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Episode 58: Alignment Dogma - Shoulders
1.3k Plays1 year ago
Welcome to Season 3 and Episode 59 of the Movement Logic podcast! In this episode, Laurel and Sarah discuss dogmatic beliefs and myths around the shoulders from the yoga, Pilates, and strength training worlds. We also discuss how given the fact that shoulder joint is a “complex” of many bones and joints, it’s much more useful that teachers keep their approach to teaching this area as simple as possible (and stop micro-managing their students shoulders!)
You will learn:
- The bones and joints of the shoulder joint complex
- Mant shoulder “fun facts”
- The directions of movement of the shoulder
- What horizontal abduction and adduction are
- What scapular tilt/winging is and why it’s not a problem
- How scapular movement often mirrors where we are reaching our hand to
- What scapulohumeral rhythm is
- That the shoulder blade’s path across the rib cage is curvilinear.
- Simplifying how we talk about shoulder movement and function to either a push or a pull.
- The relationship between shoulder posture and alignment and shoulder pain and injury
- How it’s hard to think scientifically and very human to think un-scientifically
- Why “shoulders back and down” is often (but not always!) an inefficient and counter-productive way to cue the shoulders
- Why micromanaging shoulder posture doesn’t change posture long term.
- Why “fixing” someone’s alignment in chaturanga doesn’t help them acquire the strength they’d need to build to be able to do chaturanga with optimal alignment
- How scapular dyskinesis and scapular winging are different
- The fine line between using movement to solve movement problems (which is inside of a movement teacher’s scope of practice) and then diagnosing problems for students and prescribing movement to fix it (which is outside of a yoga teacher’s scope of practice.)
- How upper and lower cross syndrome is an outdated (but still very influential) model for explaining posture and offering solutions to that posture.
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Arthroscopic subacromial decompression for subacromial shoulder pain… randomised surgical trial
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Transcript
Podcast Introduction
00:00:02
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts.
Modern Movement and Evidence-Based Practices
00:00:22
Speaker
Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
00:00:41
Speaker
Welcome to season three of the Movement Logic podcast. I'm Laurel Beaversdorf and I'm here with my co-host, Dr. Sarah Court, DPT. We are still in LA. We are. No, I did not move here.
Community and Collaboration
00:00:54
Speaker
We have batch recorded most of the episodes of this season.
00:00:58
Speaker
I would love it if Laurel decided to move here. So if there's anyone out there that feels like they know Laurel enough that they could shoot her like an email or some compelling video footage of why she and her family should move here, I think we would all benefit and we need to get on that. You're really going to need to convince my husband mostly. All right. That might be challenging. Okay. Fair enough. Good luck with that. Fair enough. We have been on a kick where we're reading reviews that people have
00:01:27
Speaker
Generously left for us. This one is particularly generous. Yes discussed This one is from Liz 9 Sorry, how many how many Z's is that at 1 2 3 4 Z's? 9 I don't think it's as long as 9 so what you sound like when you're starting your motorcycle. No, that's like
00:01:53
Speaker
that person has not left us a review yet okay five stars thank you she or he or they write an awesome resource for any kind of movement teacher or person who's interested in maximizing benefits for their movement to the point coherent they don't meander off topic and it's digestible see see what i mean by generous i mean super generous i would say
Podcast Tone and Humor
00:02:22
Speaker
All of those things are true except for the part where it says they don't meander off topic because that part is not true. That's what we do. That's our bread and butter. Meandering off topic is what we're known for. But I think we do make coherent points and I do think it's digestible.
00:02:38
Speaker
Yes, agree. And there's always a little sprinkle of humor in there to keep it light. 100%. Not taking ourselves too seriously. Oh, my God. It's a death of joy. Yeah, no.
Shoulder Alignment and Anatomy
00:02:48
Speaker
And speaking of which, today we're talking about shoulder alignment dogma. We've been doing a few of these. Talk about taking ourselves a little too seriously. The shoulders is an area, well, it's called the shoulder complex. And we're going to get into why the shoulders is referred to as a joint complex, but it's
00:03:05
Speaker
often a place that I find, at least in terms of how the shoulders are cute or what's insisted on, that just can become really terribly over complicated. Definitely. And so we are going to try to keep the shoulder light, funny, and uncomplicated for you. Fantastic. I love it. Let's see if it works. Okay. So we're going to get right into talking about the shoulder
00:03:29
Speaker
and some of the bones and joints that make up this area. So Sarah, do you want to start us off with telling us about the bones and the joints of the shoulder joint complex? Absolutely. And not to humble brag, but I am going to humble brag. At the clinic, I'm sort of known as the shoulder whisperer.
00:03:44
Speaker
Oh, nice. Yeah. My boss calls me the shoulder whisperer. That's amazing. She's like, I don't know. She's like, I don't understand how you understand shoulders that well. And I honestly, there's no reason that I should. There's just something about it where, I don't know if this is how it is for you, Laurel. I mean, here we are, not meandering, but I'm totally meandering. Are there parts of the body that you feel like you really have a
00:04:08
Speaker
Bigger like a better handle on a better grasp of your understanding of the mechanics and things like that than others Like for me hips. I totally understand hips knees Low back. I mean, I'm just starting to name all the parts But like I think like when somebody comes in with an ankle thing That's when I'm like, all right I gotta I gotta think a little harder around the ankle and the foot and all of that kind of stuff and it may be the amount of detail that I have to go into that maybe
00:04:32
Speaker
for a movement professional who's not doing rehab, perhaps doesn't have to quite so much, but that's been my feeling. But I do like shoulders. I find them oddly compelling. And there's often, this is a spoiler, not spoiler, but a lot of the time, the scapula is the part that's screwing the shoulder up. And that's something that a lot of people don't necessarily know. So the shoulder complex, like if we think of the shoulder joint, like what you would consider your shoulder, like you point at it,
00:05:00
Speaker
That spot is made up of three different bones coming together. The humerus is your upper arm bone. And the head of the humerus is the top of it, which is the part that makes your shoulder. And then it meets up with your scapula, with part of the scapula to make the little socket for the humerus to sit in. But it's barely a socket. It's more like if you visualize like a golf tee, that's about as big and as deep as the quote unquote socket is.
00:05:29
Speaker
relative to the the golf ball right the golf ball in this case the head of the humerus is more like a Like a lacrosse not lacrosse ball. That's a bit big but like some something between a golf ball and lacrosse ball It's way bigger. It's not golf ball sized sitting on a golf tee size. It's it's too big for the for the
00:05:50
Speaker
It's not too big for it, but anyway, it doesn't sit in it like a socket. And then the other bone that connects is the collarbone. So those three bones together come to this point that we think of as the shoulder, but there's not a lot of there there in terms of bone, right? So really the job of holding it all together goes to the soft tissue more than anything else. The muscles. Muscles, tendons, ligaments, joint capsule, fascia, yeah.
00:06:17
Speaker
So Sarah did some fun facts or some pelvis trivia in the first episode of this dogma series. I'd like to make a similar contribution with my fun facts. Okay. So I think something that I found really counterintuitive about the shoulder joint complex is where it connects to your torso. Like
00:06:36
Speaker
From the outside, it looks like the arm is just sort of tacked on to the trunk somehow. And then you realize, oh, actually it connects to the shoulder blade, which is kind of mind blowing. But then you go further and you're like, but how does the shoulder blade actually connect to the trunk? And you're like, well, it really kind of doesn't. The shoulder blade connects to the collar bone at the acromioclavicular joint. And then the collar bone finally, finally connects to
00:07:02
Speaker
the top of the breastbone, which is called the manubrium. And so that joint, the sternoclavicular joint, is I think sometimes called the master joint. It's the main... I've never heard that. Yeah, I don't know where I read that. I think it might've been in maybe Joe Musculino's kinesiology book. Okay.
00:07:23
Speaker
Maybe. But that joint, which is an obscure joint that I don't think very many people even know exists, is where your entire upper extremity actually has bony connection via a true joint to the breastbone. Yeah. I mean, the scapula, sometimes people talk about the scapulothoracic joint, quote unquote, which is where the scapula relates to the rib cage.
00:07:49
Speaker
on your back, but it's not technically a joint. It's a moving surface. I've heard it called a functional joint versus an anatomical joint. There's no joint space where there's a capsule. Exactly. The connection is muscular, but it's a place where two bones where movement happens. It's a place where movement happens between bones. That is another way of defining a joint. I think it's fair to call it a
00:08:14
Speaker
a joint, and it's actually really crucial joint to the way that your arm can move. So we're going to be talking a lot about that joint. And then... Can I talk about how your shoulder is actually connected to your pelvis that most people don't understand or think about too much? Absolutely. I mean, we're in fun fact territory right now. Yeah. So fun fact, your lats, which people think of as a back muscle, but is also a shoulder muscle big time, your lats connect all the way down to your thoracodorsal fascia.
Functional Movement and Anatomy
00:08:44
Speaker
or sometimes you'll call it thoracolumbar fascia, which connects to your spine and your pelvis.
00:08:49
Speaker
because back in the day and then also now, people climb trees, right? Or like back when we were monkeys or monkeys still climb trees, right? So you need something that connects your shoulder to your pelvis in order to pull your body up a tree or any other climbing surface that you're climbing on. So I think a lot about shoulder and pelvis connection, maybe more than your average bear does. Nice. All right, so let's talk about the movements available at the glenohumeral joint.
00:09:17
Speaker
So first of all, the glenohumeral joint, right, where the arm bone and the scapula or the shoulder blade meet, is if you put your fingers at the tip of your shoulder top, right, where you would like have the angel and the devil sitting, like walk way out to the tip, that precipice, and swing your arm around. And you'll probably feel the head of your humerus moving somewhat underneath your finger. But then if you walk your fingers toward your neck and swing your arm around, you're probably not going to feel
00:09:46
Speaker
that at the humerus swinging around as much because now you're on top of your shoulder blade and you're probably close to a joint where your shoulder blade and your collarbone meet, which is the acromioclavicular joint. We're not really going to be talking about movement happening at the acromioclavicular joint because it's a super small, subtle, and really nothing you could actually control or cue that much. We are going to talk a lot about movement available at the glenohumeral joint and then that functional joint, the scapulothoracic joint.
00:10:14
Speaker
There's different terminology used for how the arm moves at the shoulder blade versus how the shoulder blade moves at the rib cage. So we're going to go through all these terms now. So basically the arm can move or swing forward and back. So forward is flexion. And that's really counterintuitive, Sarah, right? Like, did you have to re kind of program your brain to say flexion when the arms were
00:10:34
Speaker
moving forward and all the way up over your head because a lot of people will cue in yoga, for example, like extend your arms up toward the ceiling. Yes, I definitely did. I mean, it was there's been it was a while ago. So my brain is now just programmed that way. But I do remember having to think about it like, OK, that is flexion. And the other way is extension. Yes, exactly. So that's in the sagittal plane. Then the arm can abduct, which is really just another I like to think of it like another route to going overhead. It's like taking a different road.
00:11:02
Speaker
to get to the store, right? So you can take your arms out away from the midline and up overhead, which is abduction. And then back down to alongside your body is adduction in the chronal plane. All these movements are mirrored by your hips. So if you understand hip,
00:11:19
Speaker
direction of movement, you pretty much have a really good handle on shoulder direction of movement. So then just like the hips, your arms can rotate internally and externally. Okay, so there's a couple of directions of movement that don't often get named, but I think are really important to understand, especially further into this episode when we start talking about ways of simplifying shoulder movement and like really codifying like how the arm and the shoulder blade are coordinating together to create force or to create movement.
00:11:47
Speaker
And so the ones that I didn't learn about until I started studying strength training actually and studying for the CSCS exam was horizontal abduction and adduction. So horizontal abduction and adduction, I like to think of the horizontal part as if you reach your arms, if you're standing upright, you reach your arms straight out in front of you like you're doing a standing plank.
00:12:08
Speaker
Your arms are then horizontal to the floor, but actually relates more to the horizontal plane of movement, which is if you were to divide the body into a top and bottom half.
