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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.