Question: Been reviewing your scapula debrief and the motions getting me a little hung up. I’ve always thought that shoulder flexion, upward rotation, ER, and posterior tilt were together? But you’re saying the scaps upwardly rotate, internally rotate, and anteriorly tilt? What’s the reasoning behind this or something I’m missing in research?

People always drove into my brain upward rotation and posterior tilt helps clear space for shoulder flexion. Any relationship or misunderstandings there?

Answer: When discussing the motion of the scapula and the humerus during shoulder flexion, it’s all about timing and location.

We typically break down shoulder flexion into 3 different phases:

1. 0-60°
2. 60°-120° 
3. 120°-180° 

During these distinct phases, you have different actions happening at both the scapula and the humerus that will drive expansion into various areas.

First, we need to know what the starting position is for the scapula. “Scapman Begins” you might say…Or not…Whatever!

Most of this stuff is drawn from this article here, so please check this awesome study out if you haven’t.

Improving shoulder flexion

Question: You and others have mentioned that when someone who is compressed in the dorsal rostral thorax and it is proven with your shoulder flexion assessment between the ranges of 60°-120° among other measures, that you would intervene with low reaching exercises below 60° flexion in various positions depending on the presentation of the ISA.

Is it possible that in this instance we could intervene with a position that includes reaching in that 60°-120° degree compressive range if we IR at the humerus?

Answer: If you peeped the scapulohumeral rhythm component above (uhh, why haven’t you read that yet fam?!), you probably garnered one thing:

Shoulder flexion is hella complicated.

In fact, the entire arc of flexion involves both anterior and posterior thorax expansion to be completed.

Although I love shoulder flexion as a test, it is more a gross measure of thorax expansion with a bias towards posterior. Whereas shoulder extension is similarly a gross expansion measure with a bias towards anterior.

In order to know where you need to drive air, you have to look at segmental expansion within the thorax.  Get your tight green wrestling pants on and lather up in baby oil, because we’re about to break it down Degeneration X-style.

Filling the thorax with air is similar to filling a cup of water. The cup fills bottom-up completely.

So to do the lungs during progressive shoulder flexion. The fill occurs in a sequential manner that corresponds to scapulohumeral rhythm.

Remember this general expansion trend with scapulohumeral rhythm:

• 0°-60°: lower posterior expansion (T6-8)
• 60°-120°: T6-8 anterior expansion in early phases, progressing to T2-4 expansion in later phases
• 120°-180°: T2-4 posterior expansion, with likely some anterior T2-4 expansion as well.

With that in mind, you have to look at other individual tests to determine where you have to drive specific airflow to get changes in shoulder flexion:

• T6-8 posterior expansion – shoulder external rotation at 90°
• T6-8 anterior expansion – shoulder internal rotation at 90°
• T2-4 posterior expansion – shoulder horizontal abduction
• T2-4 anterior expansion – shoulder horizontal adduction
• T2-4 anterior AND posterior expansion – Lower cervical rotation

Before you get all wild and crazy with your specific expansion efforts, make sure you have the stack.

If you don’t have the stack, you have no base to drive this segmental expansion, and you won’t be able to talk to me, and I’ll stay forever lonely. I NEED YOU FAM!

Once you have the stack, then you can pinpoint where the mobility restrictions are, then fill up your cup!

If you have decreased shoulder external rotation (less than 90°), I’d go with a reach in the 0°-60° range:

If you have decreased shoulder internal rotation (less than 90°), I’d go with a reach in the 60°-120° range:

You can combine expansion in both these areas by driving single-arm reaches. If I reach with my right arm, that will drive anterior expansion on the right and posterior expansion on the left:

If you have decreased shoulder horizontal abduction (less than 45°), I’d go with something that drives rotation with a more horizontal plane-bias. The sidelying armbar roll is a go-to for me:

If you have decreased shoulder horizontal adduction (less than 135°), you can use similar rules above and drive horizontal adduction. Short lever side planks are money here.

You can also go with humeral extension to improve this movement:

Lastly, if you want to drive anterior and posterior expansion with the upper segments, you can combine unilateral reaches with cervical rotation. The armbar screwdriver with head turns is an absolute beast-mode for this:

Manubrial Expansion

Question: How would you differentiate an overhead reaching exercise for purpose of upper anterior ribcage expansion (manubrium) VS upper posterior ribcage expansion (T2-T4)?