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Today’s post will be from my friend Joe Sansalone regarding the topic of shoulder packing. Joe is one of the more knowledgeable guys in the industry yet many people have never even heard of him. This is because Joe is busy training folks all day long, not writing articles and blogs. This article was adapted from several exchanges that Joe had with various coaches. It also includes several videos that Joe and his lovely girlfriend Neghar filmed together. Thanks Joe and Neghar!

Why Should I Care About Shoulder Packing?

Some readers may be asking themselves, “What in the hell is shoulder packing and why should I care about it?” As lifters, trainers, and coaches, we can’t just assume that an individual has proper thoracic mobility and proper scapulohumeral mechanics and prescribe them overhead movements. If we screen them and they demonstrate proficiency, then by all means, give them overhead movements. But if they aren’t cleared for the movements, we need to get them back into action by ensuring that we improve dysfunction such as poor t-spine mobility, poor mid-trap, low-trap, and serratus activation, weak rotator cuff muscles, absense of lat contraction, and unsynchronicized shoulder, scapular, and spinal movement in order to groove proper motor patterns and prevent chronic injury down the road.

Shoulder Packing by Joe Sansalone

There seems to be some confusion as to what packing the shoulder actually is, when to do it and why. Keeping the shoulder packed does not mean to limit or stop the normal scapulo-humeral rythm of an overhead movement. In fact, packing the shoulder will actually reinforce and create proper overhead movement mechanics.

Lets first understand what is meant by packing of the shoulder. When Gray first introduced me to the idea of focusing on packing the shoulder, I was confused like many others. I thought, how the hell am I going to get my arm overhead all the way if I have to keep my scapula down and back the whole time, if I cant let my scapula upwardly rotate? I should have just asked him to explain more, but Gray can be intimidating because he is so much smarter than me.

Sue Falsone cleared up for me what Gray was trying to get me to understand. That is that packing of the shoulder means to move the arm overhead while maintaining the Path of Instantaneous center of rotation (PICR) of the humerus in the glenoid. In order for this to happen a force couple between the upper trap, lower trap, serratus anterior and the lats has to occur for the scapula to properly upwardly rotate while in a stable position on the Tspine. When the load begins moving overhead the compressive force into the shoulder reflexively causes the rotator cuff to fire and stabilize and maintain PICR all the way overhead as long as and only if the scapula remains stable on the tspine as it upwardly rotates.

To maintain scapular stablity on the tspine as the scapula rotates upward, the scapula’s position on the tspine has to be maintained and the force couple has to occur all the way to the lockout. This requires what is now being called shoulder packing, just maintain the scapula’s position on the tspine while it upwardly rotates. This maintains PICR through the movement and makes sure the sub-acromial space is not compromised. This is the proper patterning of overhead movements and what the RKC system and Gray call shoulder packing. Engage the lats and scapula muscles to keep the scapula in a stable position as it upwardly rotates, allowing the rotator cuff to reflexively do its job of keeping the humerus on the PICR axis in the glenoid. This is also known as maintaing shoulder stability.

Remember, the rotator cuff can’t build proper tension and properly stabilize the humerus if the scapula is moving around on the tspine as it attempts to upwardly rotate. When this happens it causes the shoulder to “float” and become unstable in the joint. The upper traps have to compensate for the lack of a proper force couple and the shoulder will move in an inappropriate way compromising its integrity and decreasing overhead movement potential and increasing risk of injury to the shoulder complex and neck.

Put another way, shoulder packing is the intentional focus on proper overhead motor-programming. It is the simultaneous engagement of the lat, serratus, and traps in the proper sequence as the humeurus moves into the overhead position. This keeps the scapula stable on the tspine while it properly upwardly rotates, allowing the rotator cuff to build and maintain tension for humeral stability, keeping the humerus in the glenoid with the proper PICR as it moves into the overhead position. This keeps the sub-acromial space uncompromised and impingement potential at its lowest.

One of the problems here is it seems we are thinking that packing the shoulder is about stopping the scapula upward rotation necessary to move the arm overhead, and therefore changing the natural and normal anatomical overhead movement pattern. It is not. Shoulder packing is simply the process of maintaining proper scapula position on the tspine and humeral position in the joint as it moves overhead.

