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.
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]