Pilates for Anterior Humeral Glide Syndrome

Om Paramapoonya

September 26, 2017

Comprehensive Program

March 2017 – May 2017

Davis, California

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Abstract

Anterior Humeral Glide (AHG) syndrome is usually a result of muscle imbalances in

the glenohumeral and/or scapulothoracic joints. This problem becomes most evident

when the arms move into extension. For example, in the rowing movement when the

arms are pulled back behind the shoulder blades, over one-third of the humeral heads

will noticeably tilt forward over the acromia rather than remaining stable in the sockets

(glenoid fossae). Over time this poor movement pattern can lead to several issues from

shoulder instability and minor shoulder pain, to more serious problems, such as labral

tears, shoulder impingement and biceps tendonitis. A well-selected Pilates conditioning

program can help combat AHG by improving scapular stabilization, correcting muscle

imbalances, as well as increasing movement awareness of the overall shoulder region.

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Table of Contents

Abstract………………………………………………………………………………………….2

Table of Contents……………………………………………………………………………....3

Anatomical Description………………………………………………………………………...4

Case Study………………………………………………………………………………………7

Conditioning Program…………………………………………………………………………..9

Conclusion……………………………………………………………………………………...12

Bibliography…………………………………………………………………………………….13

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Anatomical Description

Here are the main muscle imbalances that lead to Anterior Humeral Glide (AHG)

syndrome:

1. Overactive Pectoralis Minor

The pectoralis minor—a small, triangular muscle in the upper part of the chest—is

mainly responsible for anterior tilting of the scapula. When this muscle becomes tight

and overactive, it will inhibit the posterior rotators of the humerus, including the

infraspinatus and teres minor, which consequently causes an anterior shift in the

humeral resting position.

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2. Weakness in Serratus Anterior and Lower Trapezius

Serratus Anterior

Trapezius

The serratus anterior (the fan-shaped muscle at the lateral wall of the thorax)

and the lower trapezius (the triangle-shaped, lowermost section of the trapezius

muscle near the lowest six thoracic vertebrae) function as the main scapular

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stabilizers. Weakness in these muscles combined with over activity of the

pectoralis minor results in inadequate scapular stabilization, which further

worsens the anterior tilted position of the humeral heads.

3. Weak Subscapularis and Dominant Latissimus Dorsi

Subscapularis

Latissimus Dorsi

The subscapularis is the largest rotator cuff muscle, attached to the anterior

surface of the scapula and the front of the upper arm. It is another important

shoulder stabilizer whose main functions are to rotate the humerus internally, and

at the same time, posteriorly draw the humeral head into the socket and keep it

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snug in there. When the subscapularis is weak, it is not internally rotating the

humerus as it should. Therefore, the latissimus dorsi, a much larger and stronger

internal rotator (oftentimes along with other internal rotators, such as pectoralis

major and teres major), picks up the slack and becomes overactive. However,

this compensatory muscle action does not provide the posterior pull of the

humeral head as the subscapularis does. As a result, the humeral head glides

forward rather than remaining centrated in the glenoid fossa.

Case Study

I am a 37-year-old female, recovering couch potato, who exhibits all of the

anatomical symptoms of AHG, as discussed above. My anterior-tilted humeral heads

are noticeable in the humeral resting position and become even more pronounced when

my arms move into extension. This problem is not accompanied by kyphosis or

excessive rounding of the upper back. In the anatomical position, my spine looks

perfectly normal. My shoulders are the only parts that tip forward out of ideal alignment.

I have no knowledge of when the problem first started. However, I am certain that

my tight, overactive pectoralis minor and other muscle imbalances are the direct result

of having worked a desk job for over ten years and slouching over the computer all day.

I became aware of my AHG when I started to learn Pilates about two years ago. During

some Pilates exercises, such as Chest Expansion and Stomach Massage Flat Back, I

found it almost impossible to “open the chest” or pull the shoulder heads back as my

instructor cued me. In addition, due to my scapular instability, I would often feel the

“clunking” sensation as if my shoulders were slipping out of their sockets during most

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arm exercises. And lastly, because of my short and overactive lats, I also found raising

my arms overhead to be a struggle. In order to keep my arms straight up, my body

would have to compensate by flaring the ribs and overextending the thorax.

So far, AHG has not caused me any serious issues or injuries. I occasionally

experience minor shoulder pain, but it has never been debilitating to the point that it

affects my daily life. I understand, however, that with every repetition of this poor motor

pattern I allow, I am one step closer to a permanent movement dysfunction, which can

lead to a whole host of problems as I get older, including shoulder impingement, labral

tears, biceps tendonitis, bursitis, shoulder dislocation, etc. To combat AHG, I have

made a drastic change in my lifestyle by trying to be more aware of my posture in

everyday life, quitting my desk job for good, and getting trained to become a Pilates

instructor! Plus, I have developed a “winning strategy” and a conditioning program using

the BASI block system to correct the muscle imbalances and achieve optimal shoulder

health.