00:12:20
Speaker
you would have that horizontal plane at which you would be able to then really see rotation, right? But horizontal abduction and adduction happens in that plane, but it's not necessarily pure rotation. If you take your arms forward like you're in a standing plank, and then you open your arms out to the side, to the shape of a T or a cross, that's called horizontal abduction. So again, you're taking your arms away from the midline of the body, out to the side, and then when you close your arms together,
00:12:50
Speaker
This is horizontal adduction. So in yoga, you would see horizontal abduction happening if you're going from plank to side plank, right? And that's a closed chain example. In plank, your hands are fixed to the floor, so the upper extremity is through the shoulder's closed chain. And then you take from that position, relatively speaking of horizontal adduction, you take and turn your torso open to face the side and your other arm up toward the ceiling, right? And you've just horizontally
00:13:18
Speaker
A, B, ducted your shoulders. In strength training, we do horizontal abduction when we do the bench press, right? So you're lying on your back, now you're in a supine plank, and you start to lower the bar down towards your chest. Your arms are going to move from that more midline kind of
00:13:39
Speaker
close to the midline position, out directly to the side, and even back behind you, right? So horizontal abduction and adduction are also hip movements, right? When you go from warrior three to half moon pose, this is horizontal abduction.
00:13:54
Speaker
Um, when you turn from like a lunge facing the front of your mat and then you open out to warrior two, that would be horizontal abduction of your front hip. So it's happening all the time. We just, in my teacher training and like when, even when I studied kinesiology, necessarily learn these terms, but they're, they're actually used a lot in strength training.
00:14:13
Speaker
And there's also, can I jump in with some details about it? So this movement of this horizontal abduction, adduction shows up quite a bit more in our kind of activities of daily living. Like if you think about, you get in your car and then you reach your arm across your body to grab the seat belt to then take it and put it into the whatever the thing is called that it clicks into.
00:14:35
Speaker
that's a horizontal abduction-adduction movement, right? Or if you were going to do that thing where you hold the bottom of your shirt and then you pull it up and off overhead, there's a component of that horizontal adduction into abduction in that. A lot of the way that we in rehab work on shoulder movement is with what are called the D1 and D2 shoulder patterns, which are these combined movements of adduction or abduction
00:15:00
Speaker
flexion or extension and internal or external rotation in patterns that we see typically, like so that the movement of taking your shirt off, the movement of grabbing your seatbelt
00:15:12
Speaker
the movement of, you know, I can't think of any others, but they replicate the way we move in real life, which is not one plane at a time, obviously. Yeah, totally, totally. Yeah, so horizontal abduction, I've heard described as a combination of abduction and rotation. Well, it actually, technically, it depends because you could, I could take my arm and horizontally abduct it
00:15:35
Speaker
with like my palm faced up and then the supination of my forearm and then the external rotation of my palm. So that's abduction with external rotation, but I could also choose to switch it palm down. And now my upper arm is either neutral or internally rotated and I can bring it out to the side. So it depends on what you're doing. Where I've heard that example given is when you're going from warrior three to half moon pose.
00:15:57
Speaker
the hip right so the standing hip in warrior three is neutral rotation and it's basically it's it's flexed right and then you you open up to half moon pose and now suddenly that standing hip is externally rotated and Abducted right but it's horizontally abducted. It's it's confusing but it's not confusing because well and it basically when you learn to
00:16:20
Speaker
recognize it in daily life or in your yoga practice, you're like, oh, actually, it's actually much simpler to just call that horizontal abduction. Absolutely. And that movement, that example in the hip, the part of the reason why it becomes external rotation is because the foot is fixed. Like if you were doing that movement with your leg, not closed chain, you would have an option of whether you're turning your foot out or turning it in, right?
00:16:40
Speaker
They end up just being all of these, you know, you can go crazy trying to like pick out every tiny little piece of like, well, is that there's a little bit of that horizontal adduction, but then now there's some flexion, you know, you can really go mental. So similar to the pelvis episode, we're getting into territory where this is not great podcasting material. What are you talking about? I think it's fascinating. People are fascinated by listening to us talk about something and trying to visualize it in their head.
00:17:04
Speaker
Isn't that what all great podcasting is? Very difficult to imagine. She's confident, folks. I'll give her that. So, circumduction is another like, I don't know if we call it a direction of movement. It's a way the shoulder can move basically if you do shoulder circles, right? So, that's circumduction. It's a combination of all of those directions of movement that we named. And part of why it's so easy to do circumduction in the shoulder is because that glenohumeral joint is so tiny, right? That little golf tee head.
00:17:33
Speaker
is so little that there's not a bunch of bones in the way. So you have tons of room to circle your arms around. Yeah. And that's something we should say too, like the shoulder is the most mobile joint of the body because of that's lack of bony stopping points really. Right. And then there's scapular tilt, which I love talking about scapular tilt because I mean, it's really hard to see, let alone talk about on a podcast,
Scapular Dynamics and Importance
00:17:58
Speaker
but
00:17:58
Speaker
If you remember back to the episode on pelvic tilt, where I mentioned that a good way to remember how a body part that's kind of buried in the trunk blob moves, right? It's like to just remember that when the top of the structure moves forward, it's anterior tilt. And when the bottom of the structure moves forward, it's posterior tilt.
00:18:22
Speaker
And or when the top of the structure moves back, it's posterior tilt. When the bottom of the structure moves forward, it's posterior tilt. And if you're fluent in pelvic direction of movement language, you can easily visualize that when the pelvis spills forward, it's anterior tilt. And back, it's posterior tilt. Well, you know what? You can apply this same rationale to the shoulder blade and the way the shoulder blade can tilt.
00:18:46
Speaker
So the shoulder blade, the top of the shoulder blade, the shoulder is kind of a triangle, right? So the top of the shoulder blade is kind of one side of the triangle and the bottom tip of the shoulder blade is like that.
00:18:57
Speaker
kind of apex of the triangle, right? So the apex is pointing down. When the top of the shoulder blade tilts back and the tip of the shoulder blade pushes toward the rib cage, this is posterior tilt of the scapula. And so it's really what it's doing is it's taking the whole socket of the shoulder blade and moving it further back, right? And then when the opposite happens, you see the wing tips or the chicken wings of the shoulder blades kind of winging off the back.
00:19:25
Speaker
And the top of the shoulder blade is coming forward and you might also have some associated forward shoulder positioning with that, which is often like demonized and won't get into that. But like that's, that's an anterior tilt of the scapula. And so people maybe don't realize this, but like scapular tilt is a really good thing. It's a really good thing that your shoulder blades can tilt. I think a lot of times scapular tilt is held up as this thing that we just, we should, we should like, Oh, Oh no, your, your scapula are winging your back, right?
00:19:53
Speaker
And so the only good way that the scapula tilt, according to many, is in that posterior tilt direction. And it's just not the case. Because why is it good that the scapula can tilt, Sarah? What do you think? Well, that movement of tilting is
00:20:09
Speaker
It's three dimensional in the sense of, if you imagine like what the scapula is doing is it's, it's either kind of riding up and over the top of your shoulder, right? Or it's riding back and down. And we have to think about that in terms of what it does to all of the bones.
00:20:27
Speaker
Around it and I actually have I'll see if I can add this video clip somewhere But I have this really cool clip of just the bones of the shoulder moving through all of their movements And it's so cool to watch because you really see how much like forwards and backwards movement happens around the shoulder complex Which we tend to think of like it's just your arm It's going up and down forwards and backwards side to side in and out whatever but there's a ton of anterior posterior movement and all of that is what allows for
00:20:56
Speaker
strength and stability in all of these positions like a plank or like a hang, right? Or all of these things where the arm is in a different position in relation to whatever it's... The rib cage. Yeah, but in relation to gravity and space. Right. And the rest of the... So the collarbone also moves a ton. The clavicle moves a huge amount when your arm goes overhead, right? Or it should.
00:21:17
Speaker
So all of these other bones are there to help create that strength and stability. And also they, the movement of the shoulder blade keeps the muscles in their most optimal strength range as well. So that it gives you just like the best position for your shoulder for things like a pull up or a push up or all that kind of stuff. Yeah. I mean, ultimately your shoulder blade is the root of your hand, right? So wherever you want to be able to reach your hand, which I mean, arguably I think some, some evolutionary,
00:21:47
Speaker
biologists that I read a book by camera. I think it was like Daniel Lieberman maybe made the case for the fact that our hands are actually responsible.
00:21:57
Speaker
Or a lot of times the reason people make the case for opposable thumbs being one of the explanations for the development of the human brain and how freaking smart people are, like relative to the other mammals on the planet, is that we were able to use our hands to craft tools to learn more about our environment in order to craft more sophisticated tools. And so our hands were really
00:22:21
Speaker
our window into learning about learning about how to keep learning, right? Creating tools to be able to keep learning and exploring. So if our scapula is able to move more,
00:22:33
Speaker
in this bonus kind of tilt way, it just means we're able to put our hand in more places. Because your scapula can do the winging thing that everyone likes to demonize, which is what, Sarah, Andrew? Well, it depends, because sometimes it's just the medial border of it, you know, lifting off of your ribcage. We've simplified a vastly simplified winging because there's a bunch of terminology that gets used around it. But because your shoulder blade can pop off your ribcage somewhat, you're able then to take your hand
00:23:03
Speaker
behind your back and up your back, right? So that might be useful. Totally. What's on my back right now? Let's get it off. Right. Get it off me. Well, and for people who have cats or dogs, one of my favorite things is go palpate your cat or dog's scapula. Their scapula are vertical, basically.
00:23:20
Speaker
I've heard.
00:23:37
Speaker
floating bone and i've heard people describe the shoulder blade as a modified sesamoid bone which we haven't gotten into the types of bones but the shoulder blade is either a flat bone or an irregular bone depending on who you ask like the femur is a long bone and the humerus is a long bone that makes sense but it's an oddly shaped bone but i actually really like
00:23:57
Speaker
the classification of it as a modified sesamoid bone because it floats and slides around like the kneecap. Not all sesamoid bones slide around that much, but I like that description because it gives, in my mind, a more accurate idea of what the role of the shoulder blade is, which is to float around on your ribcage
00:24:17
Speaker
I've also heard it described as a hockey puck, like an air hockey puck. It floats around on your rib cage. And what that is essentially doing is positioning the socket in different places relative to your rib cage. So to Sarah's point, the shoulder blade can move in all these different ways. And what's happening then is that the socket is being oriented differently relative to the rib cage, relative to where your hand is trying to go. And so just prioritizing, I think in our mind, this idea that the shoulder blade should move.
00:24:46
Speaker
is important and we're going to get into why. And that it's capable of moving and that it needs to be able to move and be in these places for you to then be able to put your hand where you want to put your hand or exert force on an object the way you want to do that. All right. Now, since we're talking about how important shoulder blade movement is for where you can put your hands, can you tell us about scapulohumeral rhythm with just keeping it as please God, keep it simple?
00:25:16
Speaker
I'll do my best. It's actually not that complicated. No, it's not. So if you think about degrees on your protractor from math class, right? Oh, it's already way too complicated. OK. But anyway, if you imagine your arm down by your side is 0 degrees.
00:25:32
Speaker
and your arm directly overhead is 180 degrees. That I can get on board with. That makes sense, right? Yes. Okay. So your shoulder, generally speaking, unless there's reasons why not, a healthy shoulder should be able to go directly overhead, right, to 180 degrees. Now, the movement at your glenohumeral joint, so the movement of your arm bone sitting on that little tiny thing inside your shoulder,
00:25:56
Speaker
For most people, like if you isolated just that movement, you get roughly 120 degrees. So if you didn't have a scapula, you would only ever be able to lift your arm 120 degrees, which is like a bit above midline. To get your arm the rest of the way up, the scapula does 60 degrees of movement, right? And so that adds up to our 180.
00:26:20
Speaker
You don't do 120 degrees with your arm and then stop, and then your scapula does its 60. Those two things are blended. When you start to lift your arm up in any direction, and this is something else that I wanted to talk about, like when we describe movement of the arm, we talk about like directly forward is flexion.
00:26:39
Speaker
directly out to the side is abduction, but any forward movement between flexion and abduction, right? So there's 90 degrees of possible places apart from straightforward that you can go. Anytime you're lifting your arm forwards at all, the scapula starts moving pretty quickly. Like even within like 15 to 20 degrees, the scapula has already started to do its 60 degrees worth of movement. And so together,
00:27:06
Speaker
they add up to 180 and take your arm overhead. And so that's what's called scapulohumeral rhythm, is the way that the scapula assists the arm to complete that overhead movement. And this is why I so often see issues for people where they're having issues or pain in their shoulder, in and around the glenohumeral joint.
