Tony Gentilcore

Because heavy things won't lift themselves

So Your Shoulders Are Depressed (So Sad)

What am I doing with my lives

Despite the cheekiness nature of the title, you can relax: I’m not suggesting that your shoulders are “depressed” in the literal sense of the word.

I mean, it’s not as if they just got word they contracted ebola or that their heart just got ripped out by some uppity bitch who left them for some toolbag named Cliff who goes to Harvard and rows Crew.  Or worse, they’re a Celtics fan (<—- they’re really bad this year).

Nope, we can hold off on the Zoloft, Haagen Dazs and Bridget Jone’s Diary marathon for now.  That’s NOT the depression I’m referring to.

When it comes to shoulders and the numerous dysfunctions and pathologies that can manifest in that region, generally speaking we tend to give much more credence to anterior/posterior imbalances like a gummed up pec (major or minor) or weak scapular retractors.

Rarely, if ever, do we point the spotlight on superior/inferior imbalances.

Translated into English, yes the rotator cuff is important, but we also have to be cognizant of the interplay between upward and downward rotation. More and more (especially with our baseball guys, but even in the general population as well) we’re seeing guys walk in with overly depressed shoulders.

For the more visual learners in the crowd here’s a picture that will help:

It should be readily apparent that 1) that’s a sick t-shirt and 2) there’s a downward slope of the shoulders, yes?

Hint:  yes.

This can spell trouble for those whose livelihood revolve around the ability to get their arms over their head (baseball players) as the downward rotators of the scapulae (levator, rhomboids, and especially the lats) are kicking into overdrive and really messing with the congruency and synergy between the scapulae, humeral head, glenoid fossa, and acromion process.

And this doesn’t just pertain to overhead athletes either.

We’re seeing this quite a bit in the general population as well, particularly with meatheads (those who like to lift heavy stuff), as we’ve (i.e: fitness professionals) done a great job of shoving down people’s throats ”shoulder blades down and together” for years now, emphasizing what I like to call reverse posturing.

Likewise, much of what many meatheads do (deadlifts, shrugs, farmer carries, pull-ups, rows, fist pumps, etc) promote more of what renowned physical therapist, Shirley Sahrmann, has deemed downward rotation syndrome.

Putting our geek hats on for a brief minute, statically, it’s easy to spot this with someone’s posture.  For starters, you’ll see more of a downward slope of the shoulder girdle (see pic above).  Additionally, you can look at the medial (and inferior) border of the scapulae and observe its relationship with the spine and ascertain whether someone is more adducted (retracted) or abducted (protracted).

Many trainees, unless engaged in regular exercise or sporting activity, have a slightly protracted scapulae (kyphotic posture) due to the unfortunate nature of modern society where many are forced to stare at a computer screen for hours on end.

If someone’s rhomboids and lats are overactive, however  - which is fairly common with meatheads – they’re going to superimpose a stronger retraction and downward pull of the shoulder blade, which in turn will result in a more adducted position.  In short:  the shoulder blade(s) will “crowd” the spine.

All of this to say: things are effed up, and are going to wreck havoc on shoulder kinematics and affect one’s ability to upwardly rotate the scapulae.

So, hopefully you can see how this would be problematic for those who A) need to throw a baseball for a living or B) would like to do anything with their arms above their head.

With special attention to the latter, if someone is aggressively downwardly rotated, the congruency of the joint is such that the humeral head is going to superiorly migrate, which will then compromise the subacromial space (making it even narrower) leading to any number of shoulder ouchies.

Throwing more fuel into the fire, because the lats are stiff/short, shoulder flexion is going to be limited and compensation patterns will then manifest itself in other areas as well – particularly forward head posture and lumbar hyperextension.

Which, of course, makes doing the Dougie a little tricker.

Okay, with all of that out of the way what can be done to help alleviate the situation.  Luckily the answer isn’t as complicated as it may seem, and I don’t need to resort to bells, whistles, and smoke machines or take a page out of Professor Dumbledore’s Magic Book of Bedazzling Hexes and Awesome Shoulder Remedies (on sale now through Amazon!) to point you in the right direction.