Put another way again, packing the shoulder is focusing on properly patterning the complex movement of the arm overhead. Most people have upper trap dominance issues and upon pressing overhead the force couple is not happening or out of sequence, and in order to get the arm overhead they inappropriately shrug and elevate the scapula and humerous into the Acromium causing impingement of the sub-acromial space. This is an unpacked shoulder movement, which is also a very unstable humerus in the glenoid as it is shifting up, down and all around in the glenoid instead of maintaing PICR with a scapula that is stable on the tspine while upwardly rotating.

This inappropriate scapula elevation instead of scapula control, while it is trying to upwardly rotate, causes the rotator cuff to have a hard time developing tension to hold the humerus stable in the glenoid and the humerus subsequently shifts off PICR and up into the sub-acromial space and other directions. This type of upper trap dominant, force coupling problem and inability to maintain a stable humerus position in the glenoid as it moves overhead, is major factor in the development of shoulder pathology.

One last way to talk about shoulder packing. Packing the shoulder is just the process of avoiding improper scapula elevation and humeral upward glide into the subacromial space during overhead motions. Its just the term used to describe proper overhead patterning. An unpacked shoulder is a shoulder that elevates inappropriately in the joint and at the scapula, disrupting normal overhead motion and muscle recruitment patterns.

One more last thing, and perhaps this is all that was needed to be said, shoulder packing is not about stopping the normal upward rotation of the scapula, it is about stopping the dysfunctional upper trap dominant, impingement causing pattern of overhead movements, by teaching proper overhead mechanics and positioning of the scapula and humerus.

The RKC system teaches packing of the shoulder in the lockout AND during overhead movements for the reasons I listed above, not just in the overhead lockout. Lets not let the term “packing” throw us off. Again, packing is simply about proper sequencing, rhythm and movement patterning of the scapulo-humeral complex during movement. Packing the shoulder is a new way of saying good overhead mechanics.

I hope this helps clear up some of the confusion of what shoulder packing is and why it is taught. Sorry for the long post and the major redundancy, but I wanted to say the points in many different ways since this is such a large audience and different ways of saying the same thing can be helpful sometimes.
By the way, this concept is gone over by Brett Jones and Gray Cook in great detail in their Secrets of the Shoulder DVD.

[youtube=https://www.youtube.com/watch?v=d3EHKNZ0ack&hl=en_US&fs=1&rel=0&border=1] [youtube=https://www.youtube.com/watch?v=PtYportU36A&hl=en_US&fs=1&rel=0&border=1]

The key to overhead pressing properly is to concentrate on maintaining the proper scapula position on the tspine while it upwardly rotates, which is to resist excessive scapula elevation or depression. Both can cause problems and possible pathology, but people rarely depress their shoulders too much and almost always excessively elevate, so we focus on depressing/packing to bring back the length/tension balance between the traps as the arm goes overhead.

Also, to assist the rotator cuff in maintaing the PICR of the humerus in the glenoid, the lat should be intentionally fired. If you focus on these things, the natural force coupling mechanism of the serratus anterior, upper and lower traps will fire appropriately and the scapula should maintain a stable depressed position on the tspine while it upwardly rotates, without shrugging, with a posterior tilt that happens naturally as the humerus goes overhead.
When the force couple of the scapula muscles fires properly, the serratus anterior posteriorly tilts the scapula against the tspine and the upper and lower traps maintain the scapula’s stability against the tspine. This allows the rotator cuff and lat to stabilize the humerus in the glenoid as it moves overhead, maintaing the proper PICR. This is what we call packing the shoulder.

Sometimes an RKC instructor or physical therapist will pattern the position by working on getting to the overhead lockout position and gently elevating and anteriorly tilting the scapula and then re-depressing and posteriorly tilting the scapula back into position. This is a motor programming drill much like the prone Y pre-hab exercise. The idea is to teach upper trap dominant people who do not lack proper overhead mobility but have dysfunctional scapula-humeral rhythm and subsequent instability at the scapula and humerus going into an overhead position, how to properly position the scapula and humerus by firing the lower trap and serratus to learn to control the shoulder girdle as it moves overhead.