00:27:24
Speaker
A lot of the time it's because the scapula is not moving enough and it's getting in the way and it's become stuck and it you know it has so many muscles attached to it or that like lie over it things like that that any amount of like you know tension stickiness all of the things that happen to muscles when they don't move a lot can inhibit your shoulder movement. Yeah and so when when your arm is moving into an overhead position
00:27:51
Speaker
via whatever route you decide to take. Flexion through the sagittal plane, abduction or something in between. The shoulder blade triangle, remember the apex is pointing down, is going to rotate on your back. So this is akin to, I would think of like if you were looking at someone's back and you put a dot right in the center of their shoulder blade and you could think of that as being sort of the axis of rotation.
00:28:15
Speaker
the shoulder blade spins like a pinwheel almost around that, that axis of rotation. And so the whole shoulder blade orients itself differently relative to the rib cage. And ultimately the important part about that is that the socket of the shoulder, which is the glenohumeral joint of the complex, orients from a more sideways, slightly forward facing position to a more upward
00:28:41
Speaker
facing position, which allows then the head of your humorous to stay within that golf tee, right? So scapular humoral rhythm though, Sarah, is it something that we need to control and like think about and like
00:28:55
Speaker
actively create. Well, you can't. Thank you. So don't worry about it. Exactly. But I mean, don't worry about it unless you're having shoulder pain and then maybe see what your shoulder blade's up to. Right. But your scapula, so that movement of rotation is called, the movement is called upward rotation. Yes. When it goes up, when your arm comes back down, or when your arm goes behind you, that is downward rotation.
00:29:19
Speaker
Those movements are coupled with shoulder flexion, shoulder abduction, like all of those things. So you can't tell your body, upwardly rotate my scapula, but you can tell your body, reach my arm overhead and the scapula will hopefully go along with. A lot of the time when I'm doing rehab with people, I'll have them doing active movement of their arm.
00:29:38
Speaker
I'm behind them manually assisting the shoulder blade to go the amount that it's supposed to be going right so I'm back there kind of fiddling around with and controlling that part and they're controlling the part that they can that everybody can which is the movement of the arm yeah cool yeah so this can get really complicated and we haven't even really talked about the ways that the shoulder blades can move so
00:29:59
Speaker
I mean, I did mention tilting of the shoulder blade, but actually I didn't mention the other main movements. So maybe we should back up, right? So the shoulder blades can slide up your back and down your back, elevate and depress. And then the shoulder blades can slide around the rib cage toward the front of the rib cage, which is called protraction. And then they can slide back behind the rib cage toward the spine, which is retraction. And a nice image for that I've heard is like elevator doors, right? So the spine is like the center of the entryway into the elevator.
00:30:28
Speaker
And as the shoulder blades slide apart, that's opening the elevator doors. And when they slide toward the spine, it's closing the elevator doors. It's not so linear, like left, right. So because the thing about the rib cage is that it is curved, okay? And so the motion of the shoulder blade is always also curvilinear. It's not linear, it's curvilinear. Is that a real name? It's a real word. It's not, I mean, I like the name. Maybe I'll name my next pet curvilinear.
00:30:57
Speaker
But it's a word. That's great. I've never heard that word before. It's a line that follows a curve. Amazing. Curve-a-linear. Fantastic. I mean, every time you walk on planet Earth, you're walking a curve-a-linear path. It's true. It's true. I really like that image of the elevator doors opening and closing because, yes, it's not doing a straight movement. But if you're working on your retraction or protraction, you don't need to worry about the curve. The curve is happening. Yeah, the curve is there. You're just thinking together and apart. Exactly. I love it. I'm stealing that. Great. Good.
00:31:26
Speaker
We don't need to get lost in the weeds, though. No, we don't. While moving our shoulders, what every little detail of every little bone is doing. We haven't even talked about the collar bone, and we're not going to. Oh, but I love it so much. OK, do you want to? The only thing I want to say is please, go ahead. OK. Laura's like, we're not going to talk about it. I'm like, but I want to. And she's got a look on her face of like, fine. Maybe I'll edit this out.
00:31:54
Speaker
But this is because, you know when you have favorite things? One of my favorite movements that happens in the human body, and again, this is not something that you're controlling. I just think it's amusing. So your collarbone, that clavicle that is that long, it feels like it's a big straight bone, but it's actually kind of S-shaped along that length.
00:32:14
Speaker
When you raise your arm overhead, it rolls backwards, which I adore. I don't know why. But it makes me think of, you know those machines that keep hot dogs warm in like the 7-Eleven, and it's just like it's making the hot dogs like rotate in space? Do you know what I'm talking about? That's what I think of. I think if you recall, I'm like a rotating hot dog, just moving through space, being controlled by other things, and having no idea what's going on. Nice.
00:32:39
Speaker
You know, I've always loved hot dogs, but when I was a yoga teacher, I was afraid to admit it. Oh, yeah, you're not supposed to. I'm still a yoga teacher, but I've evolved. Oh, good. I love hot dogs.
00:32:50
Speaker
If given a choice between a burger and a hot dog. Hot dog, 10 out of 10 times. Interesting. Oh, I'm the exact opposite. I'm hamburger all the way. Although it has to be a cheeseburger. I don't like a hamburger without cheese. But yeah, no, I would 100% hamburger. Listeners, weigh in. When you write a review, tell us if you like hamburgers or hot dogs better. Yes, thank you. We're going to publish it as research. Oh, and then we're going to over extrapolate to go like the people who eat the hot dogs.
Humor and Personal Preferences
00:33:18
Speaker
clearly are the most intelligent. Oh, are they? I was going to say, have shoulders that have pain. People who are the least health conscious are also the most intelligent. Just kidding. Okay. I just spat up my coffee. Yeah. All right. Throwing up my nose. Oh, Sarah.
00:33:42
Speaker
It actually went up your soft palate? Yes, it did. Okay. Should we stop and describe the pathway of the coffee? Yeah. Into my nasal cavity? And how does it relate to the shoulder? Exactly. I mean, you could draw a line, I'm sure.
Mechanics of Pushing and Pulling
00:33:56
Speaker
A curvy linear line? Curvy linear? Curvy linear. Okay, whatever you want, Sarah. Just call it what you want. We could get really super lost in the weeds. So because we've named like eight ways the shoulder blades move.
00:34:10
Speaker
and like nine ways that the arm moves. I mean, I'm not lost personally because I deal with this every day. But if I was listening to this, I might be like, when are they going to stop naming body parts? But would you maybe be a little annoyed if like someone tried to cue every single thing to you in a moving class? Oh, 100%. And have you ever been at a point in your career where you tried to cue every single thing? Oh, also 100%. Yes. So I guess what we're going to say now is like,
00:34:36
Speaker
It seems complicated. It is the shoulder joint complex. There's a reason it's called that, right? But it doesn't have to be cued in a complicated way at all. And I'm going to give you a really simple way to codify the way that the shoulder functions, which is that the shoulder is doing usually one of two things. It's either pushing or pulling, right? Nice.
00:34:58
Speaker
When we think about the way the shoulder blades tend to move in a push versus a pull, we're going to see a pattern. When we think about the way the shoulder blades and the arm tend to move in a pull, we tend to see a pattern. Now, here's where I'm going to also bring in that terminology of horizontal abduction and abduction, because in strength training, there tend to be two main ways
00:35:25
Speaker
And there's obviously way more ways than this, but like there's two main ways that we either push or pull. There's a vertical push and a horizontal push. Okay. So vertical push would be like strict presses, right? Taking a barbell and pressing it straight over your head in a vertical relationship to the floor, right? If we're standing and then a horizontal push is like the bench press, right? So there's that horizontal abduction, adduction movement again.
00:35:54
Speaker
Same thing with a pull, right? So when we row, we're doing a horizontal pull. A row is really just working the opposite musculature of a bench press, right? And then the vertical pull would be the pull up, okay? So when we do a push, it generally tends to be that
00:36:15
Speaker
the shoulder is either horizontally adducting to push something away from the body, or it's abducting or flexing to push something away from the body. And the shoulder blades have a corresponding movement with that. Typically, there's going to be some upward rotation if it's a vertical push. There's going to be some protraction most likely if it's a horizontal push.
00:36:38
Speaker
Then the pull is the opposite, right? So when we do a horizontal pull, it's probably the case that the arms are going to horizontally abduct to pull the object toward our body if it's a row, say. And the shoulder blades are probably going to move toward the spine, the elevator doors are going to close, right? Retract. With the vertical pull, the shoulder blades are going to downwardly rotate, right?
00:37:02
Speaker
the arms are going to move toward a position of extension, right? And so we don't need to cue these things happening. What we need to do is get better at cueing, pushing, and pulling, and potentially relying on more than just verbal cues to do it, right? So we have a whole episode on actually a three-part series, kind of like the Dogma series this season, last seasons in season two.
00:37:26
Speaker
on queuing, so definitely check those episodes out. All right, so let's talk about some alignment dogma now. Fantastic. Like gone through... There's so freaking much. So much about the shoulder. So much. Oh man. So alignment is being used interchangeably in this series of podcast episodes in this season with posture and also movement quality.
00:37:50
Speaker
Sarah, can you reiterate for us, remind us, what is the established scientific relationship between alignment, posture, movement quality, and pain?
00:38:02
Speaker
It's really easy. There is none. Great. Thank you. Moving on. Well, this is kind of review. Even though we just talked about this yesterday technically. We're batch recording.
Posture and Pain Misconceptions
00:38:12
Speaker
This is actually months later. So not only has science not found a relationship, which we could call a correlation between posture and pain slash injury, obviously if there's no correlation, there's also no causation. So we can't say that.
00:38:29
Speaker
tilted or winging scapula causes shoulder pain, right? And we also can't say that it's even related to shoulder pain. There's no relationship there. I mean, here's the thing, and this is also like, the more bodies you see, right? This is the thing, the more bodies you see, the more variation you see that is totally normal, you'll see something like
00:38:50
Speaker
Person with a very like when we're talking about spine dogma and how some people do not have large curves in their spine They don't have a big lord osis key foot kyphosis relationship some of those spines are very just vertical which is totally normal
00:39:05
Speaker
And their rib cage correspondingly is not very rounded, but then perhaps their scapula are still rounded as if they would be meeting up with a rounded rib cage. So then that person's scapula are always winging, always. There's nothing they can do about it, right? But it's not necessarily a pain causing issue.
00:39:25
Speaker
Or an alignment issue right it's just this is their anatomy. I think you started to say like when you've looked at a lot of bodies or you've seen a lot of people. You realize that human beings express posture in a wide variety of ways but someone else might actually.
00:39:45
Speaker
Complete that sentence by saying when you see a lot of bodies you realize how fucked up everyone's posture is, right? Because it depends on what you think you're there to do, right? So if you think you're there to make everybody look the same You're gonna see a bunch of bodies and go like what a mess glad I'm here, right? Good thing they came to class today. Good thing good Yeah, I'm gonna be you know, easily employed for life, right? I'm gonna get the wing gone I got all these people all these messes to clean up right right or you can finish the sentence like Sarah did which is that
00:40:15
Speaker
Everyone's different. There's nothing you need to do about that. What you need to do is come to terms with the fact that everyone is different. Also, it's a change in your focus. Instead of your focus being what it looks like, which is where there's going to be all of this variety that is totally normal, that is totally functional, what you want to look at instead is what is the
00:40:40
Speaker
I mean, I think of movement quality differently in alignment. I think of movement quality like, do they have full range of motion? Do they have strength at that end range of motion? But these are all just like, we could banter about terms for a while and whatever we want to call something. But I would call that capacity. OK, sure. Rather than the appearance.
00:40:58
Speaker
What's way more useful to start to and way more sophisticated is if you start looking at their capacity. Can that person with scapula that looks crazy to you still get their arm overhead without pain or hold a weight overhead or hang or do a bench press or a row? And if the answer is yes, then there's nothing for you to fix. Yeah, I always remember like just how captivatingly beautiful ballet dancers are to watch move and then also how much pain they're in.
00:41:27
Speaker
And to go like maybe movement quality doesn't predict like if someone has excellent, captivating, magical movement quality.
