Corrective Methods For Common Postural Deviations: The Shoulder

guy curling dumbbellby: Marc McDougal
Corrective Methods For Common Postural Deviations: The Shoulder In-depth coverage of all of the possible posture deviations could be an entire book (and might just be) so for the purpose of this article series, I’m going to cover the most common two problems I see on a daily basis. That being said, without a personal evaluation, it is impossible to pinpoint exact problems, so think of this as a cursory screening to point you and or your clients in the right direction.

And the first deviation is…

1. Internally Rotated Humerus

The Problem

The head of the humerus bone should sit in the shoulder socket (glenoid cavity) in such a way that causes the palm to face directly towards the illiotibial tract in a relaxed position. Although this proper alignment is uncommon in today’s society of desk jobs and poor exercise habits, it is necessary for optimal shoulder health.

Internal rotation causes faulty neural recruitment patterns during pulling and pressing movements which can lead to chronic degeneration of external rotators (the rotator cuff musculature) and a perpetual chain of muscular imbalances.

So what the hell are faulty neural recruitment patterns? Using the Overhead Press as an example, most would consider it an exercise to train the “shoulders”. Some of the kinesiology savvy folks will take it a step further and realize that most of the tension will be on the medial deltoid, followed by the anterior deltoid (dependant on degree of arm abduction during the press), and to a lesser extent- the triceps, serratus anterior, and traps (the latter three contribute mostly from 90 degrees up).

A healthy shoulder girdle will fire not only the aforementioned prime movers in the proper order and force allocation, but it will also contract the smaller supporting musculature at the exact right time in conjunction with the bigger muscles to carry out the movement in the safest, most efficient manner. When a person has an internally rotated humerus, he/she will tend to perform an overhead press in an oblique plane, sliding saggitally anywhere from 5-20 degrees out of the proper coronal alignment (the press will terminate slightly in front of the body, instead of directly over the head). This is because the pecs and subscapularis muscles are chronically tight and shortened, and the rotator cuff (specifically the infraspinatus in this instance) lacks the strength and unimpaired innervation to pull the humerus back into proper coronal alignment.


 In time, this causes inflammation, nerve compression, lack of nutrient delivery, and if left untreated can even cause severe problems such as Shoulder Impingement Syndrome (compression of the bursa sack in the shoulder under the acromion) or Thoracic Outlet Sydrome. As an “out there” example, nerve and vessel compression in the shoulder joint has been known to cause something called Brachial Amyotrophic Diplegia which can eventually result in respiratory failure! Of course this isn’t something to be realistically concerned with, but should prove as an example of how simple posture problems can spread to other systems of your body.

As another example of posture problems being the underlying root of seemingly unrelated health issues; the anterior shoulder region contains the brachial and central axillary lymph nodes, which are susceptible to reduced function when compressed due to inflammation. Lymph vessels transport lymphocytes, essential for proper immune function, and the nodes are like little filters for the lymph fluid. An internally rotated humerus can lead to inflammation causing node compression and immune dysfunction! Try running your car without a fuel filter…

Who would have thought that a bad shoulder could suppress your immune system, and actually allow you to become ill?

Aside from problems keeping a neutral overhead press, trainees with shoulder dysfunction due to internal rotation also commonly have trouble with certain bicep exercises. The proximal attachment for the long head of the biceps sits between the top of the humerus bone and the supraspinatus muscle, and is very sensitive to inflammation and shoulder dysfunction. This is often manifested when a client finds incline dumbbell curls (45 degrees or lower) painful to execute.

Being an athlete with significant internal rotation, it’s not a matter of if you will experience an injury; it’s a matter of when, and how bad.

Aside from injuries; one might also experience plateaus in strength and hypertrophy of movements involving internal rotation, such as bench pressing, pulldowns and some rowing movements. This is due to the protective habits of the nervous system and the golgi tendon organs achieving a lower activation threshold. These little intracellular structures are like a governer on an engine; your body is trying to stop the furthering of this gross muscular imbalance before you experience a full on blow out.

So, other than the overhead press and incline curl, how do you know if you’re internally rotated?