Perhaps this is what the RKC was trying to do. You certianly do not want to press overhead incorrectly and then “set” the shoulder into the right position every rep. The goal would be to get the pattern correct as you move overhead, so you end in the right positon as opposed to going up and then setting every time. That would be like descending into a squat with a hunch in the low back and then getting into proper hip flexion and properly positioning the spine and pelvis at the bottom of every rep before standing.

Once you have a person who can do a standing and a prone Y correctly, then you can progress to the standing version of that with a light weight to help reinforce positioning and patterning (as talked about above), and then begin to pattern the actual overhead motion.

The main thing to understand here, as Rob Panariello has pointed out, is you do not want to depress and retract the scapula and limit the natural upward rotation and force couple that needs to occur. Doing this, as professionalpt also pointed out, can cause the Acromium to be pulled down and when the humerus then goes overhead it can impinge the very narrow sub-acromial space. Its also just an unnatural way of moving. This is especially dangerous in those who have a type 3 Acromium hook, which creates even less sub-acromial space and subsequently even more potential for impingement going into an overhead position.

The correct patterning of the shoulder girdle going overhead is to maintain a stable scapula that will properly upwardly rotate on a properly positioned tspine. This happens through the force coupling mechanism/proper length-tension relationship of the upper and lower trap with the serratus anterior. This creates a stable scapular platform for the rotator cuff to reflexively contract against and stabilize the humerus in the glenoid, with the assistance of firing the lat. This maintains the normal PICR of the humerus as it goes up and down overhead. Thatls a lot to take in.

Because of the force couple and proper length-tension of the lower and upper trap and the serratus, the scapula will have a depressed and posteriorly tilted position on the tspine as the scapula rotates upward, much like the Y exercise. This is shoulder packing, also known as proper overhead mechanics. Whatever we want to call it.

This is the key to understanding overhead patterning and this is very different from simply depressing and retracting the scapula and stopping needed upward rotation. Doing this would almost be like creating a dysfunctional lower trap dominant overhead pattern. This is also different from pressing overhead without focusing on scapular stability, causing upper trap dominant dysfunctional pattterning and then creating the proper position at the top. We want to accomplish proper scapulo-humeral rhythm going overhead so the humerus is stabilized properly in the glenoid, maintaing the PICR, reducing the potential for injury.

[youtube=https://www.youtube.com/watch?v=V5FSZ1h_CJY&hl=en_US&fs=1&rel=0&border=1]

The Y is designed to develop proper overhead motor programming and muscle recruitment patterns. The goal of the Y is to correct upper trap dominance in overhead positions and restore proper functional mechanics and rhythm to the scapula and humerus in the overhead position.

The reach, roll and lift technique in the Y position is one of the best ways to pattern the proper overhead position and restore the correct muscle recruitment patterns of the lower trap, rotator cuff and lat in the overhead position.

Lying prone with the arms overhead, purposefully shrug the scapula and slide the hands overhead, palms down, as far as possible without lifting the arms off the floor. This will lengthen the lower traps, external shoulder rotators, and the lats. This provides a good starting point to pattern the proper scapula position and shoulder position in an overhead position. From this lengthened position we will be able to better facilitate the contraction of the lower traps, rotator cuff and lats by now having the room to depress the scapula into the proper place on the tspine and be able to better pull the humerus into the proper place in the glenoid in the next step.

Next, externally rotate the arms from the shoulder as much as possible (this will cause the palms to face upward to some degree) while simultaneously contracting the lats to pull the humerus down and sliding/depressing the scapula down the tspine by contracting the lower traps. You will notice as you begin externally rotating the arms and sliding the scapula down the tspine, that the shoulder will begin to pack into the glenoid almost automatically. This is the reflexive contraction of the rotator cuff caused by firing the lats and lower traps and by assuming the proper overhead position.

This will create the “packed” position and the proper length-tension relationship between the lower and upper traps. At this point the lats, rotator cuff and lower trap will be contracting and the shoulder will now be held on the PICR in the glenoid while the scapula muscles work in the correct overhead sequence.

Next maintaing this exact position and rhythm, attempt to lift the hands off the ground while keeping the elbows straight. The height is not important as that is more about mobility and lower trap and serratus strength. Eventually we want to develop more lower trap and serratus strength in this position, but in the beginning it is all about proper motor programming of the scapula muscles in the overhead position. The long lever against gravity in this prone position may be too much load for people to handle and you will immediately see upper trap dominance return or elbows bending to shorten the lever and relieve some of the load. These are all compensations that lead to the poor pattern that causes most overhead problems and pathology. Lifting the arms in the prone position while maintaining the lat, and lower trap contraction is vital to the development of proper overhead movement mechanics.

