Featuring Lindsay Culbert-Olds and Kia-Melinda Eastman (www.KLTrapeze.com), photo by Yolanta Birkhāne
“ARMS UP! Now, draw your shoulder blades DOWN and BACK! ENGAGE your shoulder muscles!”
How many times have you heard this verbal cue in the context of circus arts, yoga, pilates, or dance? I hear this all the time, across multiple movement disciplines. Most of the time, instructors say this with the intent of engaging the scapulohumeral and scapulothoracic muscles. While the intent is noble (muscle engagement theoretically equals a more stable shoulder and therefore less injury risk), this cue and the subsequent shoulder position is actually one that puts the student at higher risk of injury. However, before we get into why this is not an ideal shoulder position, lets have a brief discussion of normal shoulder movement and biomechanics!
First, defining important terms...
Glenohumeral: “Gleno” refers to the glenoid fossa. This is the “socket” part of the ball and socket joint, which is the lateral most part of your shoulder blade. “Humeral” refers to the humeral head, which is the uppermost part of your upper arm, and forms the “ball” part of the ball and socket joint. Therefore, glenohumeral is a fancy term for "ball and socket."
Scapulothoracic: Scapula= shoulder blade. Thoracic = upper back and ribcage. This is the articulation formed by the shoulder blade moving on the ribcage when the arm moves overhead.
Shoulder biomechanics: What ACTUALLY happens when you lift your arm up overhead?
Overhead shoulder movement is one of the most foundational movements in circus and performing arts. Handstands and hanging all require full overhead shoulder range of motion, and any lack of full motion causes some serious compensations to occur in the rest of the body. So, what actually has to happen to achieve full overhead motion?
Bone and joint biomechanics: scapulohumeral rhythm
First, I want to talk about something called scapulohumeral rhythm: this refers to the NORMAL ratio of glenohumeral movement to the scapulothoracic movement during arm elevation.
Normal overhead shoulder motion is 180 degrees. This breaks down to roughly:
120 degrees from glenohumeral range of motion 60 degrees from scapulothoracic motion
This means that BOTH the arm AND the scapula must contribute to achieve optimal overhead alignment. If one of these is lacking, then the other must take up slack…OR, we attempt to compensate from other areas of our body (example: lacking full overhead motion in a handstand? Your body may compensate by arching low back to keep weight centered over shoulders to stay balanced…and thus, the banana handstand was born!)
Here's a quick youtube video demonstrating what this ACTUALLY looks like:
Why does scapulohumeral rhythm matter in circus arts?
Scapulohumeral rhythm is important for a number of reasons- but I’m going to talk about one MAIN reason. In overhead elevation of the shoulder, proper scapulohumeral rhythm puts the rotator cuff in an optimal position to do its BEST work, WHILE protecting the rotator cuff from impingement. Basically, scapulohumeral rhytthm is the rotator cuff’s bodyguard.
Muscles: which ones are the key players in proper scapulohumeral rhythm?
Several muscle groups are important in creating the individual movements that comprise scapulohumeral rhythm:
Upward rotators of the Scapula: serratus anterior, lower trapezius, and upper trapezius are all responsible for moving the shoulder blade into upward rotation as our arm goes overhead.
Glenohumeral Abductors: this is done predominantly by the deltoid, with a little bit of assist from the supraspinatus (one of the four muscles of the rotator cuff)
Rotator cuff: These guys are the fine-tuning stabilizers that make small adjustments and tweaks as our arm goes overhead. The rotator cuff is made of four muscles that start on the shoulder blade and insert on the humerus. The job of the rotator cuff is to hug the “ball” (humeral head) safely into the “socket” (glenoid fossa) during all positions of overhead movement. ESPECIALLY during end range overhead motion!
How dysfunction happens
There are a few common places where dysfunction happens in scapulohumeral rhythm, especially in circus artists who commonly hang from our arms with our arms overhead, or stand on our hands.
Upward rotators don’t activate
Rotator cuff stops doing its job
Both of these are equally problematic, and typically dysfunction in one area leads to dysfunction in the other.