But make no mistake about it:  you WILL have to pay some attention to detail.

Lets get the contraindicated stuff out of the way first.

Basically it would bode in your favor to OMIT anything which is going to promote MORE scapular depression – at least for the time being (not forever).

Things To Avoid

To that end, things to avoid would be the following:

- Deadlifts

- Pull-Up/Chin-Up Variations (even those these may “feel” good, they’re just going to result in feeding into the dysfunction)

- Suitcase Farmer Carries (again, these are just going to pull you down more).

- Anything where you’re holding DBs to your side (think:  walking lunges, reverse lunges, etc).

- And we may even need to toss in aggressive horizontal row variations if someone presents with an overtly adducted posture.

- Overhead pressing.  Listen, if you can’t get your arms above your head without compensating, you have no business doing push presses, or snatches, or whatever it is you’re thinking about doing.  Stop being stupid.

- Sticking your finger in an electrical socket.  That’s just common sense.

Things To Do Instead

- In lieu of the deadlifts, if you have access to them, utilizing speciality bars like a GCB bar or Safety Squat bar would be awesome.  Learn to make lemonade out of lemons: why not emphasize your squat for the time being?

And because I know I just ruined someone’s world out there by telling them not to deadlift, because you’re going to deadlift anyways, at the very least, limit yourself to ONE day per week.

- You can still hit up a lot of carry variations, just not the suitcase variety.  At Cressey Performance we HAMMER a lot of bottoms-up kettlebell carries because they offer a lot of benefits – especially for those in downward rotation.

Moreover, we can also toss in some GOBLET carries like so:

- You can still implement a wide variety of single leg work using DBs, but I’d defer again to utilizing GOBLET variations only.

In this way you’re not feeding into the dysfunction by holding the DBs to your side (and pulling you into downward rotation.

With regards to overhead pressing, I’m not a fan for most people.  I’ve said it before, and it bears repeating here:  you need to earn the right to overhead press.

That said I do love LANDMINE presses which tend to offer a more “user friendly” way of “introducing” overhead pressing into the mix.  Check my THIS article on T-Nation I wrote a few months ago, which offers more of a rationale as well as landmine variations to implement.

And the Boring Stuff (<— The Stuff You’re Going to Skip, But I’ll Talk About Anyways)

From a corrective exercise standpoint it’s important that we stress the upper traps to help nudge or encourage us into more upward rotation.

And by “upper traps,” I AM NOT referring to the most meatheaded of meathead exercises – the barbell shrug.

These wouldn’t be useful because there’s no “real” scapular upward rotation involved, and you’re doing nothing but encouraging more depression anyways.

Instead incorporating activation drills like forearm wall slides and back to wall shoulder flexion – both of which encourage upper trap activation, WITH upward rotation – would be ideal:

Forearm Wall Slides w/ OH Shrug

Back to Wall Shoulder Flexion w/ OH Shrug

NOTE:  something to consider would be how you actually go about cuing the shrug portion.  We like to tell people to begin the shrug pattern once your elbows reach shoulder height.  Meaning, it’s not as if you’re going elevate your arms up and THEN shrug.  Rather you want to combine the two.

Another important corrective modality to consider would be something to address the lats.  In this regard my go to exercise would be the bench t-spine mobilization

Bench T-Spine Mobilization

And while I could sit here and pepper you with a deluge of other “correctives,” I think by now you get the point and those three should be more than enough to get the ball rolling in the right direction.

Those combined with the programming modifications suggested above should definitely help to that shoulder frown upside down. <—  HA – see what I just did there?

That’s some wordsmith magic right there.

Did I just blow your mind? Make (or ruin) your day? Leave a comment, then share this with EVERYBODY.
  • Barath

    If you put up a picture of you wearing that tribe called quest shirt one more time, Imma come over to Boston and kick your ass. For real.

    • TonyGentilcore

      Yeah, I should probably update that pic, huh?