The Y is only as good as the execution when the arms are lifted. If the packed position of the lat, rotator cuff and lower trap contracting to hold the PICR of the shoulder is compromised when the arms are lifted, you are simply training and reinforcing poor mechanics and therefore actually increasing injury potential instead of decreasing it.

The scapula must not shrug when the lifting phase is initiated, as this creates a potential impingement, unstable humerus and upper trap dominance in overhead movements. Maintain the depressed scapula and contracted lat in the lifting phase as you created in the roll phase. The positions should look the same.

Be aware of overhead mobility issues. If a person has limited mobility in the overhead position they will compensate trying to perform the Y. No matter how much you cue or re-position them they will simply compensate upon lifting because they do not have the mobility to get into the position you are asking of them. You can still work on patterning overhead with these people using the Y, but you must lower the amount of overhead flexion they are in by elevating them and lowering their arms some. When they go to perform the Y they will not lift their arms into full overhead flexion as they will compensate into upper trap dominance. It is best to work on tspine and overhead mobility in these situations to develop the ability to even get the arms overhead properly. Then work on proper patterning.

The same is true of people who are mobile enough to get the arms into the overhead position, but lack the strength to maintain the position in the lift phase. If the lever is too great they will always compensate into an upper trap dominant pattern because the lower trap, lats, serratus or rotator cuff is too weak. In this situation it is best to learn the Y in a standing position facing a wall. Perform the same reach, roll and lift maneuver with the arms and body against the wall. Be aware of excessive lumbar spinal extension compensation here. Also be aware of that in the prone Y. In fact, standing might be the best place to start with all people mobile enough to get into the Y position. Its easier to teach proper patterning without the load against gravity.

To sum up, the Y is a corrective/pre-hab drill designed to properly pattern overhead mechanics to reduce the potential of injury to the shoulder. This is done by teaching how to properly contract the lower traps and lats to effectively position the scapula on the tspine allowing the rotator cuff to have a stable scapular platform to develop tension against. This patterning develops the PICR of the humerus in the glenoid in overhead movements. It is a great exercise to correct poor overhead movement mechanics and teach the shoulder packing concept if implemented properly.

[youtube=https://www.youtube.com/watch?v=An8FxN0K394&hl=en_US&fs=1&rel=0&border=1]

11 Comments

  • Mark Fisher says:

    Holy crap Bret. Thank you soooo much for posting this. I missed this thread on the Strength Coach Forums and its something I’ve been wondering about lately. Talk about a knowledge bomb . . . I feel like I finally understand proper scapular movement in overhead pressing and how to properly cue, and progress both standing and prone y’s. THANKS!!!!

  • Greg says:

    Many, many thanks for posting this blog entry.

    You mention that this topic is discussed in great detail in Cook and Jones’ Secrets of the Shoulder DVD. What I can tell you is that I have been through that DVD many times, and the most important point you elucidate here remained opaque to me.

    It IS very easy for those of us who are less experienced to misinterpret the concept of shoulder packing as described in the RKC materials and Secrets of the Shoulder in a way that leads us to, in effect, deliberately resisting the upwards rotation of the scapulae, which I can tell you from personal experience turns out to be an absolutely fatal error for shoulder health.

    Your post is the first thing I have seen presented that cogently reconciles what I had since figured out from other reading and experience, the critical importance of upward rotation of the scapula in overhead movements, with the “shoulder packing” discussed in various materials from DD.

    The way “shoulder packing” is generally described (or perhaps its the way it is simplified for the masses) I think often results in a very conscious focus on seating the humerus firmly relative to the glenoid and holding it down to stop it from riding up, which, while intuitive, turns out to be a very dysfunctional way to think about it. The only way the humerus stays seated properly on the glenoid while avoiding impingement when reaching overhead is if both rotate upward together.

    Misunderstanding shoulder packing as a focus on keeping the shoulder, as a whole, depressed guarantees that the humerus will act as a very effective pestle against the subacromial roof, macerating everything in between with great efficiency. If one has misunderstood shoulder packing in this way, no amount of rotator cuff programing or conditioning will be of any use.

