Correcting Postural Changes at the Shoulder to Decrease Injury Risk among Firefighters
By Cody Davis - O2X On-Site Specialist
As tactical athletes, firefighters regularly perform physically intensive activities for the duration of their shifts. Whether it’s lifting patients, carrying patients, dragging hoseline, or breaching doors, the shoulder joint is central to proper function and execution of daily duties. Performing these activities shift after shift leads to muscular fatigue and compensation, leading to postural changes and injury risk long term. Most commonly, these include rounded shoulder posture, weak scapular musculature, and dysfunctional scapular rhythm.Over time, these inhibitions lead to subacromial impingement, tight pectoralis muscles, weak serratus anterior, middle and lower trapezius muscles, and overactive upper trapezius muscles. The culmination of these pathologies lend to increased risk for potential labrum injuries that may require physical therapy and even surgery.
Early recognition and injury prevention is essential to maintaining a healthy shoulder, focusing on releasing muscular tension, restoring scapulothoracic rhythm, and strengthening the rotator cuff and scapular muscles.
Anatomy: Anatomically, the shoulder joint consists of the scapula, humerus, clavicle, and thoracic spine. Optimizing the coordination of these structures is key to understanding how to implement corrective plans.
Glenohumeral Joint: This is known as a ball and socket joint, consisting of the humeral head and glenoid fossa. This joint is stabilized by the labrum and the muscles and tendons of the rotator cuff.
Scapulothoracic Articulation: Scapular motion occurs through coordination of the humerus, scapula, clavicle, and humerus. When one is inhibited, the others will compensate, increasing injury risk.
Arthrokinematics: The shoulder joint is dependent on the ability of the humerus to roll, spin, and glide within the glenoid. Limitations in any one of these areas will decrease overall range of motion, causing pain and compensation.
Rounded Shoulder Posture (RSP): Rounded shoulder posture is the combination of a tight pectoralis minor, weak lower trapezius, scapular protraction or rounding, and anterior tilt.
Scapular Dyskinesis: This refers to the winging of the scapulae, altering the natural rhythm of the joint, attributed to a weak serratus anterior and lower trapezius. This reduces subacromial space, increasing risk of shoulder impingement and rotator cuff pathologies.
Why is this important?
Rounded shoulder posture and scapular dyskinesis places increased mechanical strain on the surrounding soft tissues, leading to tightness in overactive muscles, and weakness in underused muscles. Injury prevention programs designed to address neuromuscular retraining, flexibility, movement pattern correction, and strength deficits prevent irreversible tissue injury and reduce the need for surgical interventions. Preventive programs are cost effective and provide long-term functional outcomes.
Corrective Exercise Protocols
Soft tissue mobilization:
Massage, active release therapy, cupping, and instrument assisted soft tissue mobility are key to releasing overactive tissues such as the upper trapezius, pectoral muscle group, and the latissimus dorsi.
Therapeutic Exercise:
Corrective exercise should be used to prioritize strengthening of weak and inhibited muscles.
- External Rotators:
- Standing banded external rotation: Keeping the upper arm pinned to the side of the torso, shoulder blade tucked down, and focusing on rotating the humerus out away from the torso
- Side-lying external rotation: Laying directly on the side of the torso, keeping arm pinned to the torso, and utilizing a light weight, rotate the humerus up towards the ceiling
- Middle Trapezius
- Prone T: Laying on your stomach, head flat, make a T-shape with your arms, thumbs pointed straight up. From this position, lift arms straight up towards the ceiling, pausing for one second at the top before relaxing back down.
- Banded Row: With a band anchored to a wall at about chest height, face the wall, grabbing the band with one hand. Step back to apply tension to the band, continuing to face the wall. From here, beginning with a straight arm, pull back towards the shoulder on the working side, leading with the elbow.