Winning Strategy

1. Improve the shoulders’ range of motion with more focus on external and posterior

rotation.

2. Focus on movement awareness and correct muscle recruitment patterns.

3. Strengthen the serratus anterior, lower trapezius and subscapularis to improve

scapular stabilization.

4. Daily stretching of the pectoralis minor (door stretch & wall angels) and latissimus

dorsi (on a foam roller).

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5. Avoid or minimize doing shoulder dips, such as Long Back Stretch and Frog

Back. Although these are great shoulder exercises, they might not be suitable for

people with AHG, because the majority of the motion is derived from driving the

humeral heads forward. Therefore, they tend to perpetuate or even worsen AHG.

Conditioning Program (Intermediate Level)

Pre-Warm Up (Mat) – Roll down

Rationale – Scanning the body and centering oneself

Warm Up (Mat) – Roll up, spine twist supine, double-leg stretch, single-leg stretch,

crisscross

Rationale – Warming up the entire body. Cultivating mindfulness of the body and

breath.

Foot Work (Cadillac) – Foot work series with palms facing up

Rationale – I had an opportunity to take a private session with Rael Isacowitz earlier

this year. After noticing my forward shoulders, he suggested I do the foot work series

with palms up instead of down on the carriage, as it favors external shoulder rotation.

Thus, in addition to strengthening the muscles in the lower extremities, I am also

working toward correcting AHG with this slight modification.

Abdominal Work (Cadillac) – Bottom Lift with Roll-Up Bar

Rationale – Strengthening the abs. Improving spinal flexibility and shoulder control.

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Hip Work (Cadillac) – Supine Leg Series with palms up

Rationale – These exercises strengthen hip adductors, hip extensors and hamstrings,

as well as improve pelvic-lumbar stabilization. And again, the modified hand position

works in the favor of shoulder external rotation.

Spinal Articulation (Cadillac) – Monkey original and Tower Prep

Rationale – Strengthening the abs and hip extensors. Stretching the hamstrings.

Improving spinal mobility.

Stretches (Mat) – Pole Series

Rationale – Stretching the shoulder and chest muscles. Improving scapula and trunk

stabilization.

Full Body Integration (F/I) (Reformer) – Up stretch 1 and long stretch

Rationale – Up Stretch 1 is a great shoulder-stretch exercise whereas Long Stretch

works the subscapularis, which needs to be strengthened in people with AHG. Both are

also very effective in enhancing scapular stabilization.

Arm Work (Reformer) – Rowing series

Rationale – Increasing the shoulders’ range of motion and control. Improving scapular

stabilization.

Full Body Integration (A/M) – Not applicable

Rationale – Because this is an intermediate program, advanced and master-level

exercises are not applicable.

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Leg Work (Reformer) – Single-leg skating

Rationale – Strengthening hip abductors and knee extensors. Improving pelvic-lumbar

stabilization.

Lateral Flexion and Rotation (Reformer) – Mermaid

Rationale – Improving spinal flexibility and scapular stabilization. Stretching the

latissimus dorsi.

Back Extension (Reformer) – Pulling Straps 2

Rationale – In this exercise, the shoulders remain externally rotated throughout; the

serratus anterior and lower trapezius are also constantly engaged, thus making it a

commendable corrective exercise for AHG.

Cool Down (Mat) – Roll down

Rationale – Gradually slowing down the heart rate. Allowing the body to safely readjust

to the resting state.

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Conclusion

Having used this conditioning program twice a week for two months, I have already

noticed some improvement in my condition. The anterior tilt of my humeral heads

seems less pronounced in the humeral resting position as well as in extension. The

clunking sensation in the shoulders during arm exercises is completely gone, and

episodes of minor shoulder pain have become a lot less frequent. Most importantly, my

movement awareness has got keener and more instinctive, allowing me to perform

Pilates exercises more correctly. This conditioning program has proven to be quite

effective in correcting the Anterior Humeral Glide Syndrome. I will continue to use the

program until my optimal shoulder health is achieved and am positive that I will reach

the desired outcome.

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Bibliography

Isacowitz, Rael. Auxiliary: Movement Analysis Workbook. Costa Mesa, California: Body

Arts and Science International, 2012.

Isacowitz, Rael. Mat: Movement Analysis Workbook. Costa Mesa, California: Body Arts

and Science International, 2012.

Isacowitz, Rael and Karen Clippinger. Pilates Anatomy. Champaign, Illinois: Human

Kinetics, 2011.

Isacowitz, Rael. Reformer: Movement Analysis Workbook. Costa Mesa, California: Body

Arts and Science International, 2012.

Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body

Arts and Science International, 2013.

Oscar, Evan. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.

Chichester, United Kingdom: Lotus Publishing, 2014.