00:41:37
Speaker
It doesn't necessarily mean they don't have pain. Sure. And there's so many, I mean, ballet and specifically, I could go on for hours about, because that's how I trained originally when I was a little kid. But if you think of Swan Lake and the ballerinas doing those arm waving movements, it's incredibly unnatural to do it the way that looks good, because you have to do external rotation
00:41:59
Speaker
And then also pronate your forearm. And then also go through abduction and adduction and don't let, like, you're forcing your body to do a movement in a really unnatural, weird way because it quote unquote looks nice, right? And so. And they adapt to that. They adapt to that. But they also do it repetitively. Exactly, exactly. Without maybe too much variation. No. And maybe not a whole lot of strength training happening amongst the ballerinas in the ballet
Strength Training in Dance
00:42:24
Speaker
world. Although I just came across this Instagram account
00:42:26
Speaker
Who is a person who is a ballet dancer and he's doing all of this really cool like the way that you know if a plus someone who plays golf You end up working on like their rotation in the other direction because there's all they're always rotating one way for golf This person is doing all of this instead of everything turned out It's like all of this parallel strength training and like it's a very cool like they've actually sort of figured out where are the deficits for dancers and
00:42:49
Speaker
And how do I prehab myself so I don't hurt myself? 100%. Yeah, it's very cool. Yeah, it's definitely changing. But that's new. Strength training is really new. It's catching on, Sarah. I don't know if you've noticed. It is. It is. It's a good thing. Yeah. All right. So we are going to talk about then some of this alignment dogma that, despite what people might think, it's informing. It's actually maybe getting in the way of you being the most helpful
00:43:16
Speaker
influence like teacher or clinician that you could possibly be. And we might also talk about why it's easier for people with human minds to latch onto dogma. As opposed to people with dog minds to latch onto human. As opposed to. Scientific. Suspending disbelief.
00:43:41
Speaker
in terms of what conventional wisdom has repeatedly told you is happening in favor of recognizing what large bodies of evidence are suggesting. In other words, it's hard to think scientifically and it's much easier to think like a human being, which is really not a very scientific way to think. No. I hate to tell you. We've been incredibly evolutionarily successful.
00:44:03
Speaker
To our credit it's working we've been okay we've managed to keep ourselves alive as a species right very very well but i do think that we would have a much better chance of surviving. On this planet as a population.
00:44:19
Speaker
If we became more scientifically literate. I was about to say, is this turning into a podcast about climate change? It might as well. I mean, ultimately, I can't believe we're not talking about climate change. Like why are not more people talking about climate change? But that's neither here nor there. OK, I'm going to get super bummed out. I know we can't. We've got to move on. It's the worst. It's the worst. So we are going to talk a little bit about the counterintuitive-ness that we may need to be willfully stepping into to be able to think scientifically
00:44:48
Speaker
because oftentimes scientific evidence flies in the face of conventional wisdom. All right. Also, we're gonna be engaging in some inquiry here. So rather than making bold declarative statements about like, oh, that's nonsense, that belief that people have above their shoulders is total crap. Let's just move on and forget about it now that we've thrown it in the garbage. We're actually gonna take a couple of questions and put some of this dogma to the test of inquiry, right? To see if, you know, actually our,
00:45:17
Speaker
Is there a valid goal here? Does it sometimes achieve that goal? We're going to give the benefit of the doubt to the idea. I think when we do that, when we give the benefit of the doubt to somebody's idea that we might kind of knee jerk want to reject out of hand, we are also thinking more scientifically. Absolutely.
00:45:39
Speaker
Absolutely. So we're going to ask five questions.
Challenging Alignment Dogma
00:45:43
Speaker
One is, what is the goal that this alignment dogma that we are calling it dogma, but what is it actually trying to fix with total benefit of the doubt? Does it achieve that goal? Does it interfere with it? Question number three, why or why not? Question number four is, could it still be helpful for some people some of the time? Question number five is, if so, who and under what circumstance? So we're going to take hopefully a more nuanced look at some of this stuff.
00:46:08
Speaker
to see if it has maybe not universal value, but maybe some special case value. Okay. So let's start with the low hanging fruit. The low down, shoulders back and down, low hanging fruit, Sarah. Because I'm going to ask you this one because I just want to see you get all worked up. I mean, I'm already covering my face with my hands, so I don't know how much more work I can get, but shoulders back and down is a nightmare.
00:46:37
Speaker
Yeah, so it I think it's changing it's getting better but I still occasionally go to a group fitness class where there's a lot of Insistence that everyone keeps their shoulders back and down and like every single activity whether it's a pull a push horizontal But if someone's just standing there, I mean it can be rampant and I think it's
00:46:57
Speaker
I think the message is spreading that the shoulder blades do not always need to be back and down, but I don't think it's totally hit every single person. Definitely in the yoga and Pilates world, it's still a very common cue. Yeah. Okay, so could you just unpack for us for a moment? What are the two directions of motion that we're talking about here? When people say shoulders back and down, what bone are they actually speaking to? Well, they're talking about the scapula. Right, and back. Yeah.
00:47:23
Speaker
What is that? Back is retraction, so towards the spine. And down? Down is depression, so away from your ears. Okay, so if you're telling someone to keep their shoulders back and down while they're taking their arms around or lifting a weight overhead or whatever it is, you're basically saying don't move your shoulder blades. Yes. Keep them back and down. Okay.
00:47:43
Speaker
I hear this a lot when the arms, especially when the arms need to go up, which is really problematic. Yes, because you're essentially asking for the two opposite directions that the shoulder blades are supposed to be going in in order to take your arm overhead. So if we're talking mere moments ago, we were talking about that scapula humoral rhythm. And the scapula has to do upward rotation, which is a combination movement of some protraction, but there's also some elevation happening as well.
00:48:15
Speaker
This happens to me. I turn into like, because I get so irritated that people still think it's the right place. Well, it's not that it's the wrong place always, but it's not the right place always. And that's the belief is that this is the right place always in every situation. And one of the things I think about, I'm just going to tell a patient story for a second. Patient I had a few years ago.
00:48:39
Speaker
And this is not just in the teacher world. This concept of the shoulders back and down as good posture has absolutely infiltrated gen-pop in a big, big way. Oh, 100%. When people come to me and they're like, I think I have bad posture. I feel like my shoulders need to be further back and away from my ears and in my head I'm going, oh god, oh god, oh god.
00:49:01
Speaker
But so I had this patient a few years ago and she was having some low back pain when she came in. Low back pain was her main thing. And as we're doing our eval and we started working with her and everything, I started noticing that she was just really obsessively with everything doing shoulders back and down. And I asked her about it and she was like, oh, this is just where I thought my shoulder blades were supposed to be all the time.
00:49:25
Speaker
And I said, how does it feel to do that? She's like, well, it makes my back hurt. I'm like, yeah, no shit. Because you are over activating your retraction. And then that depression, after a certain point, your lats are just working so hard. You told this story in the movement logic shoulders tutorial. Did I? Yes, you did. It was nuts. By the way, it was one of our most
00:49:43
Speaker
Popular tutorials shoulders is way the heck up. It was a yes second to hips. Yes surprise surprise surprising not surprising not surprisingly. Yeah, but so yeah, so so I Said well, what if you stop doing that and that was like 50% of what she came in for was pain associated with this aggressively positioning never moving shoulder blades back and down I Need to go take a breath Okay, so I think this is a great time for us to do the five-step
00:50:13
Speaker
Assessment? Assessment? Sure. It's kind of like doubles as therapy for Sarah right now. We're saving so much money that I would have been spending on therapy around this. Just talking it through on air. Yeah. Thank you. I appreciate it. Just find a podcast. This is a big joke. Definitely get a therapist, everybody out there. Yes. The podcast. Therapy's great. Therapy's amazing. I've been in therapy for years. Yeah. Podcast is not a suitable exchange for going to therapy. God, no. Okay. Question number one.
Social Perceptions of Posture
00:50:40
Speaker
This is going to be hard for you.
00:50:43
Speaker
What is the goal with total benefit of the doubt of keeping the shoulder blades back and down, do you think, in people's minds? Were they trying to fix or avoid or help? I think it's this idea of this quote unquote having good posture. That's a concept that is, again, not just in the yoga Pilates strength world. It's rampant. People are being told all over the place that they have bad posture.
00:51:10
Speaker
that their pain is because of their bad posture, that's why their body hurts, da da da. So I think it's completely misguided, but I think the original goal of it is to have good posture because then we're associating having good posture with not having pain.
00:51:28
Speaker
Okay, there we go. The other thing is people definitely think there's a moral failing that people feel like they have when they have bad posture. Capitalism. Well, people who come into the clinic, let's say they might be coming in because they had a knee surgery or something, but very often they'll be like, oh, my posture's really bad. And I'm like, well, does your back hurt? No, but I just have really bad posture.
00:51:54
Speaker
You know like it's it's like confessional almost right and that makes me crazy for people because I'm like you're just not only you're you've got enough problems we all do right we've got enough stressors walking around giving yourself a hard time about your own posture because you're supposed to be somewhere else just isn't that helpful. It's also not that helpful to be walking around constantly fixing your posture.
00:52:17
Speaker
The posture is determined by your nervous system. It's largely autonomic. It's not something that you have to be thinking about. Just kind of like breathing and also your pelvic floor contracting and relaxing, right? Like we talked about how this is stuff that's really governed by your nervous system and like it depends on neural tone.
00:52:35
Speaker
There are ways to change your posture, but it's not by stretching and strengthening. It's not by fixing. If you want to change your posture, maybe one of the best things you can do is go to therapy, or go on vacation, or sleep better. I had a patient recently who was having a lot of pain all over her body, especially in her neck and shoulders.
00:52:57
Speaker
She would come in and I would do manual work on her. This person's body was extremely tight. Tight is not a scientific word, but I touch a lot of bodies. It was stiff. The tissue itself was so dense and hard to penetrate that I would do ... I'm strong from doing manual on people. I would be doing manual work on her.
00:53:20
Speaker
And like nothing would change. So part of that is that neural tension. And what we sort of discovered interestingly was, because this is something that I started after, after a few weeks of like literally no change. That's when I'm like, okay, there's something bigger going on here that I'm missing because my interventions are not working. So we were, and she was open to this idea, but we were talking about like stress. Okay. Where is your stress coming from? What is in your life? Okay. This is a stressor in that one.
00:53:46
Speaker
And ultimately, what ended up happening was I suggested that she started some therapy. And she did. And a whole bunch of her pain went away. So sometimes the pain in your body has nothing to do with your body. And it's certainly not fixed by shoulders backing down. Yeah. And even if you don't have pain and you're like, I don't like my posture or whatever, posture is not just a
00:54:09
Speaker
biological or biomechanical situation. It's biopsychosocial. We talk a lot about how pain is biopsychosocial and how injury is biopsychosocial. So is just the simplicity of saying someone's posture is this. It's not just the stacking of your bones.
00:54:28
Speaker
It's not just where your shoulders are relative to your rib cage. It is biopsychosocial. And it's not a moral failing. It's not. And that's the social part, right? Because we're taught from a very young age. Stand up straight. Sit up straight. Don't slouch. It's really a signal of obedience or conformity. Totally. My dad used to take his finger and push it right in that spot between my shoulder blades and go, sit up straight. Oof-da. Yes. I mean, he wasn't.
00:54:55
Speaker
He was a little bit joking, but that was the message, was no slouching. All right. If we're looking at this queue of shoulders back and down, which I definitely, I would go to a kettlebell class regularly in New York City when I lived there, and there was a lot of shoulders,
00:55:13
Speaker
Packing, staying fixed on the back, a lot of backing down. Is this while you're swinging? This is when I'm pressing that kettlebell over my head, right? Because, I mean, there's something to be said about not letting your shoulder blade get cranked around on your back while you're doing a kettlebell swing, because that's not a great way to transfer force from the floor up through your hips to your arms, to your hands, to the kettlebell.
00:55:40
Speaker
you do to a certain extent. It needs to move somewhat. In a deadlift, in a swing, wanna keep your shoulder blades.
00:55:49
Speaker
in a narrower range of positions. And you don't need to keep them locked down. But they're not going to be moving around as much as possible. They're not going to be moving around as much as they were if you were just swinging your arm in a circle without a weight attached to it. Absolutely. And the reason for that is we're now dealing with higher forces and transferring force to a heavy object. So the thing is, though, that like Sarah said so well, it's not always the wrong thing to do.
00:56:17
Speaker
but it's definitely not always the right thing to do. So I want to give just a couple of examples where some part of this cue might actually be a good thing to work toward in some strength exercises. For example, the bench press. Okay, the bench press is we are lying on our back, meaning our shoulder blades are in contact with a surface,
Shoulder Mechanics in Exercise
00:56:40
Speaker
right?