    Your post is the clearest description I’ve seen yet, in language simple enough for a lay person to visualize, of how to understand shoulder packing while avoiding this painful error.

    The key visualization that I find helpful is to focus on fixing the axis of rotation of the scapulae, rather than the position of the head of the humerus.

    So thanks again.

    • Joe Sansalone says:

      Hello,

      I just read your post and am very glad that I could help clear up the whole shoulder packing thing! Your post here is great for explaining some of the problems that can arise when a concept isnt clearly explained. Great post. Thanks again. I think I learned some more ways to explain it from your response about what you learned!! haha!!

  • Great info! I like the procedure very much. Especially, the call outs to the common compensatory patterns – shrugged shoulder position & lumbar hyperlordosis. Also, the cause of those faulty patterns – namely, fixed upper thoracic kyphosis.

    It is mentioned repeatedly that external rotation will bring in the lats. I learned from Pr Janda that the lats actions include:
    – arm extension
    – internal rotation
    – thoracic flexion
    – lumbar extension

    Just wondering?

    Thanks,
    Craig

  • Joe Sansalone says:

    Thanks for the positive feedback Dr. Liebenson!

    In regards to the lats, I didn’t mean for it to sound like the external rotation component was the primary action causing the lats to engage. I think its really the conscious action of depressing the scapula and the concurrent movement of the humerus down into the glenoid that activates the lat and allows it to be an involved part of the stability of the shoulder in the overhead position. Almost like you are resisting a distraction force against the humerus by engaging the lat and rotator cuff, kind of like the very first motion in a pull up without the actual distraction force. I think its just good motor programming for the shoulder to practice this patterning within exercises like the Y.

    Sorry for any confusion, I probably could have been more clear about what exactly the lats purpose is in the stability of the shoulder and what exactly is causing the lats to be involved or not be involved in regards to the shoulder packing concept.

    Thanks again for the great feedback. I am very humbled to have someone of your standing in the industry mention that they liked what I wrote! Its actually quite amazing for me!

    Sincerely,

    Joe Sansalone

  • Joe,
    Thanks for the compliment, but the reality is we all have a lot of learn from each other. Scapular setting or “packing” is so under-appreciated. The patterning that you bring in the final YouTube is great. How often do we all see Lat Pull DOWN performed w/ the scapulae moving UP.

    Thanks,
    Craig

  • Great discussions guys! Craig I’d like for you to know that I recently read an entire forum thread in which you were heavily involved and you seem like a real class act. My hat’s off to you.

  • Thank you Brett. I never feel we have to get personal just because we disagree. In fact, if we can’t disagree w/out pissing someone off what does that say about how secure they are in their position? My role models were all very humble somehow if the mind is a “tabla rosa” you can be more objective & increase your velocity of learning.

    I have a question for you as you speak of the advantages of 2 leg glut work on stable surfaces for strength training. Have you entertained a dialogue w/ Mike Boyle on your respective views of 1 leg squats/bulgarian split squats/pistol squats?

    & do you see a value in 1 leg work for functional agility & eccentric control purposes?

    Thanks,
    Craig

    • Craig, I’m on the strengthcoach forums and I’ve expressed my views. I’m not sure if Mike sees me on “equal footing” as I believe he tends to surround himself with like-minded individuals who share a similar philosophy in regards to issues such as the joint-by-joint approach, single leg stability, core stability, FMS, active recovery, foam rolling, static stretching, activation work, etc. In other words, I think that he thinks of me as a “smart guy who just doesn’t get it.” His approach has actually gotten so popular that I actually find myself wanting to speak out against it, not because I don’t appreciate the approach, but because I feel that the approach has gained too much popularity and there is no “balance” in teaching both sides (kind of like how science teachers have to teach both evolutionism and creationism). For example, an emphasis on “teaching/coaching” the bilateral lifts and getting athletes to understand proper form and “police each other” might be a better approach than ditching them altogether. I did discuss my views on a particular forum thread and included EMG evidence but it didn’t make much impact.

      I haven’t shared the following information with many folks simply because they wouldn’t be able to understand, but I’ll share with you since I know you’re one of the few people who might find the information useful.

