Understanding How Thorax Position Impacts Scapular Orientation – Dr. Greg Schaible

We understand the body can move in three planes, giving us many options to move with numerous degrees of freedom.

Most can then appreciate how each joint will have different amounts of freedom based on the type of joint.

The scapula is one area in which many people are able to name all the movements, but not necessarily appreciate all its movement capabilities. Performance professionals often work with athletes who either perform overhead movements (i.e. throwing) or suffer from shoulder pain that can often stem from thoracic/scapular issues.

The main purpose of this article is to call your attention to how manipulating body position can impact the outcome of a movement based upon the athlete’s presentation.  Once you read the article and watch the video, you should have a better understanding of how the scapula, rib cage, and thoracic spine interact.

(Note:  Somewhat different than many of my other articles, this article is not as much about fixing a specific problem as it is to enhance your understanding of how the thorax and scapula interact so that you can make more appropriate suggestions and programming decisions with your athletes.)

The scapula moves in any combination of the following:

  • Elevation & Depression
  • Protraction & Retraction
  • Upward & Downward Rotation
  • Anterior & Posterior Tilting
  • Internal & External Rotation

What we like to see with the overhead position is scapula upward rotation (wrapping around the thorax), posterior tilt, and external rotation.

It’s usually not that simple though.

First, we want to ask ourselves what position is the scapula resting in?

The easiest way to generalize that answer is to figure out if the scapulas are in a protracted or retracted position? Protraction and retraction tend to be a recognizable trait which will include some coupled movements into upward rotation (protraction) and downward rotation (retraction).

The reason for asking this question is that we need to know if the scapula is starting “ahead” or “behind” the starting line.

While it’s important to make sure the scapula is moving properly when taking the arm overhead, it’s just as important to recognize their starting position as it will impact the timing and congruency of the ball and socket joint during overhead motion.

The simplest way to address this is by looking at how the resting position changes when the body position changes.

Consider the following examples:

  1. Wall Slide – The wall gives some assistance and proprioception to the movement which often facilitates better mechanics from the start. However, while standing there is going to be a tendency for some individuals (not all) to display a flat t-spine or increased lordosis to perform the activity. This could impact the scapula’s static position or dynamic position.
  2. All-4s on Elbows Reach Roll Lift – This increases the amount of proprioception. Demands more anterior core engagement, and takes gravity out of the equation until you perform the lift-off. For certain individuals, this will look and feel the best for them.
  3. All 4s on Hands Reach Roll Lift – This position you will often find people with flat T-spines struggling to manage gravity and the thorax position. As a result, you may see a noticeable medial border of the scapula.
  4. All 4s on Stability Ball for Ribcage Retraction – The sole purpose of this is to use bodyweight and gravity to apply pressure into the sternum so that the ribcage passively retracts back toward the scapula. Which for a flat t-spine individual can be a useful starting point to work on scapular coordination and strength. Many people will place the ball at waist level which would facilitate more extension to occur. Which if the individual is starting from an extended flat thoracic spine state. You should be monitoring how much the athlete relies on extension to complete the task.

None of these exercises are inherently right or wrong, but each one may be helpful depending on the person’s needs. 

This video gives you more in-depth information on these movements, and should help you understand positioning better than only reading about it:  

This very brief video from Dr. G. Bhanu Prakash of Medical Animations will give you a clear view of the motions discussed above and an understanding of which muscles produce each movement:


Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. Greg is the owner of On Track Physiotherapy and owner of the popular online education resource Sports Rehab Expert. Greg works with athletes and active individuals of all ages. As a former athlete himself, he attended The University of Findlay and competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American.

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