CPT NASM CPT Podcast Muscles

Overactive and Underactive Muscles Part 3: Arms Fall Forward - Elevation - Forward Head

National Academy of Sports Medicine
National Academy of Sports Medicine
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The finale in this series of short/tight/overactive muscles and lengthened overactive muscles based on the overhead squat assessment! Since the release of our first episode in this series, we have had excellent feedback, including several teachers suggesting it to their classes. This third of three will cover three frequent movement compensations in the overhead squat assessment:

  • Arms Fall Forward
  • Scapular Elevation
  • Forward Head

Listen for a review of short muscles that lead to this compensation and lengthened muscles that allow the compensations to occur. These episodes are anatomy heavy and may help the listener better understand functional anatomy. Functional anatomy helps listeners better understand how muscles can contribute to movement compensation and dysfunction. It is excellent as a study guide, an explanation of what is going on, or just a refresher to those that already use the overhead squat assessment as a means of providing individualized programming.

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You're listening to The NASM-CPT Podcast with Rick Richey, the official podcast of the National Academy of Sports Medicine.

Welcome to The NASM-CPT Podcast. My name is Rick Richey, and today we're going to be doing our third iteration of our biggest feedback topic that we've gotten from you, the listeners, which is wanting to better understand what are some of the over and underactive muscles when it comes to the overhead squat assessment? Can you provide some clarity to it? Can you explain why those muscles are short, tight, or overactive? And why other muscles are in a lengthened position, and potentially underactive? So this is number three of three.

And today, we're going to be talking about three different compensations and the overhead squat assessment. The first one is going to be arms fall forward. The second one is going to be the shoulders elevating. And the third one is going to be forward head. All right, so let's go ahead and jump into what we're going to be talking about right now.

The first one, you get somebody in an overhead squat assessment, feet completely straight ahead, knees neutral position in the center of the foot, neutral position at the lumbo pelvic hip complex, arms overhead, chin is in neutral. We're looking at neutral, neutral, neutral, and then move. And let's see if and how you move out of neutral. It is the how you're moving out of neutral that we're trying to figure out. If somebody does this, then these muscles are potentially overactive, pulling them out of that neutral alignment.

And there are other muscles that are underactive allowing them to be pulled because the muscles shouldn't be pulling them out of place. And even if there is some pull on it, other muscles should be strong enough to help maintain that neutral alignment or neutral position. Some of it, yes, is about coaching. But right now, we're talking specifically about what muscles might be tight, causing that movement from ideal or neutral, and what muscles might be allowing them to take place.

So now my arms go over my head. My arms go over my head in an overhead squat assessment and we squat, and you see the arms start to fall forward. So your arms when they go overhead, your shoulder is in a fully flexed position overhead. So they're only, well maybe not fully flexed, it might be abducted or adducted a little bit. So the arms are kind of a narrow Y shape overhead. And then you have somebody squat, and as they squat, the arms start to shift forward, start to extend at the shoulder a little bit. If they were to keep going, they would be all the way down at your side. So the arms don't have to move far to be an arms fall forward.

But as we do this, we have to understand, what are some of the muscles that might be a component of it? Let's look at the first one. My arms as they take overhead, what's being stretched? That's probably a good first thing to pay attention to, what's being put on stretch? Well, my arms go over my head, my lats are being stretched. My lats want to pull my arms down. Matter of fact, there's an exercise called a lat pull down. My lats want to pull my arms down. It can do shoulder extension or they can do shoulder a-d-duction.

So, if my arms fall forward, my lats will be pulling down at it. So I might not have enough extensibility of my lats. First of all, to get there or I might have the extensibility, but it's fighting too much. And then the muscles on the other side are having too much of a hard time trying to maintain it in an overhead position. There's some other potential things that are going on there. But at the shoulder, the lats could be pulling the arms down.

Well, the lats have a little brother. Brother? Brother's got a hook. But the lats' little brother, the teres major. Just like a little brother looking up to his big brother, everything that the lats can do at the shoulder, the teres major also is going to do the same thing. So anything the lats do with the shoulder, the teres major will also do, following his big brother. So it can extend, it can adduct, it can internally rotate. It just follows his big brother along that path. So that's why that muscle, the teres major, is there. It is the lats little brother.

And then we've got the pec major and pec minor. Now, there is a significant difference in what these two muscles are. But the pectoralis major, when the arms go overhead, those fibers have gotta stretch out in order for the arms to go overhead. So it will actually be in a lengthened position, especially the more lateral inferior fibers of the pec major. And so when you pull the arm, let's say this, have you done a like a really extensive chest workout and you're sore, and the next day, you go to do lat pull downs, your pecs reaching up for that bar overhead, you're going to feel them stretch, they get tightened. And that's just an anecdotal proof that that muscle is being stretched, but it also adducts because it's being stretched in that position. When you bring it back down, you know that the pecs actually bring the arm closer into the midline of the body. So the pec major will be a component of the arms falling forward, too.