Lets start with the rotator cuff (pictured above). What happens when the rotator cuff doesn’t do its job with overhead movement? The “ball” drifts superiorly, and bumps up against the socket- the acromion process of our shoulder blade- which pinches our rotator cuff tendons and can lead to impingement or rotator cuff tearing. This is clearly an undesirable outcome.
Back to the upward rotators (pictured above) - what happens if these don’t activate? This causes the shoulder blade to move LESS than it should into upward rotation as our arm goes overhead. When the shoulder blade doesn’t move into upward rotation, our body has to compensate elsewhere to get the full 180 degrees we require for many circus activities. In many people, the slack gets taken up by the glenohumeral joint. This seems like it wouldn’t be a big deal, but if the SOCKET stays down, and the BALL keeps going UP, we’re back to the previous scenario of shoulder impingement- the ball runs into the top of the socket, and wears on the rotator cuff tendons.
Back to the "shoulders down and back" cue...
Now, bringing these concepts together: lets think about the cue I often hear during hanging positions: “engage your shoulder blades, bring your shoulder blades down and back.” When you do this, you basically try to totally remove the “scapula” from scapulohumeral rhythm, and forcing the glenohumeral joint to take up more range of motion than it mechanically should. This ALSO moves the acromion process DOWN, much closer to our rotator cuff tendons. In aerial arts and hand balancing, when we are supporting our entire body weight from this unstable position, it can lead to significant rotator cuff impingement and tearing over time.
These two photos are representative of what happens in each overhead arm position in a handstand. They're screen shots taken from an AWESOME youtube video that the American Yoga School put out. If you have 10 minutes, this is NOT a waste of your time: https://www.youtube.com/watch?v=_r20Tvrly_Q
So...how do I hang?!
I typically suggest an “in-between” position as the strongest hanging position for aerialists- literally the mid-range of a full shoulder shrug. This places the shoulder blades in a naturally upwardly rotated and elevated position, doesn’t disrupt normal scapulohumeral rhythm, and puts the “ball and socket” in the strongest position for the rotator cuff to optimally work from. Additionally, the cue to “break the bar” if you’re on a trapeze/lyra is a GREAT thing to think about once you’re in this midrange position. Thinking about breaking the bar (rotating palms towards each other) is a FABULOUS way to encourage slight humeral external rotation, which will engage those scapular upward rotators, and create more space for the rotator cuff to work from. I stole this cue from several lovely aerialists in the “Safety in Aerial Arts” group on Facebook, and absolutely love it!
And what about handstands?
In my experience, this is less of an issue in handbalancers. One component of a technically correct handstand position is full elevation of your arms overhead, with an emphasis of the “shoulders to ears” cue. This puts most people in a nice, upwardly rotated scapular position, and keeps the rotator cuff happy. Another nice cue to throw in for handbalancers is to think about rotating the hands away from each other, to promote slight external rotation and give the rotator cuff more space. One issue that I DO see in hand balancing is when fatigue sets in. In most people, the first fatigue-related compensation in a handstand is going to be a slow increase in the space between ears and shoulders- letting your shoulders depress, because your upward scapular rotators are getting tired. This causes the glenohumeral joint to take up the slack, and the rotator cuff gets compressed. Take home message for handbalancers- if fatigue equals sinking in your shoulders, COME OUT OF THE HANDSTAND! Same goes for training one arms- don’t get fatigued to the point of compromising technique, unless you hate your rotator cuff and want it to be miserable.
The take home message? Kill the "shoulders down and back" cue if your arms are overhead. Your rotator cuff will thank you.
I know that this can be an unpopular concept, especially for aerailists- the upwardly rotated scapula puts less space between the ears and the shoulders, and this isn’t the MOST aesthetically pleasing position…but you know what’s even MORE aesthetically icky? A shoulder fresh out of rotator cuff surgery, in a sling. There’s nothing pretty about THAT.
Questions? Concerns? Please comment below! I’m also considering a follow-up post to this, since its such a beefy topic- if you have something you’d like me to write about that’s related, please let me know and I’ll try to address it in my next post!