Exercises to Normalize Scapular Kinematics

By Tejal Ramaiya, DPT, CSCS

Most experienced clinicians would agree that patients with shoulder pathology commonly also exhibit abnormal scapular kinematics.  Decreased scapular upward rotation, external rotation, and posterior tilt are typical of this scapular dysfunction.  A study by Oyama, et. al. studied the effects of widely used scapular stabilization exercises on the kinematics of the scapula to hone in on which exercises provide the most significant effects on the scapula.

Prone scapular retraction exercises were performed by 25 healthy adults:

Exercise 1

Prone, shoulders at 90 degrees abduction, neutral humeral rotation (palms facing floor)

Exercise 2

Prone, shoulders at 90 degrees abduction and external rotation (thumb toward ceiling)

Exercise 3

Prone, shoulders at 120 degrees abduction, neutral humeral rotation (palms facing floor)

Exercise 4

Prone, shoulders at 120 degrees abduction and external rotation (thumb toward ceiling)

Exercise 5

Prone, shoulders abducted to 45 degrees with 90 degrees elbow flexion

Exercise 6

Full extension

Participant performing exercises 1 through 6

Scapular kinematics were measured using surface EMG.

Exercises 2 and 5 resulted in the most significant movement in scapular external rotation, upward rotation, posterior tilt, and retraction compared to all the other exercises. If the goal of treatment is to normalize motion in a pathological shoulder which also demonstrates scapular dysfunction, performing these scapular retraction exercises may be beneficial.  Clinicians should choose their exercises appropriately depending on pre-existing conditions, strength deficits, and available range of motion.  In my clinical practice I refer to these exercises as T's and W's to help the patient envision the position in which their arms should end up.

Click on the videos below to see the correct way of performing these exercises.

Prone W

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Prone T (With Shoulder External Rotation)

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Reference
1. Oyama S, Myers J, Wassinger C, Lephart S. Three-Dimensional Scapular and
Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises
J Ortho Sports Phys Ther 2010; 40(3): 169-179.

Tejal Ramaiya is National Sales Representative at Force Therapeutics, a web-based comprehensive patient management solution for physical therapists. She owns a private physical therapy practice in New Jersey where she treats orthopedic, sports and spine patients.