular upward rotation).

In the last overhead sequence, I demonstrate what we DO NOT want to see – excessive upper trapezius recruitment and subsequent scapular elevation instead of upward rotation. Making sure to maintain a nice window of space between your neck and shoulder is a great way to ensure you’re not excessively using your upper traps.

 

Trapezius Related Exercises

These 4 evidence based shoulder exercises were found to display the BEST muscle activation ratios in which upper trapezius activation is minimized and middle and lower trapezius activation is maximized by Cools et al 2007. The prone and sidelying positions decrease the upper trap’s activation as a postural muscle. When you stand, the upper trap is more active as its working against gravity. Laying on your stomach or side eliminates the effects of gravity and can decrease excessive activation!

 

Plyometric Serratus Anterior Push-Ups

Scapular muscles play a huge role in controlling and stabilizing shoulder movement. One cannot address the shoulder without first addressing the scapula. The serratus anterior is among the important anterior scapular muscles. Scapular winging (i.e. SICK scapula) is a condition where the medial scapular border moves away from the rib cage. Think of the shoulder blades being close together in a resting position, similar to a bird with its wings closed. Now picture those wings ‘opening up’ when the bird goes flying. When humans move their arms overhead, the shoulder blades should only move away from one another, NOT the ribs. Scapular winging could be caused by an anterior scapular stabilization issue due to a motor control problem or muscular weakness.

In order to improve this movement pattern, you have to perform exercises that INCREASE the recruitment of the anterior scapular stabilizing muscles, specifically the serratus anterior. Here is a plyometric bosu ball push up exercise shown with a regression and progression.

According to Maenhout et al. 2016, this evidence based shoulder exercise increases serratus anterior activity in the backward push off phase GREATER than the landing phase. This is a great exercise for athletes who are returning to sports AND those who are currently playing. Note: these exercises is challenging for me, so I need to practice it more.

 

Dynamic Scapular Stability Drill

Demonstrated here is a dynamic mobility and stability drill for anterior scapular muscles. The important thing to appreciate and recognize is that this movement is different than just moving your arm freely in all directions on the wall. As I do the exercise, I apply a constant isometric force by pressing my hand into the wall as I move the slider. This external cue of ‘push into the wall’ recruits the anterior scapular musculature (eg serratus anterior and pec minor muscles) to be active and provide scapular stability.

Demonstrated here is a dynamic mobility and stability drill for anterior scapular muscles. The important thing to appreciate and recognize is that this movement is different than just moving your arm freely in all directions on the wall. As I do the exercise, I apply a constant isometric force by pressing my hand into the wall as I move the slider. This external cue of ‘push into the wall’ recruits the anterior scapular musculature (eg serratus anterior and pec minor muscles) to be active and provide scapular stability. The particular sequence of scapular movements I demonstrate is as follows:

1) protraction and upward rotation

2) protraction

3) protraction and downward rotation+depression

4) protraction and upward rotation+elevation

In summary, we are working shoulder blade mobility and stability in all directions!

It is important to note that performing closed-chain exercises similar to this (hand on wall) increases activity of the rotator cuff muscles. Increased activity of these muscles increases dynamic stability of the shoulder during movements. Remember, the rotator cuff muscles do not move the shoulder! They originate on the scapulae and insert on the humerus. This anatomical arrangement dictates that the rotator cuffโ€™s specific job is to provide dynamic stability to the glenohumeral joint. It’s what help keeps the humeral head within the glenoid fossa during any movement. Proximal stability at the shoulder will facilitate optimal distal mobility.

 

Bulletproof Shoulder [P]rehab Warm-up

Your warm-up should always incorporate priming your nervous system and target muscles for your specific lifts. This is one of my favorite shoulder warm-ups, with inspiration taken from @drjohnrusin and @thebarbellphysio. Iโ€™ll break down the 3 parts of the warm-up and tell you why you should be incorporating them too:

 

1) Face-Pull: This exercise is a modified row movement. It targets the RHOMBOIDS and more importantly, the MIDDLE TRAPEZIUS to get good activation. Additionally, EMG studies have shown that the face-pull has one of the highest average and peak EMG activities for the posterior AND middle deltoids, too!

