Scapular Instability with Climbers

“Keep your arms straight and stay low!” This classic line is heard the world over for beginning climbers. Even if preventing the T-Rex arm is a quality way to fight off pump, this doesn’t tell the whole story of how we should be moving on the wall. In fact, the way that a lot of people achieve this position can limit force output of the arm and hand muscles crucial for staying on the wall. This commonly overlooked movement fault can lead to some of the most prevalent and pesky injuries for climbers (think tendinitis…) When we hang low to save energy, we typically fail to properly activate our scapular stabilizers, which ends up hurting a climber more in the long run than any transient pump during a training session.

First, we must understand the anatomy of the scapulothoracic joint and shoulder. Our arm is directly connected to our trunk via only one small bony articulation: the acromioclavicular joint. Our arm bone, the humerus, sits in a shallow socket on the scapula which is essentially connected via muscles to our thorax. Compare this to the stable pelvis and deep ball and socket at the hip, and you can see why our upper extremity anatomy allows for such great mobility.

Pictured below is the right shoulder complex featuring the rhomboids, rotator cuff, serratus anterior with their attachments on the humerus, scapula, thoracic vertebrae and ribs. Note how the only bony articulation between the shoulder girdle and thorax is the small AC joint above the humerus. Not pictured is the trapezius muscle group, which overlays the other mid-scapular muscles.

However, with great mobility, comes the great need for stability in the form of synchronized activation and movement patterns from the muscles attaching our scapula to the rest of our body. And those muscles don’t just position the scapula; they are responsible for keeping it stable as the muscles of our arm (rotator cuff, deltoids, all the way down to our fingers) are applying forces to generate torque and motion.

Imagine an approach to the crag on a firmly packed hiking trail (stable scapula) vs. a talus field (unstable scapula). The ease you move with on firm ground is because the force you apply through your feet is reciprocated through the ground. On scree, the rocks under your feet may shift with each push off, and you find yourself working much harder. If our scapular stabilizers (traps, rhomboids, etc.) aren’t functioning when we climb, the strong arm muscles (deltoids, biceps, etc.) will yank the scapula around on your back instead of applying their full force through each hold. Thus, the shoulder may be put in compromising positions and your arms will work harder; both of which can lead to injury.

If you have any arm injuries or are interested in learning how to improve scapular function, keep reading through this blog for some simple suggestions on ways to improve your scapular control.

Assessment

A simple way to dive into this is to visually examine your back. If you have an arm that has been bothering you, have a buddy inspect your back and scapulae for asymmetries. The easiest thing to look at is the position of the scapula relative to the spine:

If there is a correlation between the side with your pain and the side with a greater distance from midline, it would make sense to follow through with the rest of the assessment program. Otherwise, initiating a scapular control and strengthening program is always a great injury prevention and performance optimization strategy.

Research has shown that when our scapula is in its ideal position, the muscles of the arm are able to generate more force (Bhatt, et al. 2013). This can be demonstrated via the modified grip strength assessment. To complete, use a hand grip dynamometer to measure your grip strength in resting position. Then, assume a more ideal posture by bringing your shoulder blades down and back into retraction.

As seen with the grip assessment, grip strength improves with scapular repositioning. On the wall, if you aren’t actively stabilizing the scapula, you are using your muscles in an inefficient way and may generate insufficient force. Compensating for weak shoulder blade muscles with overuse of the wrist and elbow muscles is common among climbers and athletes (tennis, golf); and can lead to debilitating overuse injuries such as lateral epicondylitis, medial epicondylitis, and biceps tendinitis, to name a few.

Additionally, improper scapular mechanics can lead to the pathologies of the shoulder, mainly in the form of subacromial pain syndrome. Improper scapular activity during shoulder motion or loading can lead to rotator cuff overuse and subsequent irritation of the structures in the top of the shoulder.  For this test, have a buddy help you out by testing your shoulder strength at 90 degrees of elevation in the scapular plane. Then have them keep your shoulder stable with their other hand. The manual repositioning of the scapula mimics the muscle activity of the lower and middle trapezius fibers and can reduce pain and improve strength during a resisted shoulder elevation task.

These assessments demonstrate how improving active control of the scapula can enhance muscle performance throughout the upper extremity; leading to improved performance and mitigating injury risk.