The Simple Assessment

Humerus does what to the illiotibial whaaat? In non-biomechanical terms, the initial description I gave back at the beginning means that if you’re standing completely relaxed, both of your palms should be facing directly towards each other. If you’re unsure, perform my flashlight test. And don’t complain about this being too hard to do, it takes a tiny bit of motivation and about 30 seconds. Grab a couple of mini mag-lights or same sized, lightweight flashlights (not the big caveman club sized ones). If you don’t have any, Home Depot is still open, get to it. Stand in a dark room facing a wall, about a foot away. With one flashlight in each hand, turn them on and stand completely relaxed with your arms hanging at your sides. Look at the lights on the wall. Do the beams cross or touch? If yes, you’re in bad shape. If not, step back another foot. How far back can you go without the beams overlapping? 10 feet? Well, you should be able to keep going until you run into whatever happens to be behind you. Ideally, the beams should never cross. The farther away you can walk, the better off you are. More on this later.

The Not-Quite-As-Simple Fix

Form specifics and tempos prescriptions are important; do them exactly as they are listed.

Tempos are to be read in the traditional manner, numbers represents seconds of execution: (Eccentric/Pause/Concentric/Pause)

What’s Tight:

  • Lats
  • Pec Major
  • Pec Minor
  • Subscapularis
  • Coracobrachialis

What’s Weak:

  • Teres Minor
  • Infraspinatus
  • Posterior Deltoid
  • Rhomboids
  • Mid Traps

If you could only get 1-5 feet away, you’re a damn mess.

Here’s your plan:

1. Cease all of the following movements for the next 3 weeks:

a. Bench Pressing (Incline, Decline, Dumbbell, all of it)
b. Lat Pulldowns
c. Pull ups
d. Pullovers
e. Chest Flys
f. Cable Crossovers
g. Any fixed pivot machines for the upper body

Now, don’t worry about how your chest and lats are going to shrink or get weak, consider that the track you’re on ends with either an injury or the same cessation of growth/strength you’re worried about anyway. Suck it up, and lay off the movements. It’s only 3 weeks.

2. Add in all of the following movements for the next 12 weeks minimum:

1. Seated Cable Row with a Pronated/Medium Grip (2011)

Seated Row Pronated Grip. This pic shows the proper start position.

Seated Row Pronated Grip. This pic shows an improper start position with rounded shoulders.

Seated Row Pronated Grip. Finish Position.

Seated Row Posterior View. Notice retracted shoulders, which is necessary for proper rhomboid and mid-trap activation.

Seated Row Posterior View. Improper finish position, shoulders are not retracted.


b. Seated Unilateral External Rotation (Teres Minor) (4020)

Seated Unilateral External Rotation. Start Position.

Seated Unilateral External Rotation. Finish position, notice the humerus remains neutral in the socket at the stretch position. Also, notice both shoulders square to the wall in front, do not allow non-working shoulder to drop back.

Seated Unilateral External Rotation. Improper finish position with protracted working shoulder, and non-working shoulder dropped back.

c. Standing Unilateral Cable External Rotation (Infraspinatus) (4020)

Standing Unilateral Cable External Rotation. Start, Neutral Humerus, Proper Alignment.

Standing Unilateral Cable External Rotation. Finish, Elbow Forward, Proper Alignment.

Cable External Rotation, Start. Protracted, Improper Alignment.

Cable External Rotation Finish. Elbow Back, Improper. You should think of actively trying to slide the elbow forward along the transverse plane during the external rotation to optimally activate the infraspinatus.

d. Horizontal Pull Up, with feet on Swiss Ball (3021)

Horizontal Ball Pull Up, Start. Brace Abdominals throughout movement and drive shoulders together, pulling the sternum to the bar.

Horizontal Ball Pull Up, Finish.

e. Pec Minor Stretch (hold for 30 seconds)

Pec Minor Stretch. Turn body away from post to the point of slight discomfort and hold.

f. Subscapularis Stretch (no weight, progress to holding db’s) (30 sec)


g. Pec Major Stretch (30 sec)

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Pec Major Stretch. Turn body away from post to the point of slight discomfort and hold.

h. Lat Stretch (30 sec)

Unilateral Latissimus Stretch, Start. Grab post above eye level, squat down until tension is felt on the lat.

Unilateral Latissimus Stretch, Finish. Turn body towards elevated arm to deepen the stretch, keep elbow slightly bent.

i. Prone Incline Overhead Press (lean chest against a bench set to about 80-85 degrees. Support feet on ground and perform a normal overhead press. Leaning against the bench will force the shoulders to externally rotate during the press, teaching the proper neural recruitment. (3020)

*Avoid using a towel between arm and body during rotator cuff exercises, as this activates humerus adductors (pecs/lats), which will further inhibit the already diminished neural drive to the external rotators.

If you could get 6-10 feet away, congrats, there’s a bit of hope for you.

