Shoulder Pain and Anterior Humeral Glide

Today I have a great guest blog post on Shoulder Pain and Anterior Humeral Glide.

The excellent info is from Zach Moore.

Take it away, Zach.

How can Anterior Humeral Glide Lead to Shoulder Pain?

Anterior humeral glide (AHG) is a common problem among many individuals and occurs when there is excessive or abnormal anterior movement of the humeral head during shoulder motions. AHG can occur during any movement where the humerus moves into extension or horizontal abduction.

It is important to spot and correct this mistake because AHG can eventually lead to, or further aggravate, anterior shoulder pain, AC joint problems, pec and lat strains, as well as impingements. Therefore, today I want to look at some common exercises where this often occurs and then go over possible solutions to help address it.

Again, this problem can occur during any exercise where the humerus moves into extension or horizontal abduction, but I am only going to cover a few popular exercises.

The fixes and mistakes for each will usually be similar, so you can apply them to other exercises as needed.

Horizontal Row

 

Video Demonstration of Anterior Humeral Glide during a horizontal row along with cues to help correct this:


Cues and Possible Fixes:

  • Place your hand medial to their scapula and cue them to squeeze back.
  • Point to the anterior part of their humeral head and tell them to pull that back.
  • Help guide them into the proper position. Place one hand on the anterior part of their humeral head and the other on their scapula. As the person begins to row, guide their scapula into retraction and apply posterior pressure to their humeral head.
  • Lastly, have them try rowing with both arms. Sometimes their inability to retract is just a coordination problem and this will better allow them to feel their shoulder blades being squeezed together.

Dumbbell Row

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):


Cues and Possible Fixes:

  • Same cues and fixes as described with the horizontal row above.
  • Make sure spine is neutral. If upper back is not flat then you are more likely to see a faulty rowing pattern.

Push-Up

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):


Cues and Possible Fixes:

  • Make sure spine is neutral. This will help to better position the scapula on the rib cage, which will help facilitate proper retraction on the eccentric (lowering) phase.
  • Cue them to squeeze their shoulder blades together in order to activate their scapular muscles as they lower their body.
  • Use an incline or raise the incline to make the exercise less challenging.
  • Shorten the range of motion (i.e. do not have them lower as far).

Chin-Up

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):


Cues and Possible Fixes:

  • Tell them to think about putting their shoulder blades into their back pocket.
  • Have them demonstrate to you how to squeeze shoulder blades down and back before they perform the movement. This will ensure they know what you mean.
  • Use a band or increase the band tension to make it easier.
  • Try a Chin-Up ISO. This is an exercise we will usually give to clients at IFAST before progressing them to a full chin-up. You basically get into the top position of a chin-up with chest to the bar and scaps depressed. You then hold this position for max time. It is very effective for teaching people the final portion of this exercise.
  • Lastly, if the above strategies do not work then I would take them to a Lat Pulldown where the stability requirements are less demanding.

Bench Press

 

Cues and Possible Fixes:

  • First, I would make sure the person could perform a push-up properly without AHG before giving him or her a bench press.
  • If AHG is occurring during this exercise, then you know they are not keeping their shoulder blades retracted, which is desirable when performing a bench press.
  • Make sure the client knows that he or she should not protract (i.e. make arms long) at the end range. This will better allow him or her to keep shoulder blades together.

Final Points

Never be afraid to lighten the load or decrease the stability requirements. Performing an exercise over and over with incorrect form (in this case, anterior humeral glide) will not fix the problem/form.

If the cueing and loading strategies above do not work, then you may need to resort to other corrective strategies such as soft tissue treatment and/or rotator cuff exercises.  For soft tissue treatment, I would first examine the posterior shoulder capsule as it can often be stiff and restricted, which will not allow the humerus to glide posteriorly as it is flexed.  Next, examine the pecs as they can become dominant and pull the humeral head anterior.

For the rotator cuff, I would examine the subscapularis.  If the subscap is too long or weak, then its downward and posterior pull will not be able to offset strong muscles, such as the pec major, that pull the humeral head anterior. Therefore, strengthening exercises for this muscle may be appropriate.

Summary:

Learn to retract/depress properly by squeezing the scapula back/down without allowing the humeral head to glide anteriorly.

Common Cues and Fixes:

  1. Make sure person is in a good spinal position.
  2. Put hand back by shoulder blade and tell person to squeeze shoulder blade back to touch hand.
  3. Point to anterior part of humerus and tell person to pull it back.
  4. If performing a unilateral pulling exercise try to pull with the other arm at the same time, which may allow for better proprioception.
  5. Lighten the load.
  6. Reduce stability requirements
  7. Make sure the problem is not due to soft tissue restrictions and/or a weak cuff.

Hope this helps!  If anyone has any other tips or suggestions, leave them in the comments.  It is always great to hear other cues!

Zach Moore is a strength coach at Indianapolis Fitness and Sports Training (IFAST), named one of the top 10 gyms in the US by Men’s Health magazine. He works with a variety of clients ranging from athletes wanting to improve performance to general clients looking to improve body composition, fitness, and/or get out of pain.

Zach obtained his bachelors and masters degrees from Indiana University Purdue University-Indianapolis and holds certifications with the National Strength and Conditioning Association as a Certified Strength and Conditioning Specialist (CSCS) and with USA Weightlifting as a Sports Performance Coach. Check out his blog at Zimoore.blogspot.com .

===========================

It is Rick again.

Big thanks to Zach.

Lots of great and very helpful information.

