Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin


Scapular Alphabet – The “T”, “Y” and “W”

And just when you thought all letters were created equally...

I have had the opportunity to see some rotator cuff tendonitis and biceps tendonitis patient recently who reminded me of the importance of that first statement. A quick on-line search of the "T", "Y" and "W" exercises commonly prescribed for shoulder pathology confirmed that many clinicians use these exercises more as a general means of fixing scapular instability rather than for a targeted purpose.

I've made that mistake before. And when the patient returned with equal or worse pain, it sent me back to the drawing board to figure out why. Collectively, these exercises appear to all strengthen scapular muscles. But let's take a closer look at each one:

TThe "T" - This horizontally abducted row has been shown in studies to best activate the rhomboid and mid trapezius muscles. Remember, that the rhomboid is not only a retractor, but also an downward rotator of the scapula and a prime candidate to counteract the sometimes overwhelming pull of the upper trapezius (a very strong upward rotator).


The "Y" - This is a strong activator of the lower trapezius muscle (also a functional antagonist to the over active upper trapezius). Remember, the lower trapezius muscle is activated with arm elevation past 90˚. One of the best ways to shut it off? Adopt a thoracic kyphosis or limit rotation to one side and this muscle will become neurologically insufficient (or what we call neurologically lazy).


The "W" - This exercise incorporates retraction with external rotation, so is a strong activator of the shoulder external rotators (infraspinatus and teres minor). Here is the caveat. If a patient has a trigger point in the infraspinatus or teres minor, doing this exercise can actually increase a person's pain! These muscles are not only external rotators, but relative upward rotators of the scapula (just take a look at a picture of them).

So, there you have it. I have seen biceps tenosynovitis and rotator cuff impingement patients gain pain-free status after doing the T, and then immediately have their pain return with resisted flexion or ER after doing the W. There are specific reasons to do specific exercises. Know the "Y" behind what you do. Your patients will thank you for it.

Until next time...

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