      As for glute activation on “axial lifts” like squats and RDL’s, the difference between bilateral versions and unilateral versions like lunges, step ups, RFESS, and SL RDL’s isn’t too considerable. As for glute activation on “anteroposterior lifts” like hip thrusts and pendulum quadruped hip extensions, here’s where things get interesting. Open chain movements like bodyweight quadruped hip extensions always beat out closed chain movements like single leg glute bridges in glute activation. This is strange since they are similar movements (kind of like closed and open chain cousins) but it appears that the glutes do well in an open chain environment from this directional vector. Although I’m looking to see if I can find published research to support this finding, I’ve seen a 2006 A.C.E. experiment called “Glutes to the Max” that shows that glute activation in a QHE beats out the glute activation in a 1RM squat. All four individuals I’ve tested show higher levels (some people much higher levels) of glute activation in a QHE over a SLGB.

      But what happens when you load these exercises? In a pendulum quadruped hip extension (using the pendulum on the reverse hyper for loading) you can reach much higher levels of glute activation than in the unloaded bodyweight version but when you brace the abs to ensure that there’s no lumbar extension, glute activation goes way down. Perhaps it’s due to “mixed signals,” perhaps it’s due to the fact that the glutes can do more when the pelvis is allowed to rotate a little and the low back is allowed to extend a little in an open-chain enviroment. While bracing is obviously the safest option, and you’d definitely never want to insult the spinal discs, posterior elements, ligaments, etc. by hyperextending up top (or flexing down low for that matter) when doing quadruped movements (especially under load), it’s an interesting phenomenon that I’ve noticed and it warrants more research.

      The most interesting aspect of glute activation as it pertains to “bilateral vs. unilateral counterparts” comes from bridging movements. Bilateral bridging patterns always beat out unilateral bridging patterns due to the increased stability and subsequent heavier loading made possible by increasing stability. There’s a heavy “anti-rotary” component to unilateral briding movements like single leg glute bridges and single leg hip thrusts. Up top where the hips approach neutral, the gluteus maximus really wants to externally rotate which limits the poundage one can use on these movements as if you really tried to fire the glutes as hard as possible with no regards to form you’d end up getting off balance. I believe that the glutes purposely don’t maximally engage on single leg closed-chain anteroposterior vector hip extension movements to help control the movement and prevent torsional/transverse plane movement. When people squeeze their glutes from a standing position (hips neutral) you can see the external rotation moment acting on the femurs.

      I wrote a blog about it here and included a Youtube videos that demonstrates my argument. http://bretcontreras.wordpress.com/2010/02/17/glute-training/

      Anyway, I thought you’d find this information interesting. In regards to 1-leg work for functional agility and eccentric control, I do to an extent. I’m a fan of unilateral work but I have to admit that I do more bilateral work in comparison to unilateral work. While unilateral work may be better for eccentric control and balance/proprioception, bilateral work may be better for full body motor unit activation/explosive strength/neural drive/reactive strength/RFD/etc.

      However, I should mention that I always make sure there are good balances in bilateral and unilateral strength. I trained a powerlifter once who used “all back” while lifting. He could squat 500 and deadlift 600 but couldn’t do one proper repetition of Bulgarian squats. Crazy!

      • Another thing that I’ve never heard any researcher discuss is electrode placement on the glutes. While this blog I wrote was geared toward the average reader and has tons of pictures of girl’s butts, it does contain an extremely interesting chart that shows glute activity in 4-glute areas during various exercises. I did use surface EMG so there’s always the surface/fine wire argument but it’s still very interesting and warrants more investigation.

        http://bretcontreras.wordpress.com/2010/04/23/glute-secrets/

  • Bonnie says:

    Great article but sadly, I still don’t quite understand how to rotate the scapula on the thoracic spine while NOT retracting and depressing but also not allowing them move up. Either I retract and depress or they move up. What is wrong with depressing/retracting as long as they can still rotate? Also, why do the exercises put you in the wrong position first and then correct it. Isn’t this patterning an incorrect movement sequence? Is there a way to learn to do the right movement from the start? When the woman in the videos above reaches overhead that’s wrong? THen she corrects? Thank you for taking the time to clarify. Perhaps a video contrasting right and wrong would clarify it???? Thank you again for you efforts, Bonnie

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