Let’s dive right in to what we can learn from the “Mirrored Joint Model”.
Today we will analyze the shoulder and hip and derive a few principles to help us more effectively improve their function.
To start, it’s helpful to start with an image to get a visual understanding of the joints we are discussing. It’s also helpful to view the skeletal anatomy from a quadruped position:
As an introduction to the “Mirrored Joint Model” we will use this blog to lay out the similarities between the analogous joints and the principles we can derive from them.
STEP ONE FOR PROPER SHOULDER/HIP FUNCTION: Optimize 3 dimensional dynamic joint positioning
1.) Both the shoulder and hip joints are ball and socket joints designed for maximal range of motion. For optimal range of motion however, both joints first require optimal dynamic positioning. Both the shoulder and hip are commonly limited in flexion due to either an anteriorly tilted scapula or anteriorly tilted ilium.
If the scapula or ilium are overly tilted during a dynamic movement then they will reach a bony impingement position before full ROM is expressed. Proper positioning of these bones is created by a properly positioned thorax, with a parallel diaphragm and pelvic floor. This is one place where I like to utilize exercise adaptations from PRI (postural restoration institute). I believe these “repositioning” exercises should be step one.
Anterior scapular tilt limiting flexion Anterior pelvic tilt limiting flexion
STEP TWO FOR PROPER SHOULDER/HIP FUNCTION: Release any high tone anterior musculature
2.) The anterior musculature of the hip and shoulder are prone to high tone due to commonly adopted postures and dysfunctional breathing, among other things. More specifically the analogous muscles between the shoulder and hip are the pectorals minor/latissimus dorsi and the iliacus and psoas.
These analogous muscles are prone to high tone and require proper tone reduction through breathing exercises, contract/relax stretches, and end range strengthening (or some combination of these strategies). These are also the muscles that you will always see our furry, quadruped friends stretching:
STEP THREE FOR PROPER SHOULDER/HIP FUNCTION: Address posterior capsule stiffness
3. Another similarity between the shoulder and hip is the proclivity of the posterior capsules to become stiff or immobile. A stiff posterior capsule will limit flexion and rotational range of motion of the shoulder and hip. Therefore a fully developed mobility progression should address the posterior capsule.
For the shoulder this may mean a horizontal adduction stretch done from the supine, hook lying position. For the hip, this may mean a internal rotation, posterior hip stretch on a bench or from the supine position.
Horizontal adduction stretch for posterior capsule. Posterior capsule stretch of the hip
STEP FOUR FOR PROPER SHOULDER/HIP FUNCTION: Address stability and motor control
4. Sufficient strength and a proper motor control strategy are also key in proper shoulder and hip function. It’s not at all uncommon to find the key limiter of mobility to be poor motor control. Utilizing proper activation or “reset” exercises are critical for improving mobility in these cases.
There are many great exercise that can be plugged in to accomplish this, but for me I find the neurodevelopment exercises to be great for this. Those in the rehab world will recognize another commonality between the shoulder and hip, and that is tendency for both to require strengthening of the external rotators and posterior musculature.
Neurodevelopment exercise for motor control
STEP FIVE FOR PROPER SHOULDER/HIP FUNCTION: Full active rotational range of motion
5. Another commonality between the shoulder and hip is rather obvious, they are both ball and socket joints. This means they should allow the arm or leg to rotate rather smoothly through a full 360 degree range of motion. However, most of us rarely actively explore the full range of motion of the shoulder or hip.
After working through the issues discussed above it’s good to begin a daily practice of exploring the full available mobility of the hip and shoulder to ensure that mobility is not lost over time and that the joint stays functional and healthy. Dr. Andreo Spina of Functional Anatomy Seminars, has devised a great system of active rotational exercises that he calls CARs (controlled articular rotations).
A complete sample shoulder mobility progression utilizing the principles above: (TRY IT TODAY IF YOU HAVE SHOULDER ISSUES)
1. 90/90 Breathing with overhead shoulder motion (to reposition thorax)
2. Foam Roll, contract/relax stretching of the pecs/lats, and end range strengthening (to release anterior tone)
3. Horizontal Adduction Stretch (to stretch posterior capsule)
4. Reflex Turning 2 from DNS, Dynamic Neuromuscular Stabilization (to reset motor control/stability)
5. Shoulder CARs (to actively utilize full range of motion)
Note: in many ways these steps are all related and interweaved. For instance releasing high tone soft tissue will aid in proper dynamic joint positioning, and vice versa. However, following this progression will assure success in the vast majority of cases.
Be on the lookout for part 3 of the “Mirrored Joint Model” blog on the Ankle and Wrist!