2) Shoulder external rotation in a 90/90 position: This exercise achieves concentric, eccentric, and isometric activation throughout. It also induces the exact same shoulder position of any overhead movement like the press or snatch. Strengthening in this position is key for functional carry over into crossfit.

3) Resisted Y-Upward Rotation: This exercise primes your serratus anterior, upper traps, AND lower traps due to the particular angle of the arm in the scapular plane.

BOOM. Now get out there and hit some new [P]Rs performing these evidence based shoulder exercises. Tag a friend or share with someone who needs some shoulder [P]REHAB! Want to make your own exercise playlist featuring these exercises?! Click here to try the PrehabX membership FREE for 10 days

 

Learn More Shoulder ExercisesPrehabX

Click ‘body part’ followed by ‘shoulder’ to learn HUNDREDS more shoulder exercises! Click HERE to get started

 

 

References

  1. Cools AMJ, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692โ€“697.
  2. Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: A systematic review. J Electromyogr Kinesiol. 2015;25(2):371โ€“386.
  3. Maenhout A, Benzoor M, Werin M, Cools A. Scapular muscle activity in a variety of plyometric exercises. J Electromyogr Kinesiol. 2016;27:39โ€“45.
  4. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of Scapular Muscle Balance: Which Exercises to Prescribe? Am J Sports Med. 2007;35(10):1744โ€“1751.

 

23 Comments
  • Bert
    Posted at 16:10h, 27 March Reply

    I already use some of these exercises, but Im still a little skeptic with some considerations, for example, with the premise that you can actively train and contract specifc muscle that is normally dependant on relfexes and reactiions (as the famous “core” stability work). Motor control means miliseconds of muscule activity that runs away from conscious contraction. I just see it as a way for clients to “get it” and as a source of proprioceptive information that could be helpful in some cases of relative “disconnection”. However, I think that represents a little use in a practical and functional manner.
    Regards

    • Dr. Sequoia
      Posted at 14:02h, 08 June Reply

      “Motor control means milliseconds of muscule activity that runs away from conscious contraction.”

      What???? Lol this reply does nothing to add to this article and further confuses potential readers. Anyone reading disregard this above statement. I in no way endorse or even know the original “PREHAB” authors but just had to give my 0.02$

    • Dylan
      Posted at 09:58h, 25 April Reply

      ^^ Typical comment where someone wants to sound articulate but comes off completely confusing. Like the other commenter said, disregard this ego-driven comment.

  • Kirsten Trant
    Posted at 13:11h, 01 April Reply

    Thanks for the Sharapovas! I like those, especially for those people who are really strong through their rotator cuff muscles, but may be lacking tone in through the lower and middle traps. I gave it on Wednesday for a homecare exercise for someone, but recommended they go much easier than the 5 sets you were recommending.

    • Craig Lindell
      Posted at 16:32h, 01 April Reply

      Hey Kirsten, glad you liked the exercise! Glad you were able to modify our recommendations and help your patient.

  • Ruel Fajardo
    Posted at 23:24h, 08 June Reply

    Hey Guys! Thanks for all the exercise updates. I have been using your exercises for shoulders. Where did you bought the Muscle Sense + device?
    Thanks!

    • Michael Lau
      Posted at 11:13h, 09 June Reply

      Hey Ruel,
      Sorry we do not have the exact model because we were using this one in a lab owned by USC. The devices are everywhere on the market though…you should be able to pick one up for less than $100 that is good quality!

  • Cristina Crites
    Posted at 18:40h, 24 July Reply

    Are these good for someone who already has an injured rotator cuff? I had an mri done and it showed inflammation of one of the tendons of the rotator cuff and I believe its turned into frozen shoulder.
    I have done Physical therapy, accupuncture and seen a orthopaedic not sure what to do next.

    • Michael Lau
      Posted at 11:28h, 01 August Reply

      They can be. If you have frozen shoulder, best advice would be to keep using that shoulder as much as it allows. It is a condition that has a timetable and will get better, you have to be patient.

  • Emily Harding
    Posted at 15:55h, 21 October Reply

    Thanks for the excercises! Will these help in the conservative treatment of a labrum (type 2) slap tear?

