The 3 Ps of the Shoulder: Protectors, Pivoters and Propellers

Welcome to the Performance Place Sports Care podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. I'm Sebastian Gonzales from P2 Sports Care, and this is the podcast, the official one. Thanks for joining me today. This is a place where I really try to put down as much knowledge as I can in hopefully a very simple way for you guys to understand more about sports injuries, and hopefully you're getting information about your sports injury, so you can talk to your PT, your chiropractor, your sports doc more, and more details, so you can understand how to deal with these things. Because I found over the course of working in my clinic that a lot of people don't understand their injury, and that is a big, big, big barrier to their success.

So today, we're going to be talking about shoulders and three types of shoulder muscles, which you might not know about, but it's really, really important that you do. And I was speaking with one of my patients this week about this exact thing. I thought it would be a great thing for you guys to learn about, so also, too, if you want your question on air before I go too far, we have a site, p2sportscare.com, that's plural, sports, p2 is the number, sportscare.com, and there's a button there right in the middle of the page that allows you to speak directly to your computer and get your question up.

And the ones that have the most detail and the most unique questions are the ones that I'm going to try to answer. So this one is a comment that I got that I thought I should talk about the shoulder blade, the shoulder muscles, and other types of muscles to you about. Anyway, so we'll get right to it. So I'm going to read this off. I don't get when the infraspinatus, supraspinatus, and teres monitor become tight. I don't get how they become tight. They don't actually bring the shoulder back because they're tight. Bringing the shoulder to the front are the pecs. No. Shouldn't they be slackened by rounded posture?

So the thing that this made me think about was, again, the types of muscles of the shoulder complex, again, complex, not just shoulder, that need to be learned, or you guys need to learn. And there's three types. So there's three types. There's glenohumeral protectors. Think of the Ps, three Ps. glenohumeral protectors, scapulohumeral pivotors, and the humeral positioners, also the propellers. So three types of Ps, protectors, pivotors, and propellers is the one I like to use. This was coined by Dr. Job, I believe, in 91. And I think it really breaks things down for me. And it makes things really simple to understand for the shoulder because I have people ask all the time, what are the exercises I need to do?

Do I need to do shoulder blade ones? How about pulling ones? How about rotator cuff ones? Which are the ones I spend time on? And my answer is, you need all of them. But the first two are the most important in the beginning. So glenohumeral protectors, let me explain that for a second. I'll explain first the glenohumeral joint. So the glenohumeral joint is a, it's the ball and socket. And the reason why it's called the glenohumeral joint, because there's the humerus, which is the ball, which is the arm shaft. And there's the glenoid, it's a glenoid fossa. And that's actually the shoulder blade.

So it's a really, really shallow socket, which the ball and socket come together. And there's muscles and even non-muscle structures, which keep this joint together. And if we're talking about the muscular group, it's mainly the rotator cuff and the long head of the bicep. Now the biceps is one that does go below the elbow. And it's the one that you point to the beach and show people where the beach is at to impress them, obviously. But there's a long and a short head. The long head goes past the shoulder and attaches to the shoulder blade in a section around the glenoid or the socket part. Now the biceps long head tendon actually is on the front side.

And sometimes you can move your arm around and just feel it click back and forth. And it's actually very tender on people, but it does have a job to hold the ball and socket together, as well as the rotator cuff group. Now the rotator cuff, if you don't know the muscles of the rotator cuff, they call them the sits muscles, the S-I-T-S. So there's the supraspinatus, the infraspinatus, the teres minor, not major, and the subscapularis. And all these muscles hold that ball and socket together and compress it really well into the joint so it can roll and slide around. These muscles also help out with dynamic stabilization or being able to hold the ball and socket together while you're moving your arm over your head or forward in front of you and so on.

So the rotator cuff actually provides a force which slides the head or the ball. It allows it to go downward or depress, and it limits the amount of upward motion. And the reason why this is important to understand is we call this the roll and slide of the shoulder joint. There is a space in there called the subacromial space, which is a space which isn't very big. There is two tendons, or sorry, let's go with two tendons, a muscle, and a bursa that goes through. The reason I say two tendons and one muscle is because the supraspinatus muscle goes through there, but it's kind of tendinous at that point.