  • Eugene

    Please tell me why I only see empty boxes? None of your pics or videos or whatever they are can’t be seen??? I m on an iPad if that’s any help.

    • TonyGentilcore

      Hmmm, you’re not the first person with an iPad that has mentioned this, I don’t know what to say.

      • Kim

        Actually was glad to hear someone was having same issue… Videos and pics come up on my husbands android but not on my iPhone or iPad— if anyone knows solution I would love it… I am such a visual learner and it doesn’t work well when I can’t read the blog posts with videos to support…still do my best to read religiously though!! Love the posts!

        • TonyGentilcore

          I honestly don’t know what the glitch is….sorry. If it’s any consolation, soon, when I get my website updated, it will be iPad/iPhone friendly.

          In the meantime, you can still view everything on a laptop….;O)

  • deb de rosset

    I recently got married (it was awesome)., I worked my rear off for a year getting in shape for it. I can honestly say that off the 400 or so pictures in which I appear (in short strapless wedding dress) I am unhappy with not a single one of them. Go me.

    After reading this though, I took a closer look at my back and I’m wondering if what I thought was a very nicely developed teres major is really the distal end of my scapula poking through with a vengeance.

    • TonyGentilcore

      Might be something to ponder for sure. Either way I’m sure you looked rockin!

  • Craig

    Great post Tony. You said that typical shrugs contribute to depression; do you believe that because of the rhomboid and lev scap activity, and because of the terminal eccentric phase? My scapulas actually have a bit of upward rotation at rest, but some depression, so my thinking was that typical shrugs would help me get a bit more resting elevation. Thanks!

    • TonyGentilcore

      I don’t like the eccentric phase, correct. You actually need to help the scaps move in upward rotation, and just doing shrugs won’t really help in that regard.

  • Shane Mclean

    you sure yourself and Eric were not separated at birth? Nice post Tony. I’m starting to see this more and more.

    • TonyGentilcore

      hahaha. Well, I’ve certainly learned a lot from him throughout the years. He’s still waaaaaaaay more of an anatomy cyborg than me, though.

  • luis puerta

    What would you suggest for someone with scholiosis? I’m having a lot of difficulty pin pointing exercises to help this and as much as I love dead lifts, i think they are making it worse. My left shoulder sags considerably lower than my right shouder and the size of my left arm is smaller as well. It’s really difficult for me to squat without my hips moving a bit to the left. I pay great attention to detail when doing shoulder exercises (internal/external rotations with a low weight and such) but I cant seem to help the problem. I foam roll my back witha rumble roller and hang from the pull up bar to stretch my back. My therapist said there is pressure under my left shoulder blade around C7 and then down in my lower back it bends again, forming a very slight S. She said that when i touch my toes you can’t see any issues so she thinks it s a muscular problem rather than something with the bone. The entire left side of my back feels indented whereas the right side feels raised. THe bad thing is she didn’t give me a lot of exercises to consider. I figured I’d ask you because you do so much actual research into the muscles and ligaments involved in movements. Thanks for the help.

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  • Robert

    Tony, would scapular pushups be another one of those boring-but-good-for-you exercises for treating overly adducted and downwardly rotated scapulae? My intuition tells me they would be, but I don’t want to assume and make an ass out of myself.

    And a quick note of gratitude that I hope doesn’t strike you as too sappy: these posts on scapular depression have been quite helpful for me because it’s been something that has probably been an issue for me for years since I was very much an adherent of the “shoulder blades down and back” cue, so thanks a bunch. It’s also satisfying to learn the about the nuances and exceptions that are so necessary for effective individualized training, rather than employing the dogmatic one-size-fits-all approaches.

    • TonyGentilcore

      Mmmmm, maybe. The serratus definitely contributes to upward rotation, but I feel we’ve placed such a precedence on telling people “down and back” with regards to scapular function that most have lost the ability to even use their upper traps.

      And thanks for the kind words! I really appreciate it and glad to see that I’m coming across as somewhat coherent….;o)

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