Now, the pec minor is a different story. The reason the pec minor is in this list is because the pec minor is a downward rotator of the scapula. And when your arms go up overhead, they don't go up overhead only at the glenohumeral joint or that shoulder joint itself, but the scapula has to rotate up. It has to go into this upward rotation in order for the arms to go all the way up overhead.

And when that happens, the pec minor, being a downward rotator, it doesn't like upward rotation, and it will limit or impede upward rotation if it doesn't have the extensibility and the motor learning that it needs to have in order to allow that to take place. So the pec minor is not allowing our scapula to go into upward rotation. It's trying to maintain downward rotation, and it won't let our arms go all the way up overhead. So that's why the pec minor is going to be in that list.

Now, let's look at the underactive muscles. So underactive muscles, one of the primary movements of the lower traps. So, underactive muscle, let's just go through it. Mid traps and lower traps are rhomboids, and the rotator cuff muscle group.

So as I take my arms up overhead, the lower traps actually are a huge component of scapular upward rotation, the opposite of what the pec minor does. We should also have the serratus anterior in this muscle group as well. And technically, we could add the upper traps in there as well. But I don't think anybody's looked at it and said, you know what's not working well on somebody is the upper traps and upward rotation. Upper traps kind of work in almost any exercise, sometimes dysfunctionally. So primarily, what you'd be looking at would be this serratus anterior and your lower traps that would help support upward rotation of the scapula. So that's why you see the lower traps listed there.

Now the mid traps are going to create stability at the scapula as it will the rhomboids. So they're going to create stability and maintain, not just maintain or not trying to get a retracted position, but really the problem societally, did I say that right? Is protraction. So we're often very protracted, and we're just trying to neutralize that protraction, not by going into retraction, but by retractors maintaining neutral and not losing to the muscles on the other side, creating this continuous protracted position.

And the muscles of the rotator cuff. The muscles of the rotator cuff could be underactive in the arms falling forward for a couple of reasons. But just because of lack of stability and if the joint itself is not stable, as you move up into a closed packed position by the arms going into full flexion or full abduction, and the arms go up overhead, as it creates a closed pack position starts to squeeze the joint, close its position, and muscles that are weak can't support that full range of motion or that end range of motion. So the rotator cuff might be indicated as an underactive muscle here. So that's arms fall forward, one more time, overactive muscles.

As for our CPT text, and we could probably dig a little deeper through our CES and some other contexts, but the overactive muscles are going to be the latissimus dorsi causing the arms to fall forward. Teres major, arms fall forward. Pectoralis major and minor, arms fall forward by means of lack of upward rotation at the scapula. And then the underactive muscles or the muscles that are lengthened would be the mid and lower traps, the rhomboids and the rotator cuff.

Well, now that you've got that information, what do you do? The overactive muscles need to be kind of down regulated in their facilitation. So we're going to need to turn them down a little bit. Let's foam roll them, which is a means of inhibiting muscle activation. Let's stretch them statically, which does both inhibition through autogenic inhibition, but it also lengthens those muscles. And then the underactive muscles, you got to go through an activation process. You're going to start getting those muscles in a preferentially activated through isolation and focused work so that they start realizing they have a job. And then you can go into your exercises and realize that and hopefully they realize that the job that you gave them includes this integrated movement pattern and they start behaving appropriately.

Let's move on to the next one, which is going to be shoulders elevate. And you can see shoulders elevate in so many exercises. You know, lat pulldown shoulders, elevated chest press, shoulders elevate. You get all sorts of up bring upper, bicep curls, I see shoulders elevate constantly. But in an overhead squat assessment, you might see shoulders elevate sometimes.

Shoulders will elevate because they can't go into upward rotation. They can't get that range of motion and upward rotation so they will steal that range of motion or at least try to by cheating through scapular elevation rather than scapular upward rotation. But what we look at right here, the muscles that would be overactive when the shoulders elevate would be, number one, your upper traps, your sternocleidomastoid and the levator scapulae.

So when we look at this, let's go through upper traps. Upper traps are going to be your primary scapular elevator anyway. Those are prime, you think about this when people do shrugs as an exercises. It's their upper traps that they're working. So if the shoulders elevate, then your upper traps would be a primary component of said elevation of the scapula.

Let's skip sternocleidomastoid for a moment and go into levator scapula because if anything says levator scapula or elevating the scapular or it would be the one that actually has the name that is levator scapula and it elevates the scapula. It's exactly what it is. It's exactly what it says. The levator scapula elevates the scapula or creates that shrug along with the upper traps. Upper traps is just a bigger muscle. Levator scapula is probably a bit more insidious in its component of elevation as the upper traps are a big muscle, but the levator scapula is oftentimes more indicated in these chronic elevated positions.

And then the sternocleidomastoid. And it's not so much of a scapula elevator, or it's not a scapula elevator to be quite clear on this. Sternocleidomastoid starts at the sternum and clavicle and then moves into the mastoid process on the back of the ear. But what's gonna happen is that if it's tight, it doesn't allow a rotation at that acromion, not acromioclavicular joint, the sternoclavicular joint. So it can limit the movement at the sternoclavicular joint, but also it can create a forward head position, and the forward head position oftentimes leads to a shrug position because the upper traps will do a forward head position as well and the levator scapula will do a forward head position as well. So when we get forward head positioning or translation, it does tend to go hand-in-hand with elevation of the scapula.