I'm sure there's muscle fibers. But for the most part, if this space gets closed up because the slide downward doesn't happen because the rotator cuff isn't doing its job, then it will just compress these things to hell, and they will just tear right up. So we've actually found that athletes with shoulder instability have been shown they have associated movement pattern issues as well as firing pattern issues with the rotator cuff. So there's a strong correlation with shoulder pain and rotator cuffs not working well. So they need to produce this downward slide. And the funny thing about the shoulder or the rotator cuff is that the subscapularis and the infraspinatus anyways, they were ones that were studied that it shows that they're really, really good at their job if we let them do it.

And they compared these two muscles to other muscles, which are moving groups. And two muscles which they compared them to was the posterior deltoid and the brachioradialis. The deltoid is the big cannonball one on the top of the shoulder but in the backside because it's the posterior aspect or the backside aspect. And the brachioradialis is, if you look down at your elbow, it's the one that kind of goes into the elbow crease. And you can actually pick it up if you try to pinch like you're on the top part of your forearm. So these muscles, they're really good at producing force. These ones, the deltoid and the brachioradialis.

But they have a larger window to function in. And the reason why I'm talking about this is because every muscle has what we call its length-tension relationship. The muscle likes a certain length and it has the ability to do its job within that length. And if it deviates from that length, either being too short or too long, it doesn't do a good job. And it usually becomes damaged. So they found that the rotator cuff, or at least the subscap and infraspinatus, actually have a better potential to generate more force than those two muscles. But its window of opportunity was much smaller. It didn't have the ability to go through a larger range of motion.

So the point is of this is we have to allow the rotator cuff the ability to do its job by keeping the shoulder in a good position. And this moves on to our next one, the scapulohumeral pivoters. So the scapulohumeral pivoters are responsible for putting the shoulder blade in the correct position to allow for proper function of these rotator cuff muscles. Also, so they decrease the amount of impingement on the top of the shoulder or keeping that space open that I spoke about. So that subacromial space, again, is that top part which needs to be preserved. And it can be decreased with a couple different reasons.

So we'll start with reason number one. Perhaps something on the inside is enlarged or engrossed with fluid. Say a bursitis. Bursa, by the way, is a normal thing in there. It just can be enlarged and irritated. Second thing is maybe a tendon is irritated. Or for the most part, let's just say that something's enlarged in there. We'll stick with that. Second reason why the space might be decreased, especially when raising your arm overhead, is because we didn't get that roll and slide by the rotator cuff on that ball to depress it and bring it downward so it keeps that space. By the way, if you need a visual on this stuff, I do have a video all on this thing.

It's on a rotator cuff course and it talks all about roll and slide and so on. The third reason is, especially when you get above 90 degrees of abduction or holding the arm out to the side, is that you need to raise the roof, as I call it. And that is the hook of the shoulder blade right there, which is the roof of that space. It needs to get up. And they estimate for every two degrees of bringing your arm overhead past 90 degrees, there's one degree of flare of that roof or of the shoulder blade. So if that roof isn't raising, at some point it's going to impinge as well. So these muscles, these scapulohumeral pivoters, so scapulo meaning scapula or shoulder blade, humeral meaning humerus, pivoters meaning, let's just say, positioners, if they're not working, then we will get another reason for decreased space or impingement of the shoulder.

Some muscles in this category are the trapezius, the rhomboids, the levator scapula, the serratus interior. All of these are included in this category, and they're not ones that you think about usually as, hey, you know, I want to get a huge levator scapula. You might think, hey, let's get a huge trapezius. But these are muscles that are commonly forgotten about. And they are really, really important to stabilize and put the shoulder in a good position so the rotator cuff can do its position, so then you can move things under high load, which would be the propellers or the third P. So moving on to those propellers, the major propellers of the shoulder, which can generate a lot of force and a lot of energy, and they're usually the ones that you try to develop in the gym.