Intervention

If you’ve identified an impairment in your scapular control or want to address the strength of these muscles proactively, we have included some simple and effective exercises for you. The first will be a combination of tendon gliding and shoulder/scapular active range of motion (commonly known as a wall angel or wall slide). This warm-up engages scapular stabilizers while mobilizing your finger and wrist to prepare you to pull onto the wall without increasing your risk for injury. Over time, you’ll see an improvement in your overhead shoulder range of motion as muscular limitations from the latissimus dorsi, teres major, and pectoralis major/minor are alleviated, all while facilitating scapular upward rotation through muscle control.

Another good mobility exercise can be completed while laying down on a foam roll or standing in a doorway. This involves scissoring your arms up into alternating full flexion and extension. Emphasize control of the motion via your scapulothoracic joint (shoulder blade) instead of just the shoulder joint (ball and socket). You will maximize the activation of your scapular movers including serrates anterior and lower trapezius and promote awareness of the shoulder girdle’s position during movement.

Finally, resistance exercises targeting the lower/middle trapezius and rhomboids can be used to prime the muscles before you climb and strengthen them in order to improve performance. The video below shows the exercises being completed on a swiss ball, but to start it may be best to lie on a mat in order to rest your head. This will reduce any compensation from the upper trapezius. The most important concept is to make sure you are moving from the scapulothoracic joint (shoulder blade) and not the shoulder joint (ball and socket). The arm is positioned in the various positions shown to increase the resistance by increasing the lever arm. Compensation using the shoulder joint muscles (latissimus dorsi, triceps, deltoids) can exacerbate faulty movement patterns. Try this in a mirror, or have a friend take a video to make sure you are doing it the right way.

A more functional progression of this concept will be carried out on the hangboard. Using a hangboard is an extremely effective way to build contact strength as a climber, but far too often people hang mainly on passive structures.

Although this may help you build finger tendon strength, you are not addressing (and possibly inhibiting) all the muscles required to climb hard. While you are hanging you should never feel a stretch and should always have your shoulder blades positioned down and back, your core engaged, and your elbows slightly bent.

The two images below were taken of Dr. Jared Vagy, the author of Climb Injury-Free and youth world champion climber Brooke Raboutou. In the first image, Brooke demonstrates how some climbers hang with poor technique where the shoulder blades are excessively elevated. She is hanging low off her arms, and note how her arms are basically touching either side of the head:

In the second image, after cues to engage her scapular stabilizers, you can see that she achieves a more effective retracted position. Note the “window” between her arms and her head:

Moving in and out of the positions in these two photos is a great way to strengthen the mid-back muscles in both the concentric and eccentric phase of their contractions. These modified pull-ups should target motion specifically at the scapulothoracic joint and allow you to feel how these muscles work while you are on the wall. Continue to maintain core activation and monitor yourself for rib flare, arching of the low back, and especially shrugging of the shoulders.

As you develop a foundation of mobility, strength, awareness, and control of your scapulae, you need to take these concepts to the climbing wall. However, it is best to only focus on new movement strategies during your warm-up routes/problems. When you are climbing at your limit it is disadvantageous to divert any attention away from completing your sequences.

Proximal stability is important in all movement, but it is often overlooked in the upper extremity since humans mainly use the arm to manipulate objects within their environment. The climber is the rare breed of individual who relies on the arms for propulsion, so we should constantly be applying injury prevention and performance strategies that are common place for the lower extremity in other sports!

The information in this article should serve mainly as a guide and a way for you to get the ball rolling towards a general awareness of what it takes to climb strong and maintain your health. If you fear that you have any serious injury or are in persistent pain, it is recommended that you see a physical therapist who can uncover any underlying impairments and come up with a plan tailored specifically to your needs.

About the Author

Graham Gage is a Physical Therapist from Sunnyvale, California. He earned his Bachelor of Science in Kinesiology at California Poly Pomona and Doctorate of Physical Therapy from The University of Southern California. Graham currently resides in San Pedro, California and is completing his Orthopedic Residency at USC. He recently came up on some big gear, so you are most likely to find him in a large crack in Joshua Tree this season. To contact Graham with any questions, comments, or for consultations; please email him at ggage@usc.edu