Written on October 14, 2009 at 10:30 am, by Eric Cressey
One of the most common functional limitations we see in those with shoulder issues is the inability to achieve full overhead range of motion. This can occur due to soft tissue restrictions (lat, pec minor, long head of triceps, among others), weakness (lower traps, serratus anterior), joint restrictions (thoracic spine), or a combination of several of these factors. The end result is often that a quick assessment reveals something like this:
In a “healthy” shoulder, with the lower back flat, both upper arms should be flat on the table. This is a great position to quickly check what’s going on and eliminate the muscular strength side of things, as gravity does the work for you as the arms flop down.
The question, of course, is how do you fix it once it’s there? Well, the truth is that there are several things you’d need to do a few different assessments to see exactly what’s up, and while that’s beyond the scope of an individual article, we can touch on one of them with some detail – thanks to Tim DiFrancesco, a great physical therapist who provided today’s guest post below. From Tim:
I developed the inferior capsule rocker stretch to address limited mobility of the glenohumeral joint’s inferior capsule. This limitation is often a major factor in dysfunctional shoulders of overhead athletes and/or those performing regular overhead activities of daily living. It is appropriate and necessary to assess inferior capsule mobility in those performing regular over-head activities as well as when there is a shoulder pathology suspected.
Inferior capsule integrity can be assessed with an inferior glide looking at accessory joint motion. This is paramount to address with these populations due to the fact that a restricted inferior capsule is often associated with superior humeral-head migration. Impingement then results.
To perform the stretch:
1. Begin in quadruped position and rock hips back to heels (place pad under knees). Hands flat on the floor in front.
2. Reach the right arm out into flexion/elevation in pronated position (fixing the scapula and locking the thoracic spine).
3. Roll the palm open into a supinated position (decreasing the chance of subacromial impingement).
4. Slide the arm out into the scapular plane (decreasing the amount of stress on the rotator cuff tendons and surrounding soft tissue structures).
5. Reach the left hand under the right axillary (armpit) region (cupping the latissimus dorsi).
6. Rock or shift the body weight into the right shoulder until a strong but comfortable stretch is felt in the right axillary region.
7. Hold for 30-60 seconds without pain. If pain is noticed in one focal location at the anterior/superior aspect of the shoulder, then reposition the shoulder into more precise supination and scaption.
You can also perform a similar stretch with the arm crossing the body (adduction).
Timothy DiFrancesco, PT, DPT, ATC, CSCS graduated from Endicott College in 2003 with his Bachelor’s degree in science/athletic training. While at Endicott Tim was a four year member of the varsity men’s basketball team. Tim immediately went on to the University of Massachusetts Lowell where he earned his Doctorate of Physical Therapy in 2006.
In 2007, Tim co-founded TD Athletes Edge, LLC, which offers a systematic, results-driven approach to performance training and rehabilitation. In addition to his work as President of TDAE he currently works as a physical therapist on Boston’s Northshore and is an adjunct faculty member at Salem State College. He recently accepted the position as the Head Athletic Trainer and Strength & Conditioning Coach with the NBA D-League Bakersfield Jam. Tim has a passion for working with athletes and patients of all levels to help them achieve their goals and reach their performance potential.
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I did a should flexibility test where i lie on the floor with my stomach on ground as with my whole body. I then had to put my arms infront of my head and hold a small stick and lift up, i could only get 9 inches while other people were getting around 20inches.Hopefully this exercise will work.
Great stretch! I have very tight shoulders and am super rigid around the scapula area. Doing those stretches brought to my attention just how tight I am. It’s a wonder that I don’t more of a problem that just being tight. I am definitely going to incorporate these stretches into my cool down.
I tired both methods and found differences but advantages to both. Thank you for sharing that with us 🙂 dave
hi Cressey , Cressey what books do you recommend for me to understand more about healthy shoulders, to make these associations do you do that I learn so much!
My hesitation with this stretch is the eccentric load it places on the muscles of the shoulder joint. My fear is this, in a weak or injured patient this stretch may place strain on the muscles, which in turn may exacerbate the problem being addressed. I believe this especially true if the patient has a shoulder impingement and/or spurs.
Eric, This is a great stretch and an excellent way to teach clients proper shoulder position.
It is always nice to see excercises recommended by several leaders in the industry. Helps to reinforce proper movement patterns. After all if we continue to teach our athletes how to move the rest is easy.
Joshua makes several good points and I agree that this technique is unlikely to offer the desired results.
1. Why use the body in a destabilized position to precariously “rock” the shoulder for an uncertain stretch!? This is likely to add an element of risk by creating tension–and further injury. 2. Muscles need to be relaxed rather than loaded to safely stretch; this set-up does not appear to offer this as an option. 3. It is unclear what the intended purpose of the Airex pad is–other than further destabilizing an already shaky position!
If stretching the shoulder joint muscles and capsule is the desired outcome, I would advise against this potentially risky technique altogether for injured or healthy individuals.
In response to Josh & Dominique I also agree with you that we should use our professional discretion as to when this would be appropriate. I like it for reaching that capsular tissue with a low load long duration stretch. I try to keep things simple: if it hurts don’t do it or reposition, if it is stretching in that inf capsular region without pain then do it for LLLD. The airex pad was found to be helpful to add leverage on the stretch of the capsule – it has nothing to do with destabilization in this case. Appreciate the comments guys and thanks again to Eric for providing the forum to have such a discussion.