00:56:40
Speaker
which is very different than say the bent over row where we are bent forward holding onto a weight with our hands and our shoulder blades are not in contact with a surface in the bench press.
00:56:52
Speaker
especially if you're benching heavy weight, it's a good idea to make your shoulder blades as stable as possible because then you're just going to be able to transfer more force to the bar. So this is why you'll see in a really super exaggerated way if you watch a power lifter bench an obscene amount of weight,
00:57:13
Speaker
You'll see them slide their shoulder blades as far under them as possible, retract their shoulder blades to maximum degree. Then you'll also see them do this gigantic bridge pose because they're basically trying to reduce the range of motion. They have to move the bar through. It's a little bit of a cheat, but it's not technically considered cheating.
00:57:30
Speaker
And so the shoulders back part of a bench press has some validity. Another place where you might hear shoulders down cued is something like a dip, like a tricep dip. So we want to keep the shoulders down to a certain extent so that we're not, as our elbows are bending, our shoulders are not also riding up toward our ears. We're not losing tension in the trunk. A lot of these cues to keep the shoulder blades relatively fixed or immobile on the back and strength training really have
00:58:00
Speaker
largely to do with creating some type of stable base of support, like the bench press, or creating trunk tension. Well, and also for something like that tricep dip.
00:58:11
Speaker
The name of it gives it away. We are focusing on elbow extension for activation of the triceps muscle. Therefore, the shoulder, which is the other place where the tricep attached, needs to be still. More still, I would say. I mean, there's definitely a lot of downward rotation happening at the shoulder. I mean, it's definitely like it's going to wing somewhat. It's going to have to wing somewhat. You're not supposed to. Wing meaning it's tilting anteriorly.
00:58:36
Speaker
But you're not supposed to be pushing yourself up with your back muscles when you're doing your triceps dip as much as you're supposed to be pressing yourself up from your triceps. It's much more of a chest exercise, actually, and much more of a shoulder exercise than a back exercise, I would say, like a deltoid exercise. So yeah, there is a rationale for cueing people to keep their shoulder blades relatively still. But I wanted to contrast the bench press with the bent over row, where a lot of times you'll hear people suggesting that
00:59:03
Speaker
people doing your row should keep their shoulder blades retracted the whole time. And then that's where I'm like, no, that's probably not as functional of a way to strengthen your shoulder girdle through a full range of motion. That's where the shoulder blades are not connected to a surface like I've mentioned. You can let the shoulder blades protract as the bar lowers toward the floor.
00:59:23
Speaker
and then retract as you row that barbell up towards your trunk or any derivation of a row, right? So let the shoulder blade move freely. So this is not just like all cueing of shoulder blades back or all cueing of shoulder blades down.
00:59:38
Speaker
is wrong, right? And there's plenty of opportunities to move the shoulder blades back and down in yoga as well. So I'm thinking of like reverse table, right? In reverse table, our arms are extended. We're pressing our front body up toward the ceiling with the knees bent or straight. And in this case, right, if we let the shoulder blades
00:59:58
Speaker
move up, or if we let the shoulder blades move out, we're probably not going to be able to transfer force very efficiently from the ground to our trunk, which is heavy and we have to lift it up, right? So just keep in mind that there are definitely places and reasons that you would use this cue, but I think it's overused in general. I think people just don't know what to say, so they say that.
01:00:22
Speaker
Well, I think the big thing that people learned in their teacher training was shoulders backing down, right? And I mean, we're going to get into this with like the overhead arm position because that's another one that makes me nuts, but like...
01:00:34
Speaker
Some of it, again, is an aesthetic, the shoulders back and down. 100%. Make your neck longer. Exactly. Have a beautiful carriage or whatever. I'm sure ballet dancers, it looks like they are just perpetually trying to keep their shoulders back and down almost the whole time.
Ballet and Functional Movement
01:00:52
Speaker
There's maybe a performance goal to it that has more to do with aesthetics in the dance world.
01:00:56
Speaker
I'm not going to make a judgment call on that because that is what it is. Those people are being paid to do that, and it's like, fine. But as teachers, we're instilling in our students' minds that their shoulders always need to be back and down. I think we're causing more problems. Definitely. If you're not a ballerina, your shoulders don't always need to be back and down.
01:01:15
Speaker
I'm sorry, I just I'm really entertained when you start talking about this because you get again you get like really worked up about it But like can you speak to the cube broaden across your collar bones? That's the sound my soul makes
01:01:35
Speaker
when I have to talk about broadening your collarbones. Okay, I have said that cue 80 billion times. Have you really? Oh my God, like that was a top yoga works cue, like broadening across your collarbones. Okay, so let me ask you one I gave a lot. Because I never understood it. What is it supposed to do? Okay, great. No, thank you for asking. Okay, so broadening across your collarbones. I'm also just trying to make you talk about it instead of me. I know, I don't actually use the cue that much anymore. I'm sure you don't. But I do sometimes. But broadening across your collarbones is a cue that I would give a lot in baby cobra.
01:02:05
Speaker
Okay, so baby cobra
01:02:08
Speaker
It's really hard, in my opinion, to feel what your shoulder blades are doing in baby cobra, because there's so much muscle activation happening through the back. It's not maybe a lot of tension that the back muscles are generating, but you feel your back. So to cue the shoulder blades can sometimes feel not as obvious as cueing the chest, to broaden across the front of the chest. So basically, when you cue broadening the collarbones, in my mind, what you're cueing is taking the lateral end of the collarbone
01:02:37
Speaker
away from the manubrium or the top of the breastbone. And to me what that means is moving the collarbones, really retracting the collarbones, right? So the collarbones can retract and protract just like the shoulder blades. It's the same, like when you protract your shoulder blades, your collarbones protract. When you retract your shoulder blades, your collarbones retract. So when I say broaden across the collarbones, it's actually interestingly the opposite of saying broaden across your shoulder blades.
01:03:04
Speaker
Broaden across your collarbones is move your shoulder blades towards your spine, right? That's what I think of it as. But I feel like broaden across your collarbones again in the yoga world is something that I have heard teachers giving that cue all the time in every position, including when the arms are overhead. And I'm like broadening your collarbones when your arms are overhead.
01:03:23
Speaker
is essentially impossible. In my opinion, does not work very well. No, it doesn't. Well, and the thing is, okay, so part of the reason, I don't know why, this is just one that's stuck in my crawl. I thought you were going to say stuck in my crotch, and I was like, huh. You were like, tell me more about that. It's a great expression. This one really stuck in my crotch.
01:03:42
Speaker
What is a craw? It's actually your throat. And it's this idea of something getting stuck in your throat. Exactly. Like a bone, like you're chewing your whatever and you got a bone stuck in your throat. It's like a thing that is something irritating you. It's like when you try to say throat, but you've got something in your throat and it comes out of his like... Exactly. Maybe it has to do with crows. Anyway, we'll link in show notes for more information about that.
01:04:05
Speaker
Oh, thanks. Because I'm doing the show notes. Yeah. Got to figure out where that's going to be. Something about, no, you just look up where did the word crawl come from? I might just cut this whole part. No, you will not. But anyway, I don't know why. I like threatening Sarah. Because I get pretend upset and pretend blackmail-y. I'm like, you won't. You will not. You will not as if I have anything to do with when she's at home editing. She raises her long skinny finger. This is the crawl bone that is stuck in my craw. You will not. You will not.
01:04:35
Speaker
There's certain expressions. You know the way that people have words they don't like, like panty or moist? Oh God! Right? Yes. Broaden your collarbones for me is the equivalent of moist. Like it's just a phrase that I find abhorrent. And I don't know why. Like it's got nothing to do with anything. I just, for whatever reason, my brain's stuck on this phrase as problematic. And I think one of the things about it is that I never understood what it was actually telling me to do.
01:05:00
Speaker
Yeah, that's a problem. So yeah, like, you know, if you're cueing a room and you're saying broaden your collarbones and half of the room is doing what you think that should look like, but the other half isn't, there's a strong chance it's because they don't know what the fuck you're talking about, right? And so you may have to like back it up with some actual language that describes what I mean by broaden your collarbones to see if you can move your shoulders back in space.
01:05:25
Speaker
which is kind of what you're asking to do. To me, broaden your collarbones meant, could you figure out how to make them longer, laterally at the same time? Grow them in length. And I was like, what? I never got it. So fun fact, I used to grade or rather evaluate teaching scripts so people would write a long script of themselves, like what they would say if they were teaching a pose. And a lot of people would spell collarbone, colorbone. My color bones.
01:05:56
Speaker
That's really sweet. I saw a lot of really interesting spelling. It was cute. My color bones. Do you see now the error of your ways in demonizing that cute? I'm just kidding. The shock on my face. I was like, what? If anyone tells you, like me later today, that you should broaden your color bones. My color bones? Are you going to get as mad now that you understand maybe what the Q is actually?
01:06:22
Speaker
Now that you understand, now that you've brought in your mind, would you broaden your collarbones as well? No, but honestly, in terms of other teachers, look, say whatever the hell you want. I'm not gonna be, contrary to everything I just said, I'm not gonna be out there being like, you shouldn't come up to a teacher after class. That was very stupid of you to use that cue. The bigger picture around that cue or any other cue
01:06:49
Speaker
is comprehension. If your students don't know what you mean, you need to find a different cue. That's all. Also, to the credit of what you're saying, it's like that was really the only thing I knew to say in Baby Cobra for a long time. So sometimes we lean hard into the one way that we know how to do something. Absolutely. Until we realize there's many, many other ways that we could be.
01:07:11
Speaker
Until we learn, right? Exactly. Until we get more experience. And when we're new, when we're brand new, that's a big part of it as well. Yeah. Okay. Well, thanks for getting me worked up about that. You're welcome. It's more fun for me than you, I think. I think so. Right. The next shoulder dogma was one I definitely fell hook line or like I bought hard into this one. Okay. So that's the idea that we must always
01:07:37
Speaker
aggressively externally rotate our arms to the maximum anytime we take our arms into flexion, which is when we take our arms up overhead. I had that a lot as well. Okay, great. So we'll have some commiserating to do here. Sure. Okay, so I used to teach anatomy for yoga teacher trainings as well. And so what I would do to support this bias was I would talk a lot about where two of the rotator cuff muscles attach the greater tuberosity
01:08:06
Speaker
Okay. And it's this big bump on the head of the arm bone. And then I would show like, as the arm is moving into flexion, that if you don't externally rotate the arm, that the greater tuberosity will bang into.
01:08:19
Speaker
And it was like this really dramatic moment where everyone was like, everyone's faces went like, Oh no. And like cringed in pain. Suspense. What's it going to bang into? The acromion process. Right. So yeah. So the acromion process is this wacky landmark on the shoulder blade that kind of, it's, I always wished that I was able to grant myself the wish of shrinking myself down to the size of an ant.
01:08:47
Speaker
and then going for a hike on the shoulder blade. Can I interrupt and tell you about a fantastic movie from 1988 called Inner Space? Do you know about this movie? Tell me more. This movie stars Dennis Quaid. Back in the day, Dennis Quaid and Meg Ryan were actually a romantic couple. And Martin Short starred in this movie called Inner Space. And the whole movie is about Dennis Quaid is some sort of scientist who has invented a machine that can shrink him and his leg.
01:09:12
Speaker
little space pod down to the size of like a pill you can swallow and then he goes in a body he goes in a body and you know hijinks ensue and there's the villains who are like wanting to steal the technology germs no no these are people inside someone's body no in he's the only one inside people's body
01:09:33
Speaker
you were saying you wished you could shrink yourself down and take a tour of the scapula because it is so weird because it's so the geography the topography rather of the scapula is so fascinating but anyway if you were to climb up onto the top of someone who's standing upright just to the top of their shoulder blade you could march across this precipice and it would take you
01:09:56
Speaker
away from their neck, and then you take a corner and be walking almost directly facing forward to where they're looking, and then you would just fall off a cliff. And that bone, the acromion, is where the collarbone connects. Exactly. Like a joint that doesn't even move very much. It's barely a joint. Yeah, right. So I thought that the greater tuberosity would crash into the acromion process if we didn't maximally externally rotate.
