ACUTE SHOULDER PAIN / ROTATOR CUFF TENDINOPATHY PART 3: The subscapularis

You can’t reach into your back pocket without twisting your trunk like a pretzel. Forget about a back hooking bra, grab the pull over cami. Your shoulder blade is looking like a chicken wing and it feels like its migrating away from your back.

All of these movements involve internal rotation. Let’s go back to the ball, socket and posture positions again. When you spend your time in a forward head, rounded shouldered position, you allow the ball to migrate forward in the socket. This position, when it becomes habitual (I.e. staring down at the phone you are holding right now), can reinforce poor motor patterns like shortening your front chest muscles (the Pecs) and weakening your back muscles (the Rhomboids and lower traps). The phone in hand posture slides the shoulder blades outward causing a shortening to occur of the subscapularis muscle, the 4th of the rotator cuff muscles in this series.

The subscapularis is found underneath (sub) the scapula (shoulder blade). It functions in internal rotation. When it is overused, posturally strained or harbors trigger points leading to tendonitis or worse tendinopathies, it will not work properly and cause pain with things like reaching into the back pocket or fastening a back hooking bra.

If you are experiencing pain with any of these activities, you can benefit from isometric training the subscapularis.

Remember, isometric means tension without motion. It is essentially a long and sustained hold of a contraction without any range of motion change. Isometric tension exercises are used to reduce pain without putting any excess load on the tendon while actively increasing the strength of the fibers of the muscle. They are best used in situations when you cannot actively load the tissue or use weights. Isometric exercises are given in the beginning stages of a rehab program and can be done many times throughout the day without causing fatigue or overuse.

This exercise is called the “belly push”. Straight forward and simple.