Here’s you’re plan:

1. Add up all of your sets in your entire training split of the following movements:

a. All Bench Pressing: Flat, Decline, Incline, Barbell, Dumbbell.
b. Dumbbell Flyes
c. Cable Crossovers
d. Pullovers
e. Lat Pulldowns
f. Pullups

Now, cut this number in half. That’s how many sets you’re going to do of those movements for the next 6 weeks. Now, multiply that by two (which should have striking similarities to your first answer). That’s how many total sets of the following exercises you’re going to start doing for this 6 week phase (you get to choose how many sets of each particular exercise):

1. Seated Cable Row- Medium/Pronated Grip. Keep elbows high during the pull. Do NOT keep them tucked close to your sides. (3022)
2. Bent Over Barbell Row- Same as above. (3021)
3. Incline Unilateral Row- Pronated Grip. Keep torso at same angle as bench throughout pull. (3022)
4. Incline Rear Delt Flye- Pronated Grip.

Incline Dumbbell Pronated Flye, Start. Maintain neutral head position.

Incline Dumbbell Pronated Flye, Finish. Drive shoulders together maximally throughout movement.
5. Horizontal Ball Pull up (4041) Focus on scapular retraction throughout the pull.
6. Seated Unilateral External Rotation (Teres Minor) (4020)
7. Standing Unilateral Cable External Rotation (Infraspinatus) (4020)
8. Prone Incline Overhead Press (3020)

Keep the reps high for the external rotation movements (f & g), around 12-15. Strict form is imperative; don’t try to throw heavy weights around. If you’re like most people, you’ll need to stroll over to the chrome dumbbell section and grab an 8-10lb bell for the seated rotation for your first few workouts. Who knows, you might meet your future wife over there.


Perform the following stretches before and during workouts, especially right before rotator cuff exercises. Trying to train the cuff when the humerus is out of alignment is borderline useless.

1. Pec Minor Stretch (hold for 30 seconds)
2. Subscapularis Stretch (no weight, progress to holding db’s) (30 sec)
3. Pec Major Stretch (30 sec)
4. Lat Stretch (30 sec)

If you can get more than 10 feet away from the wall without the lights crossing, you can keep up your current program, but you’ll need to do the following:

1. Switch your rowing and Pulldown/pullup movements to pronated grip. Avoid supinated/neutral grip movements.
2. Take a 1 second pause at the end of all eccentric phases of pressing movments, and the concentric phase of all pulling movements (always the point closest to the body).

Perform these stretches before/during all workouts:

1. Pec Minor Stretch (hold for 30 seconds)
2. Subscapularis Stretch (no weight, progress to holding db’s) (30 sec)
3. Pec Major Stretch (30 sec)
4. Lat Stretch (30 sec)

Perform these rotator cuff exercises, one at the end of each workout (alternate the two).

1. Seated External Rotation
2. Standing Cable External Rotation

Some will find a cable external rotation difficult to complete, and can start by performing a standing dumbbell external rotation initially. These exercises can be used interchangeably as they both train the rotator cuff with the humerus in an abducted position which emphasizes the infraspinatus.

Standing Dumbbell External Rotation, Finish. As with the cable external rotation, try to actively ‘slide’ the elbows forward and under the wrists throughout movement, don’t just try to raise the dumbbells up.

Standing Dumbbell External Rotation, Start.


Consider ART

Active Release Techniques is a method of neuromuscular deep tissue massage therapy that I’ve used for myself and clients with great success over many years. Chronic postural deviations will usually cause scar tissue and adhesion buildup, and ART is a method of breaking this up so the tissue can return to a normal healthy state. Find a qualified practitioner and get a few sessions done, you’ll be glad you did.

Use your body.

When incorporating pressing and pulling movements into the program, emphasize closed kinetic chain movements (where the body is moving through space instead of the resistance). Push ups are a great start, elevating the feet onto a swiss ball is a perfect way to increase difficulty while increasing shoulder joint proprioception and stability.

As for rowing, try the horizontal ball pull up. This allows the mid back muscualture (rhomboids, rear delts, lats, mid traps) to contract in an unstable environment, to enhance proprioception as above.

One Last Culprit

The long head of the triceps can cause the shoulder to rotate anteriorly along the saggital plane when chronically tight. This can be independent of an internally rotated humerus. One could think of this postural deviance as the way your shoulder looks at the first phase of an arm pump during a sprint, just as the arm starts to move behind the torso. If this is how you look relaxed, add in some additional overhead tricep stretching.

Next month, I’ll cover the other most common postural deviation, the Anterior Pelvic Tilt.

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