01:10:25
Speaker
arm at all times. And then I started to hear from my students that like their shoulders hurt because of how they were cranking their shoulders into this really aggressive position of external rotation in like poses like down dog or dolphin or forearm stand things like that. So I had
01:10:46
Speaker
basically bought into a myth that I think lots of physical therapists are still really attached to, which is the idea of shoulder impingement syndrome. Well, okay. Shoulder impingement syndrome has since been renamed subacromial pain. There's been a lot of research showing that people who have shoulder pain and people who don't have shoulder pain, there's no difference in their subacromial space.
01:11:13
Speaker
And in fact, some people who have more subacromial space than others, that population of people tend to have more shoulder pain. So the amount of space available in the subacromial, so that's underneath that precipice, that bony overhang of the acromion process.
01:11:30
Speaker
In between that and the head of the humerus is a lot of musculature, tendon, bursa, stuff that can theoretically get pinched. And the idea is that it's being pinched when the arm has dysfunctional movement patterns, the shoulder blades are not moving correctly, whatever it is.
01:11:48
Speaker
But as it turns out, research just shows that that's not actually the case. Yes, this is a yes and, which is a improv technique. I don't know if you learned improv ever. So I'm going to say yes and. The yes and is I don't know any PTs that are obsessed with the amount of external rotation that yoga people have been
01:12:09
Speaker
you know, taught is the amount that you should be doing. Right? I don't know any PTs. Fair. Fair. I don't know any PTs that are like, the only place for the shoulder overhead is end range external rotation. Well, also, we could also add that like when you take your arm up overhead, the shoulder externally, the arm externally rotates.
01:12:24
Speaker
It's kind of a natural couple-ish. It doesn't have to. Well, it doesn't have to, but it generally will. If you get out of the way, it will. If you leave it alone, I think the bottom line of this is leave your shoulder, the F, alone. Leave the shoulder alone. Leave Brittany alone. Maybe that's another t-shirt. Leave shoulder alone.
01:12:40
Speaker
You shoulder alone and it could be just the shoulder just shoulder crying Yeah, that would be a nice compliment to the winky to the winking, but is a crying shoulder. Yeah if anyone's a artist out there who wants to draw bones or body parts with faces of some kinds on them and like would like to Be one of our I don't know why I'm saying one of our the only contributor to the t-shirts. We actually haven't made yet Anyway, give us a call What is our what is our movement logic phone number? It's 1-800
01:13:11
Speaker
No, we don't have one. No, we don't. 1-800-scap- Email us from our website. Scap motion. No, definitely like, I mean, I would love if someone would draw this. I might, I might ask our friend Amanda Tripp to do some drawings. But anyway, my bigger point is about that shoulder.
01:13:26
Speaker
Yes, this idea of like a shoulder impingement syndrome.
Shoulder Pain and Misconceptions
01:13:30
Speaker
But I will say, when people come into the clinic and they have shoulder pain, it's usually in something that is above 90 degrees. So whether it's flexion or abduction or anywhere in between. And when I say, where do you feel that? They will point.
01:13:45
Speaker
Exactly to that spot. Well, then that's maybe the reason why it's been renamed subacromial pain. Exactly. Exactly. And again, my thing is like, it's got nothing to do with nothing. Nothing's actually banging into anything. Thank you. Because there's a lot of soft tissue in the way, regardless of what angle of rotation. Along that line, though, is it maybe a little scary to think that something is banging into something? It's terrifying. You don't want to think that at all, right? The whole name of the issue is a nocebo.
01:14:12
Speaker
Like shoulder impingement syndrome, but it's also I mean There's a lot of things that people toss around as shorthand in the p2 world and they don't actually mean it like I know the ICD 10 Which is like where I coat where you put in the codes
01:14:26
Speaker
of what the issue is, there is shoulder impingements and that still exists. Things are changing, but it's not like everything is completely changed. But bigger picture, when people are having that pain, I go back to my original thesis, which is something about the way the scapula is moving is not allowing proper movement of the humerus.
01:14:44
Speaker
Perhaps, but that's a very biomechanist way of looking at shoulder pain. And that kind of leaves out the psychosocial component as well. It does. And the movement preparation, and the history of injury, and all these other things that really are much more likely to point to. But pain.
01:14:59
Speaker
Sure, but I add like the shoulder blade might not be moving properly because they have a ton of tension in their upper back musculature because they're in a massive fight with their partner. Absolutely. And that's a variability issue, right? Like their shoulder blades are not moving in all the ways that it. Exactly. And it's not loaded in all the way. That's not so. So yes, it's a mechanical.
01:15:17
Speaker
But the tools I have are mechanical. So I can talk about other stuff. And I do. And I can get into the psychosocial part somewhat. But when they come into the clinic. The tools you have are far more than mechanical. Thank you. Yeah. But sometimes the whole relationship is not a mechanism. It's not a mechanism. The whole relationship is the psychosocial component of therapy. And then there's also the way that you language things and how you talk to people and whether or not you're increasing their fear or decreasing their fear. I would actually argue that physical therapists
01:15:47
Speaker
have fewer tools like mechanistic tools than they do these psychosocial tools and that the psychosocial tools are probably underutilized and under explored.
Yoga Practices and Shoulder Cueing
01:15:58
Speaker
For some therapists, yes, not for me. Yeah, no, that's what I mean. Not for any therapists that I think is good. They're all over all of that. Also, sometimes people get real nervous about their shoulders. I will describe something in mechanistic terms in order to de-escalate how they're thinking about their shoulder. Good, yeah. Because I'll say something, yeah, because I'll be like, look, you raise your arm up, it hurts. You put it back down, it doesn't hurt.
01:16:27
Speaker
So I'm like, that's pretty straightforward. It's not because people will come in with like nerve pain and they're like, I raised my arm and put it down now my arm hurts for the rest of the day. So a lot of time I'll use, this is totally off topic, but I'll use like a much more dramatic example like that for someone for whom that is not happening to be like, it could be a lot worse than it is, you know, as a sort of psycho tool. Keeping his in perspective. Exactly, exactly.
01:16:52
Speaker
Yeah, it's not that bad. It's not that bad. It could be way worse. Yeah. So of course, because I believe that impingement would happen if we didn't really effort toward external rotation, I was cueing that a lot. I was micromanaging everybody's shoulders. I was going around fixing everyone's shoulders.
01:17:08
Speaker
And I think I was definitely causing more problems than helping. And it was really tough for me to let go of the idea that people needed to really effort hard toward external rotation in the overhead position. But I did, eventually, because I didn't realize that there was no impingement really happening. I still thought that that was possible. But then I started to recognize that everyone's shoulders are shaped different. And so that made a lot of sense to me in terms of like,
01:17:33
Speaker
Oh, because the hips are all shaped different. The shoulders are all shaped different. The spine is shaped there. Like everyone's different. And so this universal cue of like maximally externally rotate your shoulder is just, that doesn't like track that that cue is going to work for everyone because of the fact that everyone's so different and I let it go. So did you micromanage as a yoga teacher? I mean, once I also had that idea in my head, then I did. I didn't learn that sort of maximal external rotation in my Jeevan Mukti teacher training, but I did learn a lot of like, when your arms are overhead.
01:18:03
Speaker
You know, bring your shoulders down. So it was like, once you're in that end range position, now it's time to depress your scapula, which doesn't make any anatomical sense. But that was again, like an aesthetic, you know, long neck, long arms reaching, you know, graceful, beautiful, blah, blah, blah. The, that sort of maximal external rotation was honestly something that I learned in yoga tune up. And it was an interesting counter because it was taught with protraction as the correct placement of your scapula for like a downward facing dog.
01:18:32
Speaker
instead of this shoulders back and down it was basically the exact opposite it was like shoulders up and apart which was a new idea to me can I just say I think there was a lot of cueing of shoulders down when the arms are overhead in yoga tune up yes so there was also that problem so it wasn't it wasn't taught consistently this protraction and upward rotation of the scapula
01:18:54
Speaker
for a down, was taught in a down dog as like a sort of safe, like a shoulder blade pack position, like the most stable position, but it was not taught consistently across all overhead arm positions. But one of the things that I wanted to say as well is that
01:19:11
Speaker
you know you and i were not the only people who jumped on the like tons of external rotation train no god and there were in fact people and i i i don't know who this came from but when i was a yoga tune up teacher and i would go around and teach the different trainings in different locations in canada
01:19:31
Speaker
Specifically, when they would raise their hand to ask a question, let me see if I can describe this in a way that makes sense to people watching. Instead of the way that you might raise your hand and like your palm is facing towards the teacher, did you ever see this? I don't know. So instead of that, people would raise their hand with their forearm supinated.
01:19:51
Speaker
because supination and external rotation go together, I mean naturally it co-occur, right? And so then they would raise their arm up with the back of their hand facing towards me.
01:20:01
Speaker
And I remember seeing that and being like, huh. And I think I did ask somebody eventually, like, what's up with this back of the hand? And I think there was one teacher who would just basically like, similar to you and I, who were like, external rotation or bust, like that's the only place when your arm was overhead. I don't think I ever did anything more than just sort of take note and ask like, where did you learn this in a kind of casual way? And I think I was, you know, I tried to make a non judgmental noise, like,
01:20:31
Speaker
Oh. That's so judgmental.
Debunking Shoulder Myths
01:20:35
Speaker
I know, I know, I know. Anyway, so that is something that I saw as like, that's that like external rotation taken to the nth degree, right? Yeah. And while there might be some value, if we go back to like our five questions here, it's like it's trying to solve the problem, number one, of not pinching anything in the subacromial space when it turns out that's not even a thing. Right.
01:20:56
Speaker
Also, impingement's happening all over the body all the time. It's really benign. Whenever you sit on your knees when there's impingement at your knee. The way that I'm sitting right now where my hips are behind me and I'm kind of pinched forward at the hips, there's soft tissue getting pinched at the front of my hip joint right now. And you know what? Tissues love to be squeezed. Your discs love to be squeezed. That's how they drink. That's how they imbibe. That's how osmosis works. Like a sponge. It's okay that things are getting pinched, but it's scary to think that they're getting pinched. Well, and if the pinch comes with pain.
01:21:24
Speaker
Yeah, absolutely. If that's the story that we're telling to explain the pain, it makes the pain potentially worse because now there's this whole story about things being pinched. All right, so does aligning in terms of externally rotating to the maximum degree achieve the goal of creating more space in subacromial space?
01:21:41
Speaker
No, and also to add to that, people's arms are probably, if you're getting out of the way of your body's way of patterning movement, they're already externally rotating, so you don't need to override the amount that it needs to with all this extra layering of effort. Could this be, though, here's the question, could this be helpful for some people some of the time? Absolutely. Some people actually need to work a little bit more external rotation when they take their arms up.
01:22:05
Speaker
Maybe I would say like maybe as far as they're like taking your arms apart I would say definitely in terms of just internal and external rotation Generally might be a movement that they're just not patterning very much right on not overhead necessarily But maybe like horizontally or out to the side or all of these other million gabillion places your arms could be let's rotate the shoulders Yeah, awesome. Okay, cool
01:22:27
Speaker
But in and out, not just out, medial and lateral rotation, internal and external rotation. So that comes back to this idea that alignment is not necessarily the solution, movement, variety is the solution, and capacity.
01:22:43
Speaker
Fun fact time. I love this word almost as much as I like the word. Hot dog. Curvilinear. Oh, I like the flavor of a hot dog. And the texture. Curvilinear. Such a good word. Scaption. I love scaption. Scaption's good, right? Do you know that scaption's a West Coast thing?
01:23:04
Speaker
Yeah. The Westies made up Skaptian? Yeah. I mean, I don't know if they made it up, but I learned Skaptian in California. That must mean it came from California. Well, I'd never heard of it in New York. Oh, so it must have been a Cali thing. That's right. Westies are the besties. That's right. So Skaptian is cool. West Coast, best coast. Skaptian is, first of all, the name. I have to do an Instagram post where I
01:23:32
Speaker
like, really nerd out and do like a whole thing on like, scaption this. OK, this would be the post. It's so good. Clip number one. You know what? You have to make this post before this comes out because otherwise someone's going to steal it. Scaption this. OK, clip number one. Your arms move exclusively forward and up in the sagittal plane. OK. Scaption this.
01:23:54
Speaker
Now I take my arms out at about a 45 degree angle. So if you're standing directly facing the center of a wall with two corners on the left and right side, instead of taking your fingertips straight forward toward the wall with your palms parallel to each other, you would instead direct your fingertips toward the corners of the room.
