Once you’ve fixed midline stability and assessed for lat tightness, we need to look at the coupled motion of thoracic extension-rotation. In order to accommodate the scapula tipping backwards as the arm comes up overhead, the thoracic spine and ribs need to extend and rotate out of the way to allow the scapula room to upwardly rotate and provide a stable base for the humerus. Basically, improved thoracic extension+rotation → improved scapular position and rotation → improved balance of shoulder in socket (think golf ball on a tee) → better shoulder position and stability overhead. Research supports this model of Regional Interdependence.
So, how do we functionally assess the system’s ability to couple thoracic extension and rotation to improve shoulder girdle position? Check out the video:
As mentioned in the video, while improving the joint/soft-tissue mobility is absolutely essential, it’s only one piece of the ultimate goal to improve overhead shoulder position. If the goal is to improve performance then we need to improve the ability to control the system in these new ranges. Believe it or not, gravity is sometimes too much resistance especially in those with poor motor control so we need to facilitate those movements (an SFMA/Gray Cook principle and one that I agree with) in order to allow the motor program to develop without so much load that it only serves to reinforce the problem.
Here’s a fix:
How do you know if it works? Try as many reps as it takes to improve the ease at which you can perform the exercise (20-30 reps is a good start). Remove the band, re-try the extension-rotation test without facilitation. Increased range? You’re welcome. If not, hit your classic thoracic extension mobility exercises harder (foam roll, lacrosse ball) then re-try the band facilitation. Re-test your overhead position and watch it improve. Remember if you don’t see change, there is no change.
This is a great addition to your warm-up to prime this coupled movement and prep the system for loading.
1) Shoulder pain and poor performance overhead? Assess control of thoracic extension and rotation by removing the lumbar spine from the equation.
2) Facilitate this motion – it should cue an improvement in mobility and, more importantly, control.
3) Try the shoulder flexion cue once you’ve got the first piece down. Goal is to make this as positionally-appropriate as possible.
P.S. Here’s a bonus video from Eric Cressey on a lat mobility exercise (not as much a thoracic mobilization in my opinion) to address that lat restriction we talked about last week: