Safe and effective overhead pressing (any type of shoulder press or military press) requires proper resting position of the scapula.
This is generally a well understood concept among the strength training community.
Less understood, however, is that achieving an optimal resting position of the scapula does not actually depend on the scapula.
Rather, it depends on the position of the ribcage below it.
Attempting to correct or maintain the proper resting position of the scapulas is an exercise in futility if you haven’t properly assessed the position of the ribcage beneath them.
If you want to build some decent sized shoulder muscles, and stay healthy while doing it, you’d better first consider the position of the ribcage.
It’s the position of the ribcage that determines whether you’ll be able to move your scapula and shoulder joint without pain during shoulder exercises.
"Neutral" vs "Patterned" Scapular Position
For the sake of brevity, I’m going to have to skip over the fact that proper position of the ribcage requires proper position of the pelvis. You can read all about that on my page about the left AIC pattern.
Instead I will skip straight to the right BC pattern and its influence on the resting position of the ribcage and the scapulas that sit on top of it.
The right BC pattern will cause the scapular position seen in the picture below right. The right scapula is internally rotated, and has a winged vertebral border. The left scapula is externally rotated.
In effect, they are both “facing left”. This is because the ribcage itself is stuck in a leftward rotation in relation to the rightward oriented pelvis below it. If the ribcage is rotating to the left, so will the the scapulas.
This post explains how the abnormal scapular position seen on the right occurs due to the right BC pattern and how a more symmetrical, or “neutral” resting position can be achieved through PRI techniques.
Our Goal: Neutral scapulas
Right BC Patterned Scapulas
Postural Restoration and the Right Brachial Chain Pattern
If you look at the gentleman above, you’ll notice that the left and right sides of his body “present” two different appearances.
- The left shoulder complex (including his neck) appears higher than the right shoulder.
- The area between his left shoulder and left hip appears longer and flatter and “opened up”.
- The area between his right shoulder and right hip appears shorter, curved, and “closed down”. There is also an appearance of a “hiked” right hip which leads people to believe that they have a lateral pelvic tilt.
This is actually a very typical visual representation of the right BC pattern.
You see it again below. Same presentation. Short, curved, (and tight) right side. Right hip hike. Long and flat left side.
Patterned Right Brachial Chain
This asymmetric resting position of the scapulas, due to the asymmetric position of the ribcage underneath, is often the primary driver behind such issues as
- Rotator cuff impingement
- Thoracic Outlet Syndrome
- Generalized shoulder pain
- Scapular dyskinesis
- neck pain
- rib pain and painful inhalation
- neck spasms
- lower back spasms
- QL pain
- lateral pelvic tilts
- frozen shoulder
Ron Hruska and the Postural Restoration Institute has identified this right BC pattern as an underlying neuromuscular “preference” inherent in all human beings. This is not a bad thing. To move like a human moves, it requires asymmetry. Asymmetry requires you to “pick a side”.
It’s only a bad thing when your perfectly natural right BC “preference” becomes so dominant that you stop using using it’s counter-part, the left BC pattern. The left BC pattern should be used when your weight is on the left leg.
But when the right BC pattern becomes too dominant, you drop off the left BC pattern and use your right BC pattern when on your left foot, too. How can you do that?
Well, you can’t. Except through compensatory mechanisms.
The good news is that compensation works.
The bad news is that eventually compensatory patterns break our body down due to strain, overuse, and ultimately tissue damage. That’s when we hurt.
Air Regulates Rib Position
The ribcage has a few primary responsibilities.
- It protects our organs.
- Gives our body shape.
- Provides a stable base off of which we can move our arms and neck.
- Serves as a pumping mechanism to help with gas exchange. Oxygen and Carbon Dioxide.
Watch yourself breathe. As you inhale you should see some type of expansion of your ribcage that is initiated by the downward movement of the diaphragm and the simultaneous contraction of the intercostals.
Inhalation is a muscular action.
As you exhale, the ribcage will return to it’s starting position through elastic recoil of the ribcage.
Exhalation is not a muscular action.
It’s a “return to rest” action that does not require active muscular contraction.
One would expect that both sides of the ribcage would expand actively and return passively in an equal manner.
But that is not the case.
Due to our tendency to favor our right side, we often find ourselves stuck in the right BC pattern,
In this situation we end up with more air in one side of our ribcage than the other.
In the image below you’ll see that I’m holding two balls, one larger one smaller.
The larger ball represents the amount of air in the left side of your chest.
The smaller ball is the amount of air in the right side of your chest.
When you inhale, air will take the path of least resistance. And in the right BC pattern, it’s the left side that offers the least resistance, while the right side offers lots of it.
As I explained earlier, in the right BC pattern, the left side of the ribcage is more “open” and thus it accepts air more easily than the right side. This results in the left side of the ribcage being more inflated. Since it’s more open, that’s where the air will go.