You're like, yeah, I'm going to look so yoked if I get a large pectoralis major and a large latissimus dorsi or a large lat. One that you might not consider is the teres major. There's also the delt, which obviously a lot of people try to go for the big cannonball delts, especially in bodybuilding. And these are the ones that, yeah, cool. They look cool to have, but they're not doing the job of the other two, and they're not interchangeable. And they've actually found that, let's just say with the delt, the delt's job is to elevate or bring the shoulder or bring the arm up or to move the arm up.

But if it moves the arm up and the rotator cuff doesn't have the ability to pull down, create that downward slide of the ball or create that roll and slide, then the deltoid is going to be jamming that space or pushing the ball up into the roof. Another reason for impingement again. So I guess generally speaking, we can call that muscular imbalance. But these are reasons that you should rehab not only the major movers, but the protectors, the pivoters, and those prime movers. So let's just go over a couple ideas. So I've had people ask, is doing pull-ups good for shoulder rehab? Well, they are, but have you done rotator cuff exercise yet?

No? Okay, you should probably add those in. Have you done stuff for the shoulder blade? No? Okay, add those in as well. The last thing on your list is the movement of the lat. So let's break this down into another way. Let's just say there's no impingement or pain reaching overhead. This person can do scapular pull-ups, which is just moving the shoulder blade in and out and in and out and think about it as doing a pull-up as far as you can minus ever moving the arm past or the bicep or forearm. I want to use technical terms, but I won't. Let's just say bicep. Moving the bicep past your ear and without ever unlocking the elbow.

It's just moving the shoulder blade. That's something you can easily do without even really using the lat too much. Other things you can do are T's wise or prone T's wise and so on because this is more about how to set the scapula and its strengthening of some of those shoulder blade muscles. Another thing I get asked a lot is, hey, I need to build my, I want to get my shoulders stronger. Should I do push-ups? Well, you could do push-ups, but again, we're strengthening the majority of the pectoralis major. And if the shoulder, if the shoulder itself or the ball and socket is not stable because the rotator cuff is not doing its job, then going into a deep push-up or even a deep bench press all the way to the chest can be really, really harmful for the shoulder itself because there's a lot of what we call anterior translation or the pressing of the humeral head forward and it starts to irritate some of the front side of the capsule of the shoulder.

So can you do push-ups? Yeah, but let's consider all the things that are top importance on the shoulder. Have you started with something, at least over the past couple of weeks, to strengthen rotator cuffs? I hope so. Have you worked on the shoulder blade again? Maybe not. Have you worked on the serratus anterior? Have you done pushing without ever actually going all the way into an elbow bend? Let's just say scapular push-ups are a good one to do. So you don't ever bend the elbows. You're just pressing away from the ground using the shoulder blade. So the serratus anterior is a really important muscle to train in regards to shoulder blade function.

Now, lastly, before we stop this podcast, there is the concept of training or rehabbing the shoulder to be overhead. Now, majority of people that have had shoulder conditions have been told maybe you shouldn't be lifting overhead anymore. Maybe you don't go any more than 5 or 10 pounds overhead for the rest of your life. And I think this is a little silly, honestly. Yeah, the overhead position is an unstable position. I'm not going to lie. That's their highest risk. And that's where people typically get a lot of impingement or irritation of the shoulder. But that doesn't mean we can't do it. And it doesn't mean we can't work up to it.

Now, I typically start people doing shoulder rehab below 90 degrees. And the reason is because if the shoulder blade isn't working well, and we're not raising the roof, then we might be creating that impingement. Also, too, a lot of people with shoulder conditions have pain above 90 degrees. So why would I rehab them in a painful position? So we start below 90, make sure they have full competency below 90 degrees, and then we start to work our way up. And usually when I'm working my way up, I start to work mainly with the shoulder blade. And then we start loading. At the very end, we start loading overhead motions.

You know, I think that, actually, I've heard, I don't have the resource to validate this, but I'm pretty sure if you dig around, you might find some backing to it. But they find the serratus interior is strongest on Olympic lifters who lift overhead. They might be doing jerks and snatches and so on. And they really have to forcefully drive that weight up with their serratus interior and some of the other shoulder blade muscles to secure that bar overhead. So if that is the way you get it the strongest and make it work really well, why shouldn't we try it? I'm just trying to play devil's advocate.