- Serratus Anterior
- Serratus punch: Laying on your back, holding a light weight with the arm completely straight, attempt to “punch” to the ceiling, reaching as far as possible, allowing the shoulder blade to glide
- Push-up Plus: On the floor or on an incline to decrease stress, perform a push up with an extra “reach” of the shoulder blades to the ceiling at the top of the movement
- Lower Trapezius
- Prone Y: Laying flat on the stomach, head flat, make a Y shape with your arms. From this position, lift both arms to the ceiling with a slight pause at the top of each rep.
- Quadraped Single Arm Y Raise: Begin on your hands and knees, maintaining a flat back. With one arm, you will lift from the ground to the ceiling, making a Y shape, holding a brief pause at the top of each rep.
Self-Care:
Patient education and self-care techniques are essential to the long term success of any injury prevention protocol. Once a patient has had relief of symptoms related to rounded shoulder posture, scapular dyskinesis, and has restored strength levels, preventative care must be delivered. Patients should be taught pectoral stretches, latissimus stretches, and continuing exercise techniques for the rotator cuff, lower trapezius, and serratus. Example stretches include:
- Doorway Stretch:
- Pectoralis major: Make a U-shape with both Shoulders, propping forearms and elbow on the doorway. Lean forward with your chest while keeping your arms stable.
- Pectoralis minor: Make an A-shape with your arms, propping wrists and hands on the doorway. Lean forward with your chest while keeping your arms stable.
- Latissimus Stretch
- While seated by a table, prop elbows on the edge of the table. Sit back slightly from the desk, dropping chest and shoulders down towards the floor.
Firefighters are expected to perform at a high level physically each day they are on shift. While not all shoulder injuries can be prevented, there are proper steps that can be taken prior to injury through proactive approaches to pain. The shoulder joint is exposed to acute and chronic load throughout each shift and the entirety of a firefighter’s career. Early recognition, through patient education, and specified protocols can help correct chronic shoulder pain caused by postural changes, prevents time-loss on the job, and keeps firefighters performing at the highest level.
References:
- Eastman, A. Q., Rous, B., Langford, E. L., Tatro, A. L., Heebner, N. R., Gribble, P. A., Lanphere, R., & Abel, M. G. (2023, November 19). Etiology of exercise injuries in firefighters: A Healthcare Practitioners’ Perspective. Healthcare (Basel, Switzerland). https://pmc.ncbi.nlm.nih.gov/articles/PMC10671663/
- Escamilla, R. F., Hooks, T. R., & Wilk, K. E. (2014, February 28). Optimal management of shoulder impingement syndrome. Open access journal of sports medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3945046/#sec5
- Struyf, F., Cagnie, B., Cools, A., Baert, I., & Meeus, M. (2014). Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. https://pubmed.ncbi.nlm.nih.gov/24389333/
- Thigpen CA;Padua DA;Michener LA;Guskiewicz K;Giuliani C;Keener JD;Stergiou N;, Padua, D. A., Michener, L. A., Guskiewicz, K., Giuliani, C., Keener, J. D., & Stergiou, N. (2010, August). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. https://pubmed.ncbi.nlm.nih.gov/20097090/
About O2X On-Site Specialist Cody Davis:
Cody Davis is an O2X On-Site Human Performance Specialist specializing in Injury Prevention as a Certified Athletic Trainer with DC Fire and EMS. In this role, he focuses on optimizing human performance and reducing the risk of injury by integrating functional movement patterns with strength and conditioning principles. Cody is passionate about making a real and lasting impact on the lives of first responders and their families, ensuring they can perform at their best while staying healthy and resilient.Before joining O2X, Cody spent two years working with Towson University’s football program as an athletic trainer, honing his expertise in supporting high-performing athletes. His professional experience spans Division I and Division III athletics, where he gained valuable insights into injury prevention, performance optimization, and rehabilitation strategies tailored to diverse athletic populations.Cody earned a Bachelor of Science in Athletic Training from Towson University and went on to complete a Master’s Degree in Higher Education Leadership at Salisbury University. With a commitment to professional excellence and a strong educational foundation, Cody brings a wealth of knowledge and practical experience to his role. Outside of work, he is dedicated to helping others achieve their physical goals and enhancing overall quality of life.