Scapula Positioning

  • September 26,2017

The positioning of the shoulder blade (Scapula) and co-ordinated efforts of its surrounding muscles play an important role in allowing adequate shoulder stability, positioning and efficient movement. When these muscles are not co-ordinated they prevent the scapula from acting as a stable base for arm movement. The shoulder girdle thrives on this co-ordination, without which, shoulder mechanics become altered in a phenomenon called 'Scapular Dyskinesis'. This may result in the development of abnormal stresses at the front of the shoulder, compression (impingement) of the rotator cuff, and sets the shoulder girdle up for a poor mechanical advantage.1,2

How does Scapular Dyskinesis develop?

The joint made by the scapula and the rib cage is known as the 'Scapulothoracic Joint'. Due to there being no bony connections between these surfaces, the scapulothoracic joint is highly dependent on the surrounding muscles for stability and efficient movement around the rib cage.1

Weakness or un-coordination of these surrounding muscles may cause a 'winging' of the scapula, a hallmark feature of scapular dyskinesis:

While the scapula serves as an attachment site to many muscles of the upper body, the main muscles that serve as stabilisers include: The Trapezius, Serratus Anterior, Rhomboids and Levator Scapulae. (For this blog, we will be discussing a tiered approach to targeting the mid/lower Trapezius and Serratus Anterior, which are prone to weakness.)

Scapular dyskinesis can be assessed within the clinic by observation or instructing the patient to flex or raise their arm in front of them above their head. This can be highlighted further by performing this with a 1-2kg dumbbell in hand.

How can it be managed?

Below are some progressive exercises that help to target the mid/lower Trapezius and Serratus Anterior. Some of these exercises have been adapted from a rehab protocol which had shown significant improvements in patients with shoulder impingement3:

Serratus Anterior:

The Serratus Anterior provides a 'suction cup' effect on the scapula against the rib cage.1 It's main role is to stabilise the scapula during overhead movements and allows a forward glide against the rib cage (retraction).1

Protraction holds:

To begin with, it's important to understand the subtle motion made by the Serratus Anterior. To do this you simply need to focus your attention on pushing your shoulder blades forward (protraction). To help visualise this, it may help to have your arms out in front, and without leaning or bending at the elbow, try and reach forward just with your shoulder blades. Aim for 8-10 repetitions. The focus of this exercise is control, should fatigue set in, pause and reset to ensure form is maintained.

Push-up Plus:

The Push-up Plus is a progression from Protraction holds in that it introduces resistance into the motion. This exercise is best defined as being the very last stage of a push-up where the shoulders are pushed forward (protracted). A Push-up Plus may be performed against a wall or in a quadruped position as shown below. Aim for 8-10 slow and controlled repetitions ensuring that the elbows are straightened throughout the exercise.

The plank takes the push-up plus and adds a further challenge with additional body weight to support and maintaining both scapula protraction and abdominal contraction in one. Again, control is most important during this exercise. Begin with 10-30 second holds progressing to 1 minute and above. Being mindful of maintaining scapula protraction and abdominal contraction is important and it may be useful to have a partner cueing you as necessary.

Mid/lower Trapezius:

The Trapezius has many fibres aligned in several directions. This structure can allow the scapula to be stabilised in many planes of movement. The primary function of the middle and lower portions of the trapezius is to allow sufficient tilting and upward rotation of the scapula to accommodate overhead movements.1

Retraction Holds: 

As we have performed previously with the Serratus Anterior, it is important to first learn how to activate the mid/lower Trapezius. To do this, draw your shoulder blades back and down. It may be helpful to try and visualise tucking your shoulder blades into the back of your pants. Aim for 8-10 repetitions pausing for 3 seconds with each


This exercise is a progression from the Retraction Holds with the addition of dynamic arm movements in I,T,Y and W positions. This can be performed on a bench as shown or on a swiss ball. To perform these exercises; retract both scapula back and move through the positions as shown below. While in each position, draw both arms backward squeezing the shoulder blades together even further, aiming for 5-8 repetitions at each range.



Y to W:While maintain scapula contraction, draw your arms from a Y to W position.

TheraBand pull-aparts:

Next, we will add a TheraBand to provide extra resistance against retraction. With 'TheraBand Pull-aparts' you will begin by retracting the shoulder blades. From here, keeping your elbows straight, pull the TheraBand apart working from navel, chest to overhead heights. At each level, separate the TheraBand for 8-12 repetitions. This exercise allows dynamic control of the mid/lower trapezius in these ranges.

Navel Height:

Chest Height:


Further info:

When a patient comes in suffering from shoulder pain, one region I like to look at is the Scapulothoracic Joint and the co-ordination of the shoulder blade. Whether it is due to injury or deconditioning, poor scapulothoracic control can be a strong contributor to developing shoulder pain. By retraining the necessary movement patterns alongside treating the painful site itself, patients respond very well to therapy. This gives our clients a chance to take control of their injury through performing these exercises for themselves. If you or someone you know is suffering from shoulder pain, why not book with us at Mortdale Family Chiropractic on 8068 4455 or BOOK ONLINE today!


1) Paine R, Voight ML. THE ROLE OF THE SCAPULA. International Journal of Sports Physical Therapy. 2013;8(5):617-629.

2) Voight ML, Thomson BC. The Role of the Scapula in the Rehabilitation of Shoulder Injuries. Journal of Athletic Training. 2000;35(3):364-372.

3) Moezy A, Sepehrifar S, Solaymani Dodaran M. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Medical Journal of the Islamic Republic of Iran. 2014;28:87.