Assessement of scapular position.

Hello everybody,

I am trying to educate myself on biomechanics of human body, but the more I read, the more realize that I need... to read more. It seems like it is a never-ending cycle. Some dysfunctions of the body, which are shown in the pictures (for example, lumbar lordosis etc.), are quite clear (not always) and it is possible to find treatment for them, but when the things start to get really confusing, it seems that all my reading and trying to understand things just vanish. So I would like to get some help from you in this particular case, i.e. two photos of a friend of mine (on request), who started to go to the gym a couple of months ago. Unused parts of the body (just kidding) are painted in black for the privacy reasons.

http://img.photobucket.com/albums/v491/anncia/1-1-1.jpg
http://img.photobucket.com/albums/v491/anncia/2-1-1.jpg

In my opinion, the problems are those of a regular kind: abducted scapulas, internally rotated arms, a lack of thoracic extension and depressed right scapular. Or are these winging scapulas in some way? As you see, I am not sure about this situation and your help would be greatly appreciated. It looks like I am having some kind of similar problems as he does, so I think I will post my photos when I get the opportunity to do so. I know it would be a better idea to go to a physiotherapist, but there aren't any good PTs in our area.

Hi Sadman

You are not alone. The more I read, the more I realise that there is more to read. However, there is nothing to worry about because most people are like that because learning is a never ending process and I do not think anyone can claim to know everything.

This is what my opinion is of your friend's photos.

Normally, there should be a 2.5 cm gap between the spine and each scapula. If you look at the photos again, you will see that the right scapula is closer to the spine than the left. In other words, left scapula is more abducted than the right.

Additionally, the muscles around the right scapula seem to be more active than the left. Look at the right upper trapezius muscle and see how prominent it is.

His shoulders do look internally rotated because the biceps are facing medially. This is a common problem with people who go to the gym because most of us want great pectorals. Have you strength tested infraspinatus on both sides?

Also, look at the distance between his arms and the trunk. Right arm is farther from the trunk than the left which to me looks like his right shoulder is very slightly abducted and that would explain active upper right trapezius on the right side and more shoulder abduction on the right. I would not be surprised if his supraspinatus is active too because this muscle is usually responsible for initial 15 degree of abduction (debatable).

Hope that helps.

Do I have your permission to use your photos for discussions with my colleagues and students?

I am not related to physiotheraphy in any formal way, I am a guy who effed up his body while doing sports improperly, i.e. not knowing the biomechanics of a human body. So know I am trying to educate myself on this, though it is too late.
Anyway, my friend probably has problems with infraspinatus and all other rotator cuff muscles, which is quite usual situation nowadays. I haven't tested him, because I don't know how to do it (though google suggests some tests).
Anyway, thanks for your observations and for your reply. Can you recommend any specific exercises to solve these problems? I think that stretches for the anterior part of the body (pec minor, front deltoid etc.) and strengthening the scapula adductors, rotator cuff muscles and increasing extension in thoracic spine would be a good place to start building the base for further more precise corrections.
When the photos are thrown into the internet, they become the property of the internet, so yes, you can use them wherever you want. But anyway, thanks for the honesty. If you get any ideas from your colleagues and students about this particular case, post it here, because any feedback is appreciated.

Head to your nearest physio.