    • Michael Lau
      Posted at 08:18h, 27 October Reply

      No problem! It’s all going to depend on the patient in front of you…would have to be assessed in person.. sorry! If you need help finding a provider in your local area, let us know!

  • Ashley
    Posted at 13:45h, 22 November Reply

    This is a great article. I am a personal trainer and general nerd who likes to know the hows/whys behind what I do. I’ve been suffering with severe shoulder pain for about 6 weeks that has limited my personal workouts and daily activities. I have read and researched for hours but haven’t found anything worthwhile. Long story short, I realized that some work I do for about 2 hours 5 days a week is causing a constant upper trap activation. I started researching exercises for synergist muscles and ran across this. I’ll be starting some of these tomorrow. I love the science behind it all. Thanks for writing it.

  • Karine Bezuidenhout
    Posted at 00:30h, 05 April Reply

    I’m physiotherapist that works with climbers. I found this article very useful and the exercises are easy to show my my patients. Thanx for the article, the videos made my life much easier!

  • Ryan whited
    Posted at 19:25h, 04 July Reply

    Thanks for the post guys! I am a trainer with nearly 25yrs. of experience. And have been a sponsored athlete for nearly 20yrs. (Climber). After a series of injuries led me to re-examine training and itโ€™s role in the system of care I began using the term prehab 10yrs. ago… Iโ€™m sure I wasnโ€™t the firstโ˜บ๏ธ After all these yrs. my work days as a trainer look very different today than 15 yrs ago. In one session I could be working with someone with a plantar plate tear, then in the next session I could be working with a perfectly healthy climber to emprove performance. I believe that this is what the future of PT should look like (MSK). So I appreciate what you guys are trying to do. While It has been shown that glenohumeral rhythm can be trained and changed its relevance to pain is nil. I would caution against using terms like dysfunction, fixing, etcetera. The musculoskeletal world is rife with fear mongering and misinformation, while I know this wasnโ€™t your intent we should all be cautious about who we might incidentally bias toward a โ€œdiagnosisโ€ . Keep up the good work!

    • Michael Lau
      Posted at 16:57h, 06 July Reply

      Couldn’t agree with you more Ryan! The future of PT is bright and prehab and performance will and should play a large role in MSK health going forward. Better to be proactive than reactive. In regards to your concern, you are 100% correct. This article includes most of our older work, over a year plus old, and we are constantly trying to better ourselves, our language, and the information we disseminate on our platforms. We’ve come a long way over the years and hope that you stick with us as we grow.

  • Peeters
    Posted at 09:58h, 05 July Reply

    Thanks

  • Rui
    Posted at 14:13h, 17 December Reply

    This is great info!
    How would you incorporate some of this exercises in a PPL routine?
    Always before lifting exercises as warm-up? In the days off as pre-hab?

    • Michael Lau
      Posted at 08:15h, 21 December Reply

      most of these i would incorporate in the upper body pull section of your programming. if you are using it strictyl for prehab, do it either on your days off are inbetween leg day sets!

  • Nathaly
    Posted at 12:09h, 29 January Reply

    THESE EXERCISES ARE GREAT, SEEMS TO THOSE WHO LEARNED IN THE COURSE OF HANDLING OF SCAPULAR WAIST INJURIES. YOU ARE GREAT THANK YOU FOR UPLOADING THIS INFORMATION ๐Ÿ™‚
    GREETINGS FROM THE HALF OF THE WORLD ๐Ÿ™‚ ECUADOR

  • Juan Pablo
    Posted at 04:48h, 21 February Reply

    Gracias por la informaciรณn, mucho exito chicos!!

  • Juan Pablo
    Posted at 04:49h, 21 February Reply

    Muchas gracias por los consejos! รฉxito chicos!

  • Nico
    Posted at 02:33h, 28 February Reply

    Hola, me gusta este calentamiento, por ejemplo cuantas repeticiones tendrรญa que hacer? tendria que hacer los tres ejercicios seguidos y con esto seria suficiente para empezar a entrenar? me encantan los videos muchas gracias un saludo.

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