The Shoulder Mobility Issue that is Often Missed

Hi guys, I’m Mai-Linh Dovan, Certified Athletic Therapist and Founder of Rehab-U Movement and Performance Therapy.  

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This week, we’re going to talk about shoulder extension mobility. 

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So when we talk about shoulder mobility, we tend to focus on overhead mobility, right? And we’re thinking about that flexion range of motion, that abduction range of motion. And one of the ranges of motions that we don’t stop to think about sometimes is shoulder extension. 

Okay, why is shoulder extension important for things like bench press, push-ups dips, muscle-ups?  If we’re talking about CrossFit, what’s going to happen is when the hands come close to the chest, if the athlete doesn’t have good shoulder extension, the scapula is going to tilt forward to make up for that missing range of motion and they’re going to wind up in that rolling forward position, okay? 

Now, there are a number of ways that you might see this, you might see it during movement, or you might use something like the trunk lowering test in your assessments. And that’s where you might kind of see that shoulder rolling forward as someone comes down in a push-up. I’m going to show you what that looks like.

Caro’s going to come in and demonstrate for us. So she’s going to do a good trunk lowering test where she just lowers down to the ground and you can see she’s nice and stable. Now, with some people, what will happen is as they get closer and closer to the ground, the shoulders will start to dump a little bit more forward. Okay. They’re going to get a little bit more shrug, a little bit more retraction. She actually has a hard time doing it wrong, which is a really good thing. 

Okay? So what I want to talk about as well, in the level 1 course (if you’ve taken our level 1 course, and if you haven’t, you should check it out) we talk about anterior humeral glide or the anterior humeral glide screen, which is a test that we use where we have someone pull on the elastic with very little resistance to see whether that shoulder dumps forward. And we use that as a functional test to see if they can maintain good, scapular control. I don’t want you to confuse the terms anterior glide. In the glenohumeral joint it is actually normal that the humerus needs to glide anteriorly. That’s an accessory movement. And it needs to do that for you to get extension range of motion. And also for external rotation range of motion that test we use is to see if people can control that movement, okay? So there may be a question that people’s shoulders are dumping forward on things, like bench, press, push-ups, and so on because they don’t have the scap control. But it could also be because they don’t have the shoulder extension. 

So we’re going to check out how we look at that restriction. I’m going to get Caro to come over here again. So let’s say we looked at Caro whose trunk lowering test, and we’ve seen her work in the gym and we’re seeing that shoulder dump forward, I want to know: Does she have a restriction? I’m going to go and see what her extension range of motion is like, I’m just going to show you guys one side here, but let’s get that other arm by your side as well. So, what I’m going to do is I’m actually going to lift her up a little bit because I don’t want her to be in this resting position because of gravity, the scapula is already being pulled forward, right? So I’m just going to lift her up to stabilize her and then I’m going to check to see what her extension range of motion is like.

Typically you want to get about like a 45 degree angle, 45 to 50 degrees of that extension, okay? Now she doesn’t have a limitation in that extension. 

Now, if you’re a therapist, you could also get your hands on and check out the articular capsule and see if there’s a restriction in the anterior capsule, right? But she doesn’t have a restriction in her passive range of motion. 

So, if I’m seeing the shoulder dumping forward in her active movements, I know that it’s more of a scap control issue, okay? But let’s say there was a restriction. What kind of exercises could you give someone? 

So if someone actually did have a joint restriction in the joint capsule that was limiting, their extension range of motion, obviously, as a therapist, you could get your hands on them and mobilize that and that’s always going to be effective. But what’s also effective is being able to give people self mobilizations so that they can do a little bit themselves when they’re not with you, right? So if they’re comfortable doing it then, go right ahead and give people self mobilizations. I like to find things that are simple for people to understand especially if you have people who are a little less body aware.  One really simple anterior capsule mobilization, so an anterior Glide mobilization for the shoulder is just an elbow prop mobilization, where Caro is just propped up on her elbows and she’s moving around. And you can actually let the weight of your torso sink into your shoulders. So we actually want to use the lever of her elbows, pushing that head of the humerus anteriorly and she’s resting there and she can move around in circles and side-by-side to kind of move that around in there, but letting the Torso rest into the elbows. 

So this is a really simple and helpful anterior glide self mobilization. 

But remember that you never want to just stop at creating space or increasing range of motion, right? Mobility is about range of motion, motor control and strength. So you want to make sure that now that the person has gained that range of motion or gained that space in the anterior joint that they’re also going to be able to control that scapula tilting forward because that’s the pattern that they’ve had now for so long. 

So once we’ve done mobilizations, we want to to work in extension and we want to work close to end range extension, because that’s where the tendency will be for the scapula to anterior tilt. So we’re going to get Caro far enough from the wall that she’s at about her end range of extension. And then we’re having her push isometrically into the wall and making sure that she’s not letting that scap dump and drive forward. Okay. Now, sometimes for people, if you get them to their end range of motion right away, it’s going to be a little bit difficult. So then you can back them a little bit up to the wall, and then do the same in a little bit of a more limited range of motion, but you want to work your way towards end range of motion. 

And then, another great exercise is just a simple dumbbell extension. Why an isometric hold: I like to use isometrics. We’re really trying to create awareness of that position, so what better way to do that than hold the position, a slightly forward position, and then she’s going to bring the dumbbells back, getting into shoulder extension and making sure that she controls that, and she can hold there for maybe again 5 times 10 seconds, maybe three sets of 30 seconds.  You can play around with those parameters based on where the person is at, how much they’re able to handle, quality versus quantity. So, how long can they hold a quality position if five times ten? Is going to give more quality than struggling to try to hold 30 seconds, and that’ll be your go to. 

Alright, guys. So overhead mobility is important and I talked a lot about flexion and abduction, but remember that extension is important as well when doing things like bench presses, and push-ups, and dips, and muscle ups. So, we want to have that shoulder extension range of motion. So now you’ve got tests to check whether there’s a restriction, tests to check whether it’s just a control issue, and a strategy to clear up any restrictions if there are and then build that capacity to move without dumping the shoulder forward, which by the way, you should do. Also if the person didn’t have a restriction, but dumps the shoulder forward, those two last exercises that I showed you will be useful for getting that control. 

We’ll see you next week.

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U