If you want to check out the Rotator Cuff Exercise Program that I use with my client, it is right here:


A few other articles on shoulder pain and injuries that may interest you:

These videos may interest you as well:

Bench Press Technique and Injuries

 

Shoulder Pain and Tricep Dips

 

 

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What to do about Weight Training Injuries?

Facebook comments:

8 Comments

  1. A very interesting article. Long though. I skimmed it and initially couldn’t see the difference between the 2 variations of pull ups in the video. Upon closer inspection I understand what you guys are getting at. Thanks Zach and Rick!

    [Reply]

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    Rick Kaselj Reply:

    Steve,

    It is subtle but has an effect on the shoulder.

    Rick

    [Reply]

  2. Hi Rick

    Thx alot for the article and the fine videos….. I would like to ask you for some expertice regarding my shoulders..

    I have been working out for almost 18 years, and the last 2 years ive been suffering from pain in both shoulders, and im almost sure that it comes from AHG…. my shoulder blade seems to tilt forward and resulting in impingement and pain in front shoulders, and i can feel pain and stiffness in back of shoulders to…it feels like my whole upper back/shoulders is tilting forward…. what would you recommend me to do ? is there some excercises that is good for working the shoulderblades downwards again ? im not doing any chest/shoukder excercises because of the pain….

    [Reply]

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    Zach Reply:

    Hi Rene,

    It is hard to say for sure about your shoulders without assessing you, but I will try to give you a guide.

    First, how is your upper back posture? Make sure you have good thoracic (upper) spine extension. Otherwise, your shoulder blades will not sit smoothly on the rib cage and will tend to sit higher up.

    Second, check for stiffness/shortness in your pecs and/or pec minor. The pecs can pull the shoulder forward and pec minor can anteriorly tilt (tilt forward) the shoulder blades.

    You must then balance out the stiffness of the these muscles by strengthening muscles that will pull your shoulder blades down. Strengthening exercises for low trap will be important here.

    Lastly, as I pointed out in the blog, try some soft tissue on the posterior cuff muscles (infraspinatus, teres minor) and also possibly lat and teres major. Basically, just pin a tennis ball/lacrosse ball between the wall and the area on the back of your shoulder where these muscles lie (back of shoudler blade and between the posterior humeral head and shoulder blade) and try to find sensitive spots.

    Hope this helps! Let me know if anything does not make sense. Good luck with your shoulders.

    [Reply]

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    Zach Reply:

    One other VERY important thing I forgot to mention is your breathing. How is your breathing? Are you an upper chest breather? If so, this will tighten up a lot of anterior chest muscles that can pull your shoulders forward. Work on improving your diaphragmatic breathing. A simple progression is to lie on your back with your feet up in the air (hips and knees at roughly 90 degrees). From here, place one hand on your belly and one hand on your chest. Take a deep breath and make sure only the hand on the belly moves (the belly should move outward as you breathe in).

    [Reply]

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    Rene Fredsgaard Reply:

    First thx alot for your time.

    About my upper back posture i will say i have a forward head posture, and also my lower back is forward (wich is giving me some pain in lower back to) i suppose its called an S posture. About my chest, im stretching every day.
    Im doing alot of row excercises for my back routine, but i can see that i have made the mistake about the AHG i was testing in front of the mirror and could see i failed 🙂

    Im using a Backnobber on my shoulderblade.

    And lastly im defently af chest breather (i will focus on correcting that one) to be honest i think i chest breath because i focus on my belly always look tight and slim ;o)

  3. Tons of good stuff here! Thanks Rick and Zach!

    I’m sure everyone’s guilty of incorrect form from time-to-time, so it’s always nice to get a reminder on how we should all be performing these movements correctly. I had to watch the push-up video about 6 times to see the difference, but I wanted to make sure that I didn’t mess up considering I just did a post on them. 🙂 Didn’t want to piss Rick off!

    Thanks for sharing,

    -Matt

    [Reply]

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    Zach Reply:

    Thanks Matt!

    [Reply]

  4. @Rene Fredsgaard

    Well, it sounds like you are doing a lot of good stuff. Just fix that rowing:)

    In reference to the breathing, I also have a lot of women who do not like to diaphragmatically breathe because their belly pooches out:)
    However, this could make the biggest impact on your shoulder health (along with a TON of other benefits). I would definitely work on it.

    Good luck!!

    [Reply]

  5. Hello Rick,

    Thanks! I came across your blog while trying to research how to deal with rotator cuff injuries. You have a set of really helpful videos that can aid me finish my term paper I need to submit by next week.

    I also have another concern I need to find answer with, hopefully you could release an article about it too. Actually my question is, if treating rotator cuff would require surgery, how long does it take to recover from surgery?

    I’m trying to find other resources below but I need to validate if these are good answers:
    https://answers.yahoo.com/question/index;_ylt=AwrXnCGDQuJX4RoAJklPmolQ;_ylu=X3oDMTEyZ210NGNrBGNvbG8DZ3ExBHBvcwM1BHZ0aWQDQjI1NTlfMQRzZWMDc3I-?qid=20090325202004AAvnYSf
    http://www.exercisesforshoulderpain.com/blog/2012/08/arthroscopic-shoulder-surgery.html
    https://answers.yahoo.com/question/index;_ylt=AwrXnCGDQuJX4RoAKklPmolQ;_ylu=X3oDMTEyMGRqczVwBGNvbG8DZ3ExBHBvcwM3BHZ0aWQDQjI1NTlfMQRzZWMDc3I-?qid=20071030114930AAebG9W

    Thanks again for sharing these stuff!

    [Reply]

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