So overactive muscles, upper traps, sternocleidomastoid or SEM and the levator scapula. What's underactive? Well, underactive are the muscles that would create more of a depression at the scapula. It's the opposite of elevation, depression. So the mid-traps and the lower traps would have a better component of that. So one is stabilization at the scapula, and the other one being primarily a scapula depresser. So we look at the underactive muscles of scapulars elevating and that would be the mid-and-lower trap complex.

Isn't it strange, too, the traps are all one muscle. Upper traps, mid traps and lower traps, they're all the same muscle. Except there are three primary different components of that muscle and oftentimes they have differing joint actions. They don't do the same joint action even though it's the same muscle and I find that pretty fascinating.

All right, enough of my fascination, let's move to your questions and get to the last one here, which is head moves forward. So in an overhead squat assessment you see the head jutting forward. Or in any exercise, we're not limited to an overhead squat assessment, but it's gonna be the same muscles for our overactive muscles here.

If the head moves forward, upper traps, because the upper traps, you ever see somebody shrugging and when they shrug their head juts forward? That is a cheat. Because the upper traps connect into the external occipital protuberance, that's a word for you, but if you go to the base of the back of your head there's this big boney notch just right above your neck at the base of your head. That's the external occipital protuberance and the upper traps connect there. So, it will pull down at the base of the skull and cause the chin to lift up and jut forward.

So the upper traps are a big component of a forward head position. And the sternocleidomastoid definitely a big component. This bilateral activation of the sternocleidomastoid on each side is a head jutting forward machine. So it will jut the head forward and then the levator scapula will do the same thing as well. All of these cause the head to move forward, but your mid traps and lower traps are not going to be a remedy specifically for head moves forward. This is gonna be a group called the deep cervical flexors.

Deep cervical flexors are deep, so superficial means closer to the surface and deep means farther away. So they're deep into the neck on the anterior side and we will go into a chin-tucked position in order to get these guys activated. Now, chin tucked does not mean lowering your chin down toward your chest. But it's more retracting your head backward. Almost like you're trying to give yourself a double chin. We're not bringing the chin flexing down close to the neck, we're retracting. Almost like if somebody's coming at you with bad breath and you wouldn't lower your face down, but you might retract your face to get it farther away from them. Then that's what you would be doing in order to activate your deep cervical flexors.

And maintaining neutral spine, especially for when a head juts forward, the deep cervical flexors are going to be activated, they're going to be working. So maintaining that neutral spine will then activate and help support deep cervical flexors. As a matter of fact, if you get into a prone position, so you're on all fours, and you practice deep cervical flexion, then what you're doing is you're allowing the weight of your head to be the resistance as you practice your chin tuck position.

You could go supine, which means face up, and you could lie down and in a neutral position just push the back of your head back into a pillow or the floor, wherever you're doing this practice, and you'll feel a little bit on the anterior side of the neck the deep cervical flexors activating. Don't push too hard. This should not be a difficult or hard exercise 'cause as soon as you start doing too much, much like the small muscles in the core, if you start trying too hard then all the big muscles that are already dominating the action will jump in and say, hey, let me help you. So we don't want that. What we do what is a series of light muscle activations to get them to later integrate into normal motor patterns and normal movement patterns.

So, head moves forward, overactive muscles, upper traps, sternocleidomastoid, levator scapula. Underactive muscles are going to be the deep cervical flexors. Reviewing for shoulders elevate, overactive muscles, upper trapezius, sternocleidomastoid, and levator scapula. And the underactive muscles will be the lower traps and mid traps. And then the arms fall forward, the last part, the last review, overactive muscles potentially, latissimus dorsi, teres major, pectoralis major, pectoralis minor. Underactive muscles, mid-to-lower traps, rhomboids, and rotator cuff.

I hope this final view of what we're doing for The NASM-CPT Podcast and our series of overactive and underactive muscles based off of the topics that you, the listeners, were asking for. I hope you find this very helpful, very beneficial. So this is three of three. Now we're out. So keep coming with more topics.

You can hit me up at Rick dot Richey, R-I-C-H-E-Y, at nasm.org. Or you can hit me up on Instagram at @Dr.RickRichey and message me, DM me, do what you gotta do in order to get my attention. Let me know what you want to hear topics about and everybody's been doing a wonderful job, by the way. I've got a list of topics. And so what you may suggest may already be on the list. It may not be, but if I get a lot of them then certainly those will rise to the top and be some of the first ones they get produced. So, thank you so much for listening. This is The NASM-CPT Podcast.

The Author

National Academy of Sports Medicine

National Academy of Sports Medicine

Since 1987 the National Academy of Sports Medicine (NASM) has been the global leader in delivering evidence-based certifications and advanced specializations to health and fitness professionals. Our products and services are scientifically and clinically proven. They are revered and utilized by leading brands and programs around the world and have launched thousands of successful careers.

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