Scapular and Thoracic Motion and Rehabilitating the Shoulder Girdle

During elevation the scapula upwardly rotates, externally rotates and tilts posteriorly to keep the subacromial space open, and this depends on thoracic extension and ipsilateral rotation. Ian notes that no muscles act directly on the sternoclavicular joint: posterior rotation of the clavicle comes from the conoid and trapezoid ligaments, while subclavius must be able to lengthen. Forward head posture, apical breathing, gym training that overdevelops the pectorals and tight anterior and middle scalenes raising the first rib can all block clavicular motion. Rehabilitation follows a published AC joint progression. It starts with posture, aiming for the diaphragm and pelvic diaphragm to sit parallel, then kinetic chain exercises such as the lawn mower and low row, wall slides and foam roller work for upward rotation, and prone elevation cued as an arc to avoid recruiting levator scapulae. Later stages add multiplanar PNF patterns, long lever work and functional tasks such as band-resisted press ups, early plyometrics and a tornado ball to test kinetic chain coordination.