Got shoulder pain? A tight posterior cuff is associated with a handful of shoulder dysfunctions like subacromial impingement syndrome, posterior impingement, anterior instability, etc. And thus, increasing posterior shoulder mobility is part of the treatment protocol for many with shoulder pain. There’s a high probability increasing your posterior shoulder mobility will help, and we’re going to show you some of our favorite posterior shoulder mobility drills that you can perform now to give you some relief!

 

The “Correct” Cross Body Stretch

The cross-body stretch is a fantastic way to target the posterior cuff (infraspinatus and teres minor) but far too often it is done incorrectly! In order to effectively stretch the posterior cuff, you need to keep your scapula stabilized ie your scapula cannot move!

If you pull your arm across your body and your scapula comes with it into horizontal adduction, the only stretch you’re getting is of your mid-scapular muscles like your rhomboids or traps. Furthermore, in this position there’s more of a distraction force on the glenohumeral joint than a true stretch of the posterior cuff – aka not as specific as it can be. They are essentially two completely separate stretches, and if the goal is to increase posterior shoulder mobility, you absolutely must keep your scapula stabilized like in the bottom video.

To perform:

1. First, pull your shoulder blades back. This will keep your scapula in a retracted position.
2. Using your other arm, pull your shoulder across. The key here is maintaining the position of your shoulder blade pulled back the entire time. This is the only way to target the posterior cuff.

Pay attention to where you feel the stretch, as you should feel a “deep stretch” in the back of your shoulder in the highlighted area on the video. If you feel a stretch or anything else not in the back of the shoulder, you’re either doing the stretch incorrectly or abutting other structures in your shoulder due to pathology (ie don’t do the stretch anymore and seek out a physio if you’re in pain).

READ: Evidence Based Shoulder Exercises

 

Closed Chain Posterior Shoulder Mobility

Here is a great way posterior shoulder mobility drills to hit the posterior cuff/capsule, which often gets tight in the dominant arm of overhead athletes. Posterior shoulder mobility deficits often lead to limitations in shoulder internal rotation and horizontal adduction. With cross-body stretching, people will often allow the shoulder to dump forward, defeating the intent of stretching the posterior shoulder region. This exercise is great because it will allow the head of the humerus to stay posterior, which will further increase the stretch. You are essentially giving yourself a posterior glide of the shoulder joint. To progress the stretch, you can turn your hand inward which will now also address internal rotation and horizontal adduction limitations.

Note: Taking up the slack of these muscles initially through horizontal adduction is often more comfortable than internal rotation.

 

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Does your shoulder feel tight or are you dealing with discomfort? Difficulty putting on your shirt or reaching behind your back to loop your belt? The Shoulder [P]Rehab Program is our very own program that will teach you how to maximize your shoulder health for life.

 

Sleeper Stretch vs Horizontal Adduction Stretch For Optimal Posterior Shoulder Mobility?

There are many ways to increase posterior shoulder mobility, and two of the most popular stretches are the side-lying sleeper stretch and the side-lying horizontal adduction stretch. A previous study had shown that the horizontal adduction stretch was more beneficial in restoring internal rotation at the shoulder than the sleeper stretch. However, a newer study by Yamauchi et al 2016 found that both stretches effectively increased shoulder internal rotation and horizontal adduction with no significant differences between groups!

The cool thing about this study though, is that they looked at muscle stiffness of both the infraspinatus and teres minor using ultrasound. Both of these muscles make up what is known as the “posterior cuff.” It is the posterior cuff, in addition to the posterior shoulder capsule, which contributes to deficits in posterior shoulder mobility.

➡️ Interestingly enough, the study found that the sleeper stretch decreased infraspinatus muscle stiffness.

➡️ Whereas the side-lying horizontal adduction stretch decreased teres minor stiffness.

Why is this relevant? For baseball pitchers, the teres minor demonstrates the highest level of EMG activity of all the shoulder muscles during the deceleration phase. Furthermore, at 90 deg of adduction (ie the position of the shoulder during throwing), the teres minor to infraspinatus muscle activity ratio is significantly higher than 0 deg of adduction. Thus, the throwing motion requires higher intensity eccentric contraction of the teres minor than the infraspinatus, which could lead to the teres minor being more fatigued and thus more muscle stiffness after pitching.

The moral of the story, if you’re a baseball player, try the side-lying horizontal adduction instead of the sleeper stretch to stretch your posterior shoulder! Check out The Ultimate Shoulder Warmup!

 

Dealing With Shoulder Pain? Learn How To Test Your Rotator Cuff!

 

Posterior Shoulder Soft Tissue Mobility Drills

The shoulder joint is a menace for a reason, intuitively it doesn’t make sense! The posterior cuff is composed of the posterior glenohumeral joint capsule and the teres minor and infraspinatus. However, when these structures are tight, the ball of the shoulder actually moves away from the shoulder joint. The head of the humerus will actually sit anteriorly, and this disrupts normal shoulder movement ie. arthrokinematics.

LISTEN: SHOULD LABRUM AND BICEPS WITH DR. ALEX WEBER

 

What does this mean? Well, the posterior cuff is a connection between the scapula and the humerus. If this is tight, whenever you reach across your body with your arm, the scapula will also be going for an early ride with the humerus. Think of a tug boat towing another boat with an extremely “tight” and short rope. This is trouble, because the scapula is connected to the clavicle, and excess scapula movement with horizontal adduction of the shoulder can stress a host of shoulder structures including the acromioclavicular joint.

 

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Closing Thoughts

As shown throughout this article, there are various ways to gain mobility at the posterior aspect of the shoulder. Ensure that if you are attempting to work on the mobility solely of the posterior aspect of the shoulder, the scapula is not moving! Be sure to take your time gaining mobility, and as you keep a consistent routine, you will be able to move into more available ranges of motion!

 

Take Control of Your Shoulder Health

To win an NBA championship in this current era it seems at least 3 superstars are needed on the team. Behind these 3 superstars includes the entire support staff that takes care of the day-to-day operations allowing the stars to perform. Sounds like they are using the model of the shoulder! You will learn how to create balance among the support staff which will allow the 3 joints of the shoulder to perform to their superstar abilities!

 

References

1. Marcondes, Freddy B., et al. “Posterior Shoulder Tightness and Rotator Cuff Strength Assessments in Painful Shoulders of Amateur Tennis Players.” Brazilian Journal of Physical Therapy, vol. 17, no. 2, 2013, pp. 185–193., doi:10.1590/s1413-35552012005000079.
2. Wilk, Kevin E., et al. “The Modified Sleeper Stretch and Modified Cross-Body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete.” Journal of Orthopaedic & Sports Physical Therapy, vol. 43, no. 12, 2013, pp. 891–894., doi:10.2519/jospt.2013.4990.
3. Yamauchi, Taishi, et al. “Effects of Two Stretching Methods on Shoulder Range of Motion and Muscle Stiffness in Baseball Players with Posterior Shoulder Tightness: a Randomized Controlled Trial.” Journal of Shoulder and Elbow Surgery, vol. 25, no. 9, 2016, pp. 1395–1403., doi:10.1016/j.jse.2016.04.025.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.