EXERCISE TECHNIQUE
Bilateral Scapular Retraction and Shoulder External Rotation With Resistance Bands
TYPE OF EXERCISE
Bilateral scapular retraction (squeezing the shoulder blades together) with shoulder joint external rotation (BSRSER) with resistance bands and its variations can be performed in either the standing, sitting, or supine/hook lying (lying face up) positions is a basic-level exercise and is intended to strengthen muscles within the posterior shoulder girdle.
MUSCLES INVOLVED
The infraspinatus, teres minor, deltoid (primarily the posterior fibers), trapezius (middle and lower fibers), and rhomboids (Figures 1A, B) are activated (see Video 1, https://links.lww.com/FIT/A83).
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Figure 1: A. Muscles activated during the bilateral scapular retraction and shoulder external rotation and Brugger relief exercise. B. Bilateral scapular retraction with shoulder external rotation.
BENEFITS OF THE EXERCISE
The BSRSER exercise and its derivatives or variations can activate muscles responsible for control of upper body posture (1,2), optimal positioning of the scapula on the thorax, and control of the shoulder girdle or complex during upper extremity activities (3,4). Similar in muscle activation to the previously discussed prone Y (5) and prone T exercises (6), the BSRSER exercise differs in that the upper arms remain in the “neutral position” at the side of the body with the elbows flexed to approximately 90 degrees and requires no elevation or lifting of either the shoulder girdle or joint, respectively (7). The BSRSER exercise and its derivatives also are easy activities to perform at a desk or computer workstation. The BSRSER exercise will be described in this article. In addition, one of its derivatives, the Brugger relief position exercise (BRE) also will be described briefly in a subsequent section.
INTRODUCTION
The BSRSER exercise can be applied in a number of settings for clients with varying levels of strength, physical fitness, and training experience. The neutral, arms-at-sides position used during BSRSER exercise minimizes upper trapezius muscle activation and stimulates higher levels of posterior shoulder girdle muscle activity, respectively (4). Exercises that condition the posterior shoulder girdle muscles are important parts of postrehabilitation, athletic performance enhancement and general injury-prevention programs (1,3,4,8–15). Functional imbalances between the upper trapezius and the lower trapezius, middle trapezius, and the serratus anterior muscles have been associated with conditions like shoulder instability and subacromial impingement syndrome, which can cause shoulder pain and dysfunction (1,3,4,8-15). This article is not meant to help readers diagnose or treat shoulder pain or injuries. Clients should be free of shoulder or upper extremity injuries and related pain before performing these exercises. The onset of injury-related pain warrants termination of exercise and immediate client consultation with a physician, physical therapist, or other health care provider. The combination of a short lever arm position created by flexing the elbow and elimination of any shoulder elevation distinguish it from other exercises that strengthen posterior shoulder girdle muscles and can be a good precursor to performing more advanced exercises like those within the prone T-Y-I-W series. (The starting/ending and outward pulling phase positions appear in Figures 2A, B). Videos of the BSRSER exercise with resistance bands and with resistance band loops, respectively, can be viewed here (see Video 2A, https://links.lww.com/FIT/A84, and Video 2B, https://links.lww.com/FIT/A85).
Figure 2: A. Starting/ending phase of the scapular retraction with shoulder external rotation exercise. B. Pulling/outward phase of the scapular retraction with shoulder external rotation exercise.
Aside from the standing or seated positions, the BSRSER exercise can be performed in the supine hook position (lying on back with hips and knees bent approximately 90 degrees) on either a matted floor or (treatment) plynth table. When performed in the supine position, a small pillow under the head and rolled towels under the upper arms can ensure comfortable support of the cervical spine (neck) and shoulder girdle, and the padded floor or table can facilitate in-line stabilization of the cervical and thoracic (neck and upper back) spines. The hook lying position can enhance alignment and provide additional support to the lower back. (The BSRSER exercise appears in Figure 3).
Figure 3: The bilateral scapular rotation with shoulder external rotation exercise performed in the supine hook lying position.
Videos of the BSRSER exercise in the supine position can be viewed here (see Video 3, https://links.lww.com/FIT/A86).
BILATERAL SCAPULAR RETRACTION WITH SHOULDER EXTERNAL ROTATION IN THE NEUTRAL POSITION (THE "BSRSER EXERCISE")
Starting Position/Phase
When sitting or standing, maintain throughout the exercise an upright trunk position with the top of the sternum raised upward, chin tucked in slightly, and ears aligned with the shoulders, elbows, and hips. The shoulders should be relaxed and no shoulder girdle elevation should occur during the exercise. Position the arms at the side of the body so that the elbows are pressing gently against the midline of the trunk/torso just below the ribs and just above the hips. Rolled towels placed between the medial humerus (upper arm) and the trunk/torso can ensure comfort within the shoulders and provide the client with additional tactile feedback to ensure they are retracting (squeezing together) their scapula throughout the exercise. Elbows should be at and remain in 90 degrees of flexion throughout the exercise. Forearms should remain in a midprone, thumbs up position (3,4,7). A resistance band should be either grasped or looped around each hand so that mild tension occurs in it before the start of the exercise. Alternatively, a resistance band loop can either be grasped or wrapped around the hands. Clients lacking the conditioning necessary to comfortably maintain the position can either perform this exercise in the supine position (lying on the back) or by resting their arms on a smooth table, counter, or plynth/treatment table while maintaining the proper exercise position and alignment (8,9,13,16). (Anterior and posterior views of the starting and ending phase positions appear in Figure 2A).