Over on the right side, the more “closed” right side is restricted and shut down. It won’t accept air as easily. This results in the right side being more deflated. If it’s closed and can’t expand easily, air can’t get in as easily.
This also has the unfortunate effect of not allowing the right lung to fully inflate.
Due to the asymmetrical airflow within our ribcage, the foundation underneath your scapulas is not even.
So what’s the point of trying to address the position of your scapulas with scapular muscle exercises without setting a proper foundation first?
There is none. Trying to do direct scap muscle work won’t change the underlying realities:
- There is more air in the anterior left side of the upper ribcage(big ball of air), so the left scapula is sitting on a fuller more expanded upper ribcage.
- There is less air in the anterior right side of the upper ribcage (little ball of air), so the right scapula is sitting on a deflated, restricted, and tight upper ribcage.
In addition, function of the scapula musculature: in particular the traps, serratus anterior, subscapularis, and pec minor, are all compromised.
Left side of the ribcage is more open (externally rotated ribs) and ready to accept air.
Right side is more closed (internally rotated ribs) and not ready to accept air.
It's All About Air
For the foundation to be set properly, the right BC pattern has to be resolved, and that requires air going into the right side of the chest. We have to open up the right frontal plane and close down the left frontal plane to even things out.
The only way that can happen is through proper breathing mechanics.
It’s an air issue!
This ribcage needs to regulate air better to achieve proper position of the scapulas.
This ribcage has regulated airflow and thus properly positioned scapulas.
Obtaining a Left ZOA for Scapular Position
When we are in the right BC pattern, our frontal plane on the right is closed down. It’s given the name of right thoracic abduction.
This right thoracic abduction position results in the common complaint of tight right intercostal muscles (muscles between your ribs) and a tight right ab wall.
Due to the position of the right scapula that is also anteriorly tipped, there will also be a tight pec minor and subclavius on the anterior chest wall.
Right Thoracic Abduction. How we are living 24/7.
Left thoracic abduction. What we need to establish for a left ZOA.
To inhibit the right BC pattern, and thus establish a more neutral position of the scapulas, we need to obtain a zone of apposition on the left to even things out. This means that we need to re-establish thoracic abduction on the left.
Establishing a ZOA on the left simultaneously inhibits (turns off) right thoracic abduction. This is what allows our body to return to neutrality.
The exercise below is designed to do just that.
It does so by positioning you exactly as you see my left thoracic abduction picture. My back is rounded (not arched/extended) and I’m thoracically abducted to the left. The towel under my knee puts me in left AF/IR, and thus inhibits the left AIC pattern.
All I have to do is maintain that position for five breaths. It’s much harder than it seems.
Image from the most recent Postural Restoration course that I helped out at. Same exercise (minus the right arm reach). Used for the same reason: establish proper position of the ribcage.
For comparisons sake, look at the pictures below.
Obviously I’m exaggerating my position for demonstration purposes, plus I’m sitting down, but these comparisons should show you just how prevalent this right BC patterning is. This is how the vast majority of people are living without even knowing it. They are lifting weights, running, throwing, breathing, walking, playing chess, doing whatever they do, with too much muscular activity on the right side and too little appropriate activity on the left.
To be balanced and healthy, you have to get your ribcage back into a more neutral position. Otherwise all movement and breathing is compromised and more susceptible to injury.
This exact exercise produced the “after” position.
Neal, in strengthening the right Serratus anterior would it be ok to use protraction and upward rotation exercises? Or is the right shoulder already too protracted? Also, is it important to strengthen the right Subscapularis?
It’s a bit complicated. The right scapula needs to be integrated with the left hip. So trying to do anything with the right arm when your pelvis isn’t shifted into Left AF/IR (or left stance) is useless.
Any PRI right serratus technique will have you shifted into the left hip. In that case protraction is good because it’s being supported by a stable left hip/side of the body (left hamstring, left adductor etc…). If you aren’t doing a PRI technique, trying to simply strengthen your right serratus through traditional means probably won’t do much good.
Surely the All Fours Left ZOA exercise is not an instant RBC cure for everyone. For over a year I have been on a PRI journey, guided by a PRI trained PT. We are currently trying to focus on rib cage and scapula issues. Can you talk a bit more about your personal left ZOA journey? From what you have written here and in other posts, it was not an easy, straightforward process for you. I was/am a patho PEC and I am really struggling with making progress at expanding my left posterior mediastinum. In previous months, while I was focused on the pelvis, I thought my ZOA was fine, but I now realize that you have to start somewhere and usually the pelvis is the starting point. I long for the day when my unconscious brain automatically fires left hamstrings with left abdominals and I FEEL my left posterior rib cage expand with air. So far, it ain’t happenin’. Reading about others’ successes might be helpful for lots of us.