I did see a study where they were talking about an overhead shrug, which was not a below the head shrug. The bar was actually more in a, almost like a snatch grip. It was up into a weight rack or a rig and you secure it overhead, press it up out of the, out of the, out of the, the hooks, stand up with it. And then you're just basically shrugging it overhead with the shoulder blades only. And then re-racking it. This is one that really stimulated some of the lower trap as well as serratus interior, which I thought it's interesting. If those muscles are stimulated with overhead work, why are we staying away from it?

Because it just makes it so you're deconditioned over the long haul. And yeah, you won't be able to put any amount of weight over your head for the rest of your life because the shoulder blade pivoters are not working. Okay. So consider that if you want a healthy shoulder, you need to make sure all three of these things are working well. So the three types, I'll revisit it one more time. Glenohumeral protectors. Okay. That's the ball and socket. Scapulohumeral pivoters. And lastly is the propellers or the prime movers. All right. If you guys want your questions or topics even put up on this podcast, please go onto the website.

This is a way where I can get most of you or get your question directly. We have a button there and you just talk directly to your computer. And I'd love some feedback as well. So leave your comment there. Give me some feedback. Tell me what I'm good and bad at. And I know that public speaking in the past, I usually when I get on videos, I'm okay. And then when I talk to friends, I end up slurring and mumbling and stuff. And it's funny, like going through this podcast, I'm really, I catch myself sometimes just flying into different words and not really differentiating and enunciating. And let me know if I need to clean this up.

And I really want to make this the best user experience for you that I can. I want you to learn. I don't want bad audio and I don't want you to not understand what I'm saying because I'm not getting my words out well. So if you guys are looking for the courses that we put on, they are ones that I personally designed. They are ones that I feel are the best information for those conditions that I could share. They are currently rotator cuffs for pitchers and hip impingement. We are doing other ones for distance runners. We're going to do knees. We're going to do core strength. We're going to do hip injuries.

We're going to do everything we possibly can. And I know the one we'll probably do second for, or the one that we're going to do next is probably IT man for runners because that is a really, really common one. And it's frustrating to see that people spend a lot of time just doing passive modalities or even tissue work only on it and foam rolling. And not to say these aren't good, they're great, but we really need to show the gems of how to rehab these areas. And it all starts with the trunk and hip. If you're not doing that for IT band conditions, you really, really need to. And if you have a lack of understanding how to rehab these areas or the basic understanding, go to this course.

Some are free. Some are paid for. But I guarantee the paid for ones are going to be better than any other course you've ever paid for. And we have 100% money back guarantee. By the way, the disclaimer on this, and I need to keep saying it every time, is I need you guys to go get diagnosed properly if you are listening to this for your own personal use. And I don't think I ever talked about it before. I might have. But I actually did a study on the accuracy of self-diagnosis, and it was for an ankle injury called Achilles tendinitis. And we did an ultrasound study to validate whether the people were right or not.

And honestly, I went to some running groups and I said, look, if you have Achilles tendinitis or you think you do, and you have not been correctly diagnosed or had an image, actually, an MRI or an ultrasound, come in. We'll check it out. And someone looked at me and they said, what's Achilles tendinitis? And I'm like, you know what? Like, you can come in and be pointing to your shoulder and I'll still image you. And again, the point is to figure out if we had a correct diagnosis or if you had one or not. It's not about whether I'm right or not. It's whether if people can diagnose themselves properly.

And the end result of the study was that less than half of the people got it right. And it's really funny to see that they got it wrong because that was the reason I picked that one is because most people know what the Achilles tendon is. And you can easily feel it. And you should be able to get it right. And there's more complex ones, which I wouldn't expect everyone to get. But we found that even some of the basic ones people don't get. So go get diagnosed. And after you get a proper diagnosis, then you can start on a rehab thing. And then our courses will be really helpful for you guys to learn about that condition so you can just blow through your rehab and get better as fast as you can.

So this is helpful. And thank you guys so much for sharing the podcast and watching and liking the YouTube videos. It really helps me know that I'm doing the right thing. I love making them. I love making podcasts. I love making YouTube videos. And I just want to make sure that I'm speaking about what you guys care about the most. I'll talk to you guys soon. And I'll see you or I'll talk with you, talk to you next week.