Outward Pulling Phase
By concentric actions of the lower trapezius, middle trapezius, rhomboids, infraspinatus and teres minor, and posterior deltoid, the scapula are retracted and the upper arms (humerus) are maximally externally rotated while maintaining light pressure with the elbows against the midline of the trunk at a point between the bottom of the ribs and the top of the hips. The forearms stay approximately parallel with the floor throughout the exercise. The scapula and arms are held in this position for a count of three. Clients are prompted to keep their elbows firmly against their sides to avoid raising/elevating their shoulders, straightening their elbows, or allowing their arms or forearms to pass behind their torsos. The arms-behind-the-torso position can increase stresses on the anterior shoulder joint (11,12,14). Clients should exhale during the pulling outward phase and inhale during the return phase of each repetition. External loading should never prevent clients from performing each exercise in a controlled manner. (The outward pulling phase position appears in Figure 2B).
Inward Recovery Phase
The arms and scapulae return to the starting position in a controlled manner by eccentric actions of the middle and lower trapezius, rhomboids, infraspinatus, teres minor, and posterior deltoid (8,9,11,16). (The inward recovery phase appears in Figure 2B).
The entire BSRSER exercise sequence performed alternatively with a resistance band loop appears in Figure 4.
Figure 4: The bilateral scapular retraction with shoulder external rotation exercise performed with resistance band loops.
Exercise load and intensity selection can be based on the individual goals of each client (13). Although lighter resistance and higher repetitions have typically been recommended for scapulo-humeral stability exercises that require significant movement control, results from a few studies suggest that it might not be necessary to limit the amount of resistance used with some exercises if tolerated and if performed properly in a controlled manner by healthy individuals without a history of shoulder pathology (13,17,18).
ALTERNATIVE EXERCISE
The Brugger relief position is a variation of the BSRSER exercise and can increase posterior shoulder girdle postural and stabilizer muscles. It resembles the BSRSER exercise except that the forearms remain in a supinated (palms up) position, with the wrists and fingers slightly extended and abducted (spread apart), respectively, while the elbows extend during completion of the outward pulling phase. The shoulders are extended and the scapulae are retracted (2,19). The outward pulling phase with the elbows extended is held for approximately 3 seconds before the recovery phase, which consists of a gradual and controlled return to the starting position. Clients should exhale during the pulling outward phase and inhale during the return phase of each repetition. External loading should never prevent clients from performing each exercise in a controlled manner or by achieving full shoulder external rotation extension and scapular retraction. The BRE can be performed with resistance bands in the hands or with a resistance band loop. An upright trunk with the neck and lumbar spine in a neutral position should be maintained throughout the exercise. Clients who are deconditioned can perform two or three repetitions at a time with short rest periods to enable them to accumulate a full set of repetitions. The BRE can be performed at a desk or computer workstation to condition upper body postural stabilizing muscles. (The BRE with a resistance band appears in Figure 5.) Videos of the BRE can be viewed here (see Video 4, https://links.lww.com/FIT/A87).
Figure 5: The Brugger relief position exercise.
In addition, the BRE can be performed in a supine hook lying, seated, or standing position. Clients also can rest their arms on a table and slide their arms across the table surface when performing the BRE in a seated position to reduce fatigue in the shoulder region (see Video 5, https://links.lww.com/FIT/A88). Anterior and posterior views of the BRE performed with resistance band loops around the wrists appear in Figures 6A and B, respectively.
Figure 6: A. Anterior view of the BRE with a resistance band loop. B. Posterior view of the BRE with a resistance band loop.
SUMMARY
The BSRSER exercise and its derivative, the BRE, and their variations are intended to improve scapulothoracic and glenohumeral joint muscle function and shoulder complex stability. They can be performed in a home, work, clinical, or gym environment, require minimal equipment, and can be adapted for use by clients who are either unaccustomed to doing them or deconditioned as well as by highly conditioned clients and can be a precursor to more challenging exercises. Body positions can be modified to enhance client comfort. Band tension and resistance can be increased when prescribed numbers of repetitions are easily and consistently exceeded while proper technique and movement control are easily maintained.
Sidebar: Exercise Instructions
BILATERAL SCAPULAR RETRACTION AND SHOULDER EXTERNAL ROTATION
STEP ONE
Begin with band looped around your hands, with a length of band between your hands approximately a shoulder width apart.
STEP TWO
Squeeze your shoulder blades together, gently stretching the band between your hands.
STEP THREE
Hold and slowly return.
TIP: Keep your back and neck straight.
Don’t extend your elbows during the exercise; keep them bent at your side.
BRUGGER POSITION RELIEF EXERCISE
Begin with a long (2.5-meter) band wrapped on each hand with palm open. Perform the following movements against the resistance of the band with both hands:
ONE
Thumb and finger abduction and extension
TWO
Wrist extension
THREE
Forearm supination
FOUR
Shoulder external rotation and elbow extension
FIVE
Shoulder abduction and extension
SIX
Scapular retraction
Slowly return in exactly the reverse order. Repeat 2 to 3 times. Maintain an upright posture with neutral neck and back.
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