I would recommend that you do exercises that help to quiet down the muscles that depress and downwardly rotate the scapula (particularly dominant rhomboids will downwardly rotate the scapula). You also want to watch that the client is not over-working their lats (which will drive the glenohumeral joint downward).

So, start to wake-up the trapezius muscles and serratus anterior. Do this by giving exercises that encourage upward rotation and elevation of the scapula and minimize the over-use of rhomboids and lats. Then, re-educate the clients movements in order to achieve good balance of all the scapular muscles in a neutral position, making sure mid and lower trapezius are working to place the scapula centered rather than in downward rotation or depression. In addition, you want to encourage the client to set their glenohumeral joint by using their rotator cuff muscles rather than over-empasizing the connection with lats.

Exercises that may help:

Side-lying overhead push-thru:  Lay the client on his side with his hand on the push-thru bar. Then have him push the bar overhead, watch that he is creating upward rotation and elevation with the scapula. He or she may feel a big stretch on the lats. Help he or she guide the movement of the scapula.

Superman:  Lay prone on a box facing the footbar on the reformer. The bar will be down one rung from the top with 1 spring. Have the student push the bar away using his scapula to create the movement. Watch that he is getting pure elevation and upward rotation rather than protraction and the thoracic and lumbar spine stay stable. Make sure the glenohumeral joint stays centered and doesn’t drop forward during the movement.

Mermaid: Work on the patterning of bringing the arm overhead and watch that he or she is not depressing or downwardly rotating the scapula to initiate the movement- again, you may need to guide that movement for the student- encourage upward rotation of the scapula during the movement. If he or she has been over-working rhomboids or lats there may be a lot of resistance on the scapula.

Rotation prone on chair:
Getting more range of movement into protraction will help to diminish the overuse of rhomboids. Watch that the scapula glides properly along the ribcage and the client doesn’t side bend but creates true rotation of the spine.

Side arm preps on reformer:
These will be great to encourage proper stability of the scapula and glenohumeral joint. Make sure that the student’s bones look centered and keep the weight light (1/2 spring is good). The shoulder should look “square” and “placed” rather than depressed. Make sure he or she is placing and moving by using the rotator cuff rather than lats or pecs. Melanie often speaks of “fluffy armpits” to keep a sense of openness in the armpit rather than gripping down into the lats.

Push-up on the wall:
Again, encourage centering the bones rather than overworking rhomboids and lats encourage mid and lower trapezius support. This could progress to more challenging weight bearing exercises so long as the joints and bones are centered.

Remember, always watch that the head is staying centered over the spine and not going into forward head posture during all the exercises listed above.

I hope this helps! There are hundreds of others that you could do, but I hope these give you a good foundation to be more creative with the other exercises you know. Also, Melanie will be doing a 3 day upper extremity workshop on September 17-19, 2010 (we haven’t even announced it yet) that you may be interested in participating in. This may be a great hands on workshop for you to learn how to work better with shoulder, scapula and cervical spine.

Take Care, Leslie