01:24:13
Speaker
at an angle, right? And so, scaption this. It would be kind of halfway between the sagittal and coronal plane. And it's really coming from the shoulder blade. So the shoulder blade can slide as we discussed toward the posterior side of the rib cage.
01:24:30
Speaker
it could come around to the more anterior, kind of side anterior side of the rucation, halfway between that, what we would call like a 45 degree angle. Well, the angle itself is going to depend because really what you're trying to do is get the curved backside of the scapula to meet the curved backside of the ribs really consistently so that the head of the humerus in the glenohumeral joint is
01:25:00
Speaker
centrated as ideally as possible, right? So for some people it's going to be farther towards abduction. And for some people it's going to be closer to that flexion. Like I've heard it described as like abduction, but then 15 degrees forward. So that's, you know, but it's, there's a, there's a variety. It's based on your own anatomy. Structural variation for the wind. Yeah. Yeah. So scaption this, right? That's great. And it, and you could do another clip where someone's taking their arms purely out and up in the coronal plane or the frontal plane.
01:25:30
Speaker
scaption this and they would move their arms 15 degrees. And then you could do a whole bunch of yoga poses, right? Where like warrior two is suddenly like looks totally different because instead of your fingers pointing over your front knee and over your back foot now,
01:25:42
Speaker
all of a sudden your fingers are kind of pointing forward a little bit where you're facing. You could try to do some kind of side plank situation, like maybe using a wall where you would tip your whole torso sort of facing the ground, and then you're like pressing like mad into the wall. I love this. Yeah, so this is definitely going to be the post for this podcast episode. Sc caption this.
01:26:05
Speaker
And so Skaptions cool. I think Skaptions cool for my past as a more a Jengar influenced yoga practitioner where I had it in my mind that like everything had to exist along the lines of my yoga mat like everything had to either be facing the front short edge or facing the
01:26:22
Speaker
Long edge and then when I started to break out of that box literally I found like these more in-between Pathways of movement felt so good probably because I wasn't doing them and also like there's a reason why scaption like taking your arms Over your head through that scaption path. I don't think that's a technical word for it like scaption How would you say like scaptioning?
01:26:48
Speaker
I
Yoga Alignment and Movement Exploration
01:26:49
Speaker
mean, I'm trying to think how, like in my medical notes, I write scaption. And I mean, it's something that you see all the time in PT.
01:27:00
Speaker
We'd say something like just moving through scaption and you understand what that means. It felt so much, it felt like it literally wasn't that there was more space, it felt like there was more space. Well, like another example, and there's nothing wrong with this, but there's an exercise that people do sometimes where you stand with your back up against the wall.
01:27:21
Speaker
And you either bend or you don't bend your arms depending on what you're doing and then you do like sort of a snow angel with your arms with the back of your hands touching the wall. That's tough. And what, yeah, and I think like because, well, what that's doing is taking your arms behind the scaption plane, right? And so for me, it was always super uncomfortable. It just doesn't feel great on my body to do it.
01:27:41
Speaker
And I always thought, oh, it's not a it's a wrong slash bad movement, because for me to do that, then the head of my humorous moves forward, right? So then it's not staying super centrated, whatever that means, right? But then if you are on the wall, but take your arms a little bit forwards,
01:27:57
Speaker
Then the scapula rotates around the sides of your body enough that the movement of the arm feels sort of smoother and easier. It feels like there's a more natural path for it, for me at least. But this is the thing. We fairmonger positions, but it's like, well, if my arm can go there and I'm not...
01:28:16
Speaker
Like one of those crazy contortionist people that's like like obviously Sub like disjointing their shoulder and wrapping it around their head backwards. Like oh have you seen that stuff? It's nuts, right? So it's off. It's not that that I'm asking to do I'm just saying take your arms back till they touch the wall and maybe that doesn't feel as you know, quote-unquote natural or whatever It's probably gonna challenge some of the soft tissue. Yeah, but it's but there's nothing wrong with that challenge is my point In fact, there might be a lot right with that. Yeah
01:28:44
Speaker
All right, well, we've talked so far about shoulders back and down. We've talked about externally rotating to the maximum degree when taking the arms up our head. Next, we're going to talk about scapular winging or tilting. Winging is typically used to mean like the derogatory, like sort of like, you don't bad thing. You nasty, I can see your shoulder bite winging on your back. And is that tilting, I think is a more neutral term.
01:29:09
Speaker
Oh yeah, I was totally fear-mongering, winging, especially in Chaturanga. I just meant that tone. Yeah, oh yeah, that's how I talk. Oh my god, you guys, your shoulder blades are totally winging. This is my voice when I'm not podcasting. I don't know if you know this, but neither Laurel and I actually talk like that. This is how we talk. You guys, totally bring your arms overhead, and like, but drop your shoulders.
01:29:33
Speaker
The scapulae, by the way, also fun fact, scapulae is how I've heard the plural of scapula pronounced. And I think it's actually really technical if we're going to be adhering to the plural of Latin. It's scapulae. Or scapulae. Or scapulae. I like scapulae better. A-E on the end instead of A-S.
01:29:54
Speaker
Yes, it's not scapulas. No, it's not. But I think we could call it scapulas and thunder would not, or a bolt of lightning would not strike a stone. I mean, you can do it. I'm gonna move away in case it does. So the shoulder blades tilt, that is a normal motion that they can do. And so we don't need to demonize tilting. However, if you see somebody in Chaturanga, this is where I really like get all up in arms, pun intended. Oh my God.
01:30:22
Speaker
Chaturanga Dandasana. And they would dump their, their, their humoral heads forward and their wing tips of their scapula would come like off their back. It's like, stop call the fire department. And, uh, and, and, you know, and like, we would have this conversation about the alignment of Chaturanga, right? Well, like what's wrong with this conversation?
01:30:44
Speaker
There's something really inherently wrong with having a conversation about alignment of the shoulder blades in Chaturanga when someone is clearly not strong enough. To do it the way that people want it to look like.
01:30:57
Speaker
Okay, sorry. There's a lot of me holding my face in this episode, as it turns out. It's a good thing this is not a visual medium, because you just see me with my hands covering my eyes and talking under my hands. But the biggest problem with Chaturanga Dandasana is not the position of people's scapula. It's the fact they're not fucking strong enough to do it, and they're being asked to do it over and over and over and over again. It's a version of a push-up. And then posture shamed when they're fatiguing and flagging. Right, and then somehow they're supposed to. Yeah.
01:31:27
Speaker
Meanwhile, you go. I can't. I know. So chaturanga issues with not being able to lower that moving plank down to the ground. We've created a lot of obstacles for ourselves in this pose. One is that we do way too many of them for most people. Another is that we insist on the wrist being underneath the elbows and the elbows being
01:31:48
Speaker
You know 90 degrees and the elbows being close to the body and like there's all these ways that we inhibit like the bigger stronger muscle of our Shoulder shoulders in this in this yoga push-up, right? But we're just gonna focus on maybe we'll do a chaturanga episode I just had a horrible flashback of the of being taught and also teaching myself that when you're lowering from your plank You got to actively bring your shoulders forward so that your elbows stay over your wrists. Oh dear god. Yes
01:32:10
Speaker
Oh right, shifting forward. Oh yeah, so yeah, oh my god. I'm having like a PTSD moment about shifting forward. Yeah, there's so many ways that we like, we took a hard pose and we made it so much harder. So much harder. So much harder for people. Here's like the hardest way to do a push-up because I'm not gonna let you use your chest especially much. Absolutely. So not only are we asking people to do the hardest kind of a push-up, right, where you don't get to use your chest, we're also saying do not access the muscles
01:32:37
Speaker
that would make this in any way easier because you have to shift your whole body forward in space so that your elbows and your wrists stay vertically aligned. But
Scapular Myths and Realities
01:32:45
Speaker
I used to teach that. I taught that. I practiced it.
01:32:51
Speaker
Yeah, I did too. Yeah. I mean, it's a great way to make sure that you're always going to have something to teach is just make the pose impossible. And therefore, everyone's like, I can't do it. Teach me how? And you're like, yes, great. Perfect. That's working. We'll work on it. OK, yeah. We're just going to continue to work on this. Keep working on it. Yeah. Just keep working on it. So the shoulder blades are winging off the back probably because you lack upper body strength. And you probably lack upper body strength because you just haven't been progressively overloading your
01:33:21
Speaker
horizontal push or loading your triceps sufficiently under sufficient load over the course of multiple weeks and months to be able to lift your heavy body or even just lower it with control. We're not even lifting our body in Chaturanga. We're doing an eccentric exercise basically. Every time you lower from plank to Chaturanga and you never press back from Chaturanga to plank, you're really doing eccentric string training and
01:33:47
Speaker
I'm having a second flashback about forcing people to then, from that vertically aligned elbow over wrist position, to then push themselves back up into a plank. Oh my God. I'm sorry, everybody. I'm so sorry. Mea culpa. What are some other places you would see scapular winging? Not necessarily because someone lacks strength, but can you think of some other poses where the shoulder blades might ping?
01:34:13
Speaker
Yeah, absolutely. Any of the bound angle poses, right? Any of the poses where you're taking your arms behind you, so you're going into extension, and then some amount of internal rotation and adduction, because at some point, the idea is your hands are clasping behind your back. And usually, I mean, when you describe yoga anatomically, it sounds insane, right? Because I'm like, OK, you're going to clasp your hands behind your back. Fine. But also, you're going to take one of your legs and stick it in there as well.
01:34:40
Speaker
Right? Like a bound angle pose or a bound seated, you know, rotated spinal twist pose, whatever, right? It sounds bananas, right? It does. It does. And I actually really love the binds. I have long arms. Yes. So it's like not hard for me to do binds. If you have shorter arms, like you're just going to feel... It's tough. Or if you have... Maybe, maybe you will. Maybe, hopefully you won't. Or... Hopefully the teacher's like, why don't you just use a belt?
01:35:06
Speaker
Or you might, this is the thing about these sort of like visually goal oriented shapes that you're trying to get people to do, is if someone's anatomy does not lend itself towards getting there, if you don't know to teach like the goal is not the goal, the goal is improving whatever range of motion you have in all of the directions. Right, the goal is not to clasp your hands together. Yeah, exactly. The goal is to get a good stretch across your shoulder. Exactly.
01:35:32
Speaker
So if you're teaching and you're not telling people that the goal is not getting your hands clasped, the goal is improving your scapular movement, you might end up having people start to injure themselves in your class because they're going for the goal of the hands clasped, right? And they're working towards that by hook or by crook. So if you're doing this bind, your scapula or I mean, your shoulder is going through that extension, it's horizontal adduction behind your back.
01:36:00
Speaker
Right? It's internal rotation. There's all these movements where your scapula basically just needs to get out of the way as much as possible. Right? And so if I'm trying to keep it, you know, flush, quote unquote, flush against my back, there's no, I can't do that and get my arm behind my back successfully at the same time. I'm going to rip something. And also like who told you that that's what you're supposed to do. It's probably somebody
Scope of Movement Teachers
01:36:22
Speaker
fear mongering winging, right? It's like, it's like, just don't.
01:36:24
Speaker
Or in all fair, like let's give benefit of it out. Some of the benefits of keeping the shoulder blade more, let's say, like not letting it tilt off the rib cage in that anterior kind of winging fashion would be like now you're going to get more capsular stretch, right? Like you're going to take your glenohumeral joint exclusively like without so much shoulder blade motion. I know you're testing, but just hold tight with me for a second. You do Gomukasana and you reach your hand
01:36:53
Speaker
behind you and up your back, like you're trying to snap your bra together or something. If you simultaneously try to put the wing tip of your shoulder blade closer to your rib cage, you're maybe going to feel a lot more sensation at the top front of the shoulder. I feel it down my arm here. Right, and it might be nervy and unpleasant. But anyway, it's not necessarily wrong to inhibit
01:37:18
Speaker
Scapular tilts, especially if you feel like maybe you're going to get more benefit from the stretch or exercise if you don't tilt the scapula as much, because maybe your goal, it depends on what your goal is, right? But it's not correct to think that winging of the scapula is an inherently bad thing that the scapula are doing. Now, there is something, Sarah, called scapular dyskinesis.
01:37:42
Speaker
Okay. And that is sometimes confused. People confuse winging with this pathology that I think we could probably uncouple in people's minds if that is the case. Like if you have this idea that like a winging scapula is predictive of some type of pathology.
