Today, like many other days in the week, I had the opportunity to hang out with my niece and nephew, Grace and Nathan.
Most of my time spent with these kids and their parents generally turn out to be lessons in parenting for when my own children come around but this day was somewhat different. This day was a lesson in scapular stability.
For those of you in the musculoskeletal rehabilitation setting, scapular stability will probably be an everyday concept used in your practice. Additionally, letters such as Y, T, W, and L and words such as Blackburn may be commonplace as well. But how many of you think of the word quadruped when considering the concept of scapular stability?
Well, seeing Grace and Nathan spend close to 90 minutes crawling around the floor pretending to be puppies immediately made me think of how much scapular stability they're likely to have when they get older.
You see, playful childhood activities such as creeping and crawling promote the development and integrity of the scapulothoracic joint and lacking such stability often is a result of abnormal central nervous system development. Surely, the sedentary lifestyle may contribute to such dysfunction but it should be noted that this degree of maturity is never attained in 30% of children whereby faulty posture and muscular imbalances begin at early stages of their development (Kolar P, Rehabilitation of the Spine)...or lack thereof. Therefore, the reason I prefer quadruped-based activities for scapulothoracic stability over contemporary exercises such as YWTLs and Blackburns is due to their closed kinetic chain, neurodevelopmental nature. Isn't Janda's test for scapular winging performed in a closed kinetic chain position with the hands on the floor? Now I recognize that we, as humas, are bipedal in nature however, the development of motor control is largely based on the concept of the "Punctum Fixum".
The “Punctum Fixum” as taught within DNS by the Prague School are the specific areas where movement begins. The direction of muscle pull, in general, project toward these regions and the choices of support zones that our body makes depend on the initial position of that body. Thus, such “fixed point” will be dictated by whether a specific movement pattern is of the open chain or closed chain varieties. Additionally, as Dr. Kolar states in Dr. Liebenson’s text, “Rehabilitation of the Spine“,
“The muscle may not be weak in itself, but it may not function well because its attachment point is insufficiently fixed. A muscle must have a punctum fixum.”
So when it comes to the playful activity of crawling like a puppy, the punctum fixum, the hand, creates the support zone upon which the body is pulled toward. Therefore, in order for the body to locomote itself forward, it must create stability in the scapulothoracic region in an instinctive fashion. And isn't natural, subconscious movement what we're truly after in rehabilitation? I mean, have you ever thought of the "birddog" exercise as a scapular stability exercise?
So next time you rehabilitate a shoulder for dysfunctions in scapular stability, ditch the YTWLs and get your patients and athletes on the floor to act like puppies. In all seriousness, getting your patients quadruped may truly be a better way of promoting scapular stability. You already test it that way (pushup on the floor or against the wall) so why don't you treat it that way? There are many ways of doing so choose any exercise you wish. But just to get you started, here are a few examples:
Take note that the first exercise above is the correct pattern while the second is the faulty pattern. The correct pattern promotes scapular retraction throughout and respiratory control at end range. You are welcome to follow this up with unilateral thoracic rotation with the hinge point at the scapulothoracic region rather than the spine (proper) as commonly seen in mobility-based exercises.
This exercise that Tony is performing here obviously isn't quadruped but I think you get my point.