This is great information and thank you for posting. I have always been active in sports and athletics, and have recently begun training in some of the olympic lifts (Overhead Squat, Clean & Jerk, Snatch, etc.). Never before in my life have I been limited in physical ability to perform a movement – very frustrating as you can imagine! I’m simply tight as a robot in my upper back and shoulders…
I’ve begun a daily regime of stretching to increase my flexibility, and will certainly add this to my routine.
Again, thanks for the excellent (and factually based!) information.
This stretch fixed my shoulder which had been semi-frozen for over 8 months – I couldn’t lift it up beyond 45 degrees from horizontal. I’d tried heaps of stretches but this one made a noticeable difference in 2 days and major difference in about 2 weeks. Very very happy.
My Osteopath had diagnosed that the ball of my shoulder was very tight and pushed forward but her work on it had not made any difference after 3-4 visits. Her diagnosis of inferior tightness led me to this site through my own searching. By the way this stretch hurt a bit and so I had avoioded anything like it previously because the advice was always – if it hurts stop doing it. In this case the advice was wrong – I had to do what hurt most to fix it. My shoulder has been fine now for over a year. Thanks very much for the one stretch that worked for me.
October 15th, 2009 at 9:34 am
I did a should flexibility test where i lie on the floor with my stomach on ground as with my whole body. I then had to put my arms infront of my head and hold a small stick and lift up, i could only get 9 inches while other people were getting around 20inches.Hopefully this exercise will work.
October 15th, 2009 at 10:06 am
thanks very much for that instruction about shoulder.
That has been one of my bigest limitation.
very much appreciation
iva
October 15th, 2009 at 4:15 pm
Great stretch! I have very tight shoulders and am super rigid around the scapula area. Doing those stretches brought to my attention just how tight I am. It’s a wonder that I don’t more of a problem that just being tight. I am definitely going to incorporate these stretches into my cool down.
I tired both methods and found differences but advantages to both. Thank you for sharing that with us 🙂 dave
October 15th, 2009 at 6:14 pm
I forwarded this to everyone with “jacked” up shoulders (myself included)-the powerlifting world thanks you!
October 15th, 2009 at 6:36 pm
hi Cressey , Cressey what books do you recommend for me to understand more about healthy shoulders, to make these associations do you do that I learn so much!
October 15th, 2009 at 8:22 pm
Rafael,
I actually list a few of my favorites on my Resources page:
http://ericcressey.com/resources
The Athlete’s Shoulder and Physical Therapy of the Shoulder are both great.
October 18th, 2009 at 10:09 pm
My hesitation with this stretch is the eccentric load it places on the muscles of the shoulder joint. My fear is this, in a weak or injured patient this stretch may place strain on the muscles, which in turn may exacerbate the problem being addressed. I believe this especially true if the patient has a shoulder impingement and/or spurs.
October 19th, 2009 at 9:59 am
Eric, This is a great stretch and an excellent way to teach clients proper shoulder position.
It is always nice to see excercises recommended by several leaders in the industry. Helps to reinforce proper movement patterns. After all if we continue to teach our athletes how to move the rest is easy.
October 21st, 2009 at 7:44 am
Joshua makes several good points and I agree that this technique is unlikely to offer the desired results.
1. Why use the body in a destabilized position to precariously “rock” the shoulder for an uncertain stretch!? This is likely to add an element of risk by creating tension–and further injury. 2. Muscles need to be relaxed rather than loaded to safely stretch; this set-up does not appear to offer this as an option. 3. It is unclear what the intended purpose of the Airex pad is–other than further destabilizing an already shaky position!
If stretching the shoulder joint muscles and capsule is the desired outcome, I would advise against this potentially risky technique altogether for injured or healthy individuals.
November 4th, 2009 at 7:38 am
In response to Josh & Dominique I also agree with you that we should use our professional discretion as to when this would be appropriate. I like it for reaching that capsular tissue with a low load long duration stretch. I try to keep things simple: if it hurts don’t do it or reposition, if it is stretching in that inf capsular region without pain then do it for LLLD. The airex pad was found to be helpful to add leverage on the stretch of the capsule – it has nothing to do with destabilization in this case. Appreciate the comments guys and thanks again to Eric for providing the forum to have such a discussion.
TD
December 2nd, 2009 at 2:36 pm
Eric & Tim,
This is great information and thank you for posting. I have always been active in sports and athletics, and have recently begun training in some of the olympic lifts (Overhead Squat, Clean & Jerk, Snatch, etc.). Never before in my life have I been limited in physical ability to perform a movement – very frustrating as you can imagine! I’m simply tight as a robot in my upper back and shoulders…
I’ve begun a daily regime of stretching to increase my flexibility, and will certainly add this to my routine.
Again, thanks for the excellent (and factually based!) information.
JM
July 30th, 2010 at 11:17 pm
isn’t the glenohumeral joint capsule already lax inferiorly? why would we want to further stretch the area?
August 17th, 2011 at 12:16 am
This stretch fixed my shoulder which had been semi-frozen for over 8 months – I couldn’t lift it up beyond 45 degrees from horizontal. I’d tried heaps of stretches but this one made a noticeable difference in 2 days and major difference in about 2 weeks. Very very happy.
My Osteopath had diagnosed that the ball of my shoulder was very tight and pushed forward but her work on it had not made any difference after 3-4 visits. Her diagnosis of inferior tightness led me to this site through my own searching. By the way this stretch hurt a bit and so I had avoioded anything like it previously because the advice was always – if it hurts stop doing it. In this case the advice was wrong – I had to do what hurt most to fix it. My shoulder has been fine now for over a year. Thanks very much for the one stretch that worked for me.