01:37:59
Speaker
pathology. Can you talk to us about this real pathology called scapular dyskinesis? So yeah, scapular dyskinesis or dyskinesia is basically if you break down the word, dis is mean like not, right? And kinesiology is the movement, right? So it's basically your scapula is not moving the way it should. The big picture with this is that when you see it,
01:38:19
Speaker
And in order to not make you do all of the work on the show notes, I'll find a video clip for you on YouTube because there's lots of videos where people have filmed their patients and they'll have their patients take their arms through abduction or scapion and you can watch both of the scapula. They're not doing the same thing. So one scapula is going through upward rotation and downward rotation and the other one
01:38:41
Speaker
has either some sort of initial movement delay or a lot of the time it's on the return where it'll just like stop and then at some later point it'll like snap all the way down, right? So it's just, it means that it's not doing its regular movement properly for whatever reason. And sometimes it's a nerve impingement and sometimes it's, I don't know, some other sort of injury. Sometimes it's a frozen after having a frozen, there's all kinds of reasons.
01:39:06
Speaker
But the big picture is that compared side to side, one of them is doing something different than the other one. Right on. And so this is probably not something we have to worry about as movement teachers. No, and it's outside of your scope of practice to try and fix it anyway. Way outside, okay. So don't pathologize normal. Scapula tilts as normal. If someone has scapular disk disease, it's not your job to fix that at all, and it's really definitely not your job to diagnose them with that. Nope.
01:39:30
Speaker
If there's pain, yeah, roof her out, maybe. Okay. So let's talk now about alignment dogma in everyday life, because we've spent a lot of time talking about alignment dogma within the context of moving the arm into different positions or being in different positions. But now let's actually talk about posture, like everyday life posture. First of all, to start, Sarah, do you think it's within a yoga teacher, Pilates teachers, strength coaches, scope of practice, to tell a student or suggest in so many ways that a student has bad posture?
01:39:58
Speaker
and then to offer ways to fix it? Well, it's awfully posture shaming. Yes. But it's also a good way to maintain your revenue. Yeah, create a problem. So you have something to solve. If everyone's got bad posture, you're never going to run out of clients. And so a lot of people believe that they have bad posture. And again, as we discussed, they think it's a moral failing, or they think it's related to their pain. And it's definitely not the first one. It may have nothing to do with a second.
01:40:28
Speaker
Posture is not a diagnosis, although there is an ICD-10 code called abnormal posture. But that I use for someone who has severe scoliosis. Having a little bit of a schlumpy shoulder is not abnormal posture. It's just a version of a place you could be.
01:40:47
Speaker
And it's again, uncoupling this idea of there's one alignment that is the right alignment. There's one right place to be and all the rest of the places are wrong places to be. So if there's only one right place to be, yeah, go for it. Walk around, tell everyone they've got bad posture because they're not in that one right place.
01:41:06
Speaker
But that, I mean, a lot of people will say things like, I started doing Pilates and my posture improved. I'm like, yeah, because your back muscles got stronger, because your arms got and your neck got stronger. Like a lot of the time it's just weakness. A lot of time pain is physical deconditioning, right? So the pain of that posture is that their muscles, their body does not have the ability to tolerate
01:41:50
Speaker
the position of
01:41:52
Speaker
pathologizing normal, you're diagnosing. And then the second thing is if you shouldn't diagnose, then you also should not be prescribing because prescribing
01:42:03
Speaker
assumes that you've diagnosed a problem. Right. OK. So it's going to fix your problem. Right. And the thing is, is that actually
Posture Myths in Therapy
01:42:09
Speaker
movement fixes a lot of problems. Yeah, just moving. So helping people learn to move and keeping people moving and motivated to move and like enjoying movement is fixing a ton of problems. Yeah. The difference comes when a yoga teacher names the specific problem. And then. And names a solution. Names a specific solution for that problem. I think any time we're doing that, whether it's around mental health of our students, whether it's around any type of pain,
01:42:33
Speaker
whether it's around any type of postural, something that they're seeing, I think we're stepping outside of scope of practice. And when we step outside of scope of practice, it could be said for any profession, we get in our own way. We stop really fully being able to help people because we've gone beyond our area of expertise and now we're kind of just like,
01:42:53
Speaker
Um, bullshitting, you know what I mean? Like we're making shit up. Ultimately, wouldn't you like to be the kind of teacher who is popular and has a lot of students, not because you've fear mongered all of them into, you know, never leaving your class or else their spine is going to fall out, but instead you are optimistic and positive about the amount of change they could possibly find.
01:43:14
Speaker
the strength and versatility and vitality, you're encouraging a positive outlook on their physical self-expression. Like, let's get you moving in all of the ways and you're going to feel better. Not like everything you're doing is wrong and I'm the only one holding the correctness key. Oh my God. I think that's the kind of movement teacher I want to be. 100%.
01:43:33
Speaker
Well, now I'm going to turn it back onto the PT world. Have you noticed there are ideas around bad posture and good posture in the PT world, Sarah? 100%. 100%. Do you have any notion of where this idea of, for example, forward shoulder position has been often vilified? I think in the PT world, in addition to the yoga world, the Pilates world, oftentimes I've heard physical therapists
01:44:01
Speaker
suggests that shoulder impingement comes from forward shoulder posture, right? So we're tying every, all the different like,
01:44:09
Speaker
maybe erroneous ideas around pain, again, connecting them to posture. And these are ideas that really refuse to die. But again, I think it's getting better. But can you talk at all about upper cross syndrome? Oh, I sure can. Because I think, to a large extent, that this is where this idea about forward shoulder position being bad,
01:44:34
Speaker
originated from. So it's basically the theory for why it's bad and explaining how it happens is laid out in this idea of upper cross syndrome. I have fully taught upper cross syndrome, lower cross syndrome before. Well, it was a very popular working model for understanding posture,
01:44:56
Speaker
pain like back in the 60s. Yeah. So it started with someone named, I believe, Dr. Vladimir Yanda. Yanda. This idea of upper crossed and then there's also this lower cross is, visually, if you took someone and looked at them from the side, so you're looking at like there aren't, and you drew an X, basically
01:45:17
Speaker
like with the center of the X crossing. So the idea is muscles along each line of the X have some sort of either they're working too much or they're not working hard enough. So forward shoulder position is explained as the pecs being in a shortened position and the rhomboids on the back being in a perpetually
01:45:40
Speaker
overstretched or lengthened position. And then also the other part of it is the upper traps being too shortened, and then the other part that I forget. It has to do with the lower traps being too lengthened. Yes, it's all like, this is too long, this is too short, this is too long, this is too short. And the muscles as modeling clay. Yes. But listen, to be fair to the theory, humans like patterns.
01:46:06
Speaker
and we look for patterns everywhere so if you're walking around and you're in your yonda in the you know it's 1957 or whatever and you're looking around you're seeing a lot of people coming to you with like upper back and neck pain or shoulder pain and you're like huh i see a ton of people and like they all their head is forward and their shoulders are rounded so
01:46:22
Speaker
what might be the pattern? What's the one commonality? I have a patient who's a medical doctor, and I get to have a lot of really interesting conversations with him. And we were talking about diagnosing things just generally. And something he said that they're taught as medical doctors is you are taught to look for the one unifying diagnosis that explains all of the symptoms. So if someone has a headache,
01:46:48
Speaker
There's any number of things that could be, but if they have a headache and they also have swollen feet and they also have whatever, you're trying to find one diagnosis that covers all those things. You're not trying to say, well, they have migraines and they have diabetes. You're trying to find the one thing. That is a model that I think a lot of medical professionals go for in lots of ways.
01:47:11
Speaker
This model was developed because it was like it was this one unifying answer, right? Yeah, I took all of these things. That's great context. I mean, it's really connected them. Yeah, it's really easy to take old ideas that were popular that have since been debunked, right? There's been a lot more research out kind of showing that upper cross syndrome is no longer a respected theory, right?
01:47:30
Speaker
Although some
Muscle Length and Stretching Myths
01:47:31
Speaker
people are still adhering to it. Sure. Whether subconsciously or consciously, right? Well, there's still a lot of ideas in the yoga world that like in order to get our shoulders out of that forward shoulder position, we need to strengthen our rhomboids as though like strengthening a muscle shortens it perpetually and stretching a muscle lengthens it perpetually. Like the muscles is modeling clay theories really.
01:47:50
Speaker
is still strong in many people. But the thing about it is that this guy actually had a really good idea at the time and started making a lot of sense that had not been made prior to that. And the same thing is just going to keep happening because science is not about arriving at one
01:48:09
Speaker
Conclusion and then sticking with that forever because that is now the law science is about being open to changing your mind when new better evidence presents itself so it's okay to learn about upper cross syndrome to understand where people are coming from in fact it's probably valuable because then you'll be able to spot. The dog more easily.
01:48:30
Speaker
But upper cross syndrome has been and I still think is enormously influential in Guiding people's thought processes toward this really mechanistic Muscles is modeling clay way of looking at the body like these muscles are short and these muscles are long and so we have to strengthen the long muscles and
01:48:48
Speaker
stretch the short muscle. So stretch your pecs, strengthen your rhomboids. Wouldn't it be great if we just stretch the pecs and the rhomboids? So to strengthen the pecs and the rhomboids, then we could just have better tissue capacity and more movement options. But I wanted to bring it up because I think that this is maybe, if there is a route for why we
01:49:08
Speaker
vilify certain postural tendencies, I think a lot of them originate in the PT world. Definitely. Honestly. I believe that a lot of PTs still very much not just correlate, but cause eight posture and pain. I don't think cause eight is the way you decline. Cause. Oh, they try to show cause. Yes.
01:49:30
Speaker
Not even relationship. They're actual cause. They assume there's a relationship. Now they've moved straight to the cause. Your pain is because of this posture. And that is going to be a hard thing to let die. Not least because changes in the world of medicine and academia move at a snail's pace. So the kind of thing. I learned upper cross, lower cross syndrome in PT school in the year of our Lord 2015. It was taught.
01:50:01
Speaker
So, and it probably, there may or may not have been exam, a question on the board exam on, I blacked out for most of the exam process, so I don't remember, because it was a nightmare. Everyone says that and has taken the exam. They're like, I know I failed, and then they pass. I went and drank at least three margaritas afterwards, because I was convinced I had failed, and I didn't know what I was going to do. And then three days later, turned out I passed. But yeah, it's a horrible exam to take. I don't remember almost anything except sheer panic.
01:50:29
Speaker
for about four and a half hours. But more to the point, it's taught in PT school. It's in textbooks.
Episode Wrap-up and Reflections
01:50:34
Speaker
It's going to take a long time for that idea to actually shift in the general understanding of posture in the clinical world. And also, I will shorthand write things in my notes, my clinical notes, because I know what the insurance will pay for.
01:50:57
Speaker
This is another point in the episode where I'm going to start to get really depressed. Yeah, but the thing is, I look at that as, that's just my, I'm writing these things out because I know insurance will pay for it, but it's got nothing to do with what I know or what I'm teaching the person in front of me or what we're actually doing. You're playing a game. Yes, it's 100%. You're in a massive circus.
01:51:18
Speaker
Yes. Luckily, it's a cash clinic, so we don't work directly with insurance companies, but I want to give my patients the best chance of getting some amount of reimbursement, so I have to play the game a little bit when I write my super bills and my notes. But ultimately, shoulder health is maximum appropriate range of motion, maximum appropriate strength in all the ways, period. So simple. Right? Couldn't be easier. Yeah.
01:51:46
Speaker
Well, I hope you enjoyed this episode, everybody, and that it's totally cleared up the five-step process to achieving perfect shoulder posture. Oh, tell me about this five-step process. I'm excited. Step one, shoulders back and down, duh. Step two, rotate, rotate, rotate. Step three, make some muscles weaker to balance out the weak muscles on the other side of the joint. Step four, stop being a bad person and start being a good person, because this is the most organic way to stop slouching from within.
01:52:13
Speaker
and step five never forget broaden across your collarbones mother fuck i knew that was coming in jk okay you can check out our show notes for links to references we mentioned in this podcast you can also visit the movement logic website you can also get on our mailing list i will also say this we give away a lot of free stuff oh god a lot of free stuff people really like it
01:52:39
Speaker
So if you like free stuff, you should get on our mailing list. We also offer massive discounts on our popular tutorials, including the shoulders tutorial, massively popular shoulders tutorial. So join us on our mailing list and also please help us out if you like this episode.
01:52:54
Speaker
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