scapula during press up

Hi,

I am a personal trainer and have a particular problem with one of my clients. It
occurs when I get him to go into a full press up position. He can’t keep his scapula
depressed and retracted, instead his scapula are very wide apart and sticking out.
If he tries to do a press up his thoracic area collapses down, his head and neck
juts forward and his scapula come together. I have done loads of shoulder stability
work, TVA, lower and middle trap work, rhomboids too. What is going on? From my research so far in am thinking he has weak anterior serratus. Any good anterior activation exercises for me? I am constantly telling him to see a physio which I think he will eventually do. I have noticed in general allot of people can stabilise there shoulders, but not there TVA at the same time and vice versa. What is that all about? Some people out there might think as a trainer I should know these things already, in my defence I will say that we all start somewhere and I am doing my best to learn and progress. I am discovering a passion for corrective exercise but I find the shoulder complex very difficult! Hope someone can help.

Thanks.

hi
i feel there is an imbalance in the serratus anterior and trapezius force couple.there is a need to regain the balance

Hi Linbin,

Thanks for your reply:) Do you have any good methods to strenghen that force couple?(hope thats not too cheeky) or can you recomend any books that cover this subject.

hi friend
therapeutic exercise-moving towards function by Hall will be helpful to you

hey,

Thanks for the recommendation, i have ordered a copy.Also i want to get a book on Kinesiology, any ideas.

cheers

You could try regressing the press up's for a while until your client achieves better scapula control. Try getting your client to set his/her scapula and hold it in a retracted position whilst performing a press up on their knees or if they cannot manage this, try some in standing against a wall. With regard to corrective exercises for scapula control keep the wieght light and the movements quite slow performing lots of reps with the scapula set in a neutral position. Also regular stretching around the chest may help especially if your clients shoulders are protracted.

Hi I would agree with Robert, try reducing the intensity and give the patient an increased awareness of thier scapula position.

However, if he has no symptoms you might experience problems as he has adapted to this position and even though it is not 'ideal' it is functional for him. Most physios treat this problem in the presence of pain so its easy to justify changing the position (I remember changing a students shoulder position once as the head of humerus was too forward-she experienced pain in this new position even though it was anatomically better!).

Hallamshire Physiotherapy

Jedi, I am sure you have most things under very good control already , however the suggestion from your description does fit a picture where serratus anterior may be less than strong. In a physio clinical setting, I may target the use of this muscle under load by using various forms of feedback. The most valuable of which comes in a little box with batteries which , very likely , your local physio may have.
Bio feedback works well when the neurological connections are essentialy unimpaired, and weakness is the primary feature. The device is easily sorted out and I often lend mine for periods where at home practice is the way forward. Usually I take a session to both instruct in the devices best use , along with suggestions for positions and movements that are likely to involve the target muscle. Any isometric hold of the shoulder forcing a push up type action ought to work for SA.
Cheers
Why not check with your local physio, he/she may be a turn out to be a good ally.

For Scapular control see Doyles "Functional Training for Sports". He describes the following sequence....

Have your clients lie prone on the floor or a flat bench. Start the exercise in the "Y" position (yes as per "the village people") with thumbs pointing up, contolled movement to the "T" position (thumbs up), contol to "W" position (i.e. arms adducted, elbows flexed, Hands switch to PRONE) and then to the "L" position (arms adducted, elbows move to 90 degrees, hands prone)........This sequence proves difficult for many and may well expose some of the weakness' you suspect. Good luck

Again lying Prone
"Y"
"T"
"W"
"L"
repeat