FUNCTIONAL REHABILITATION
R. Barry Dale, PhD, PT, ATC, CSCS, Column Editor
Proprioceptive Neuromuscular Facilitation
for the Scapula, Part 2: Diagonal 2
T
HIS COLUMN DESCRIBES the general
principles of applying proprioceptive neuromuscular facilitation (PNF) to the scapula
and is a continuation from the March Functional Rehabilitation column, which addressed Diagonal Pattern 1 (D1) for the scapula. The basic principles
discussed in the previous column remain the same
with respect to the athlete’s position and the clinician’s
hand placement and body position.
Similar to D1, the second scapular diagonal (D2)
consists of two positions from which movement begins
or ends. These two positions are anterior depression
and posterior elevation, and the athlete may move
from either position as a starting point.1 Table 1 presents a summary of hand placements and movements
in both diagonals.
Positioning the Athlete
The side-lying position is perhaps best for the athlete
because it allows the clinician to control the involved
scapula with relative ease. The athlete should lie on
the unaffected side with pillows between the knees
and supporting the head and involved upper extremity. The athlete’s body segments should be in a neutral
position; for example, the head properly aligned with
the trunk (watch for excessive cervical flexion) and
the trunk not rotated or laterally flexed. Observe the
scapula and pelvis for neutrality, with particular attention to protraction and retraction.
D2
Movements in this diagonal relate well to scapular
movement during many sport-specific activities, and
the clinician should consider concentric and eccentric
muscle actions and their relationship to sport specificity. The following discussion relates to a clinician
treating an athlete’s right scapula.
Concentric Movement
From Anterior Depression to Posterior Elevation
The athlete’s scapula begins in a position of protraction
and depression (anterior depression). Movement into
elevation and retraction occurs as the scapular elevators and retractors act concentrically. The clinician’s
right hand should be on the spine of the scapula while
the left hand contacts the acromion (Figure 1). Only the
heel of each hand should contact the athlete during this
movement to avoid facilitation of antagonistic muscle
groups. The clinician’s body should face the athlete’s
right lower extremity to adequately resist scapular
elevation and retraction.
Eccentric Movement
From Posterior Elevation to Anterior Depression
Eccentric activity of the scapular elevators and retractors occurs as the athlete resists the clinician moving
the scapula into protraction and depression from a
retracted and elevated position. The clinician’s hand
placement does not change during this phase if it follows the concentric movement. Rather, the movement
direction reverses as the athlete slowly resists the clinician providing the movement force.
Concentric Movement
From Posterior Elevation to Anterior Depression
Although body positions for both the athlete and the
clinician remain the same for concentric movement
from posterior elevation to anterior depression, the
© 2005 Human Kinetics • ATT 10(3), pp. 51-53
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MAY 2005  51
Table 1. Scapula Positions and Clinician Hand Placements
for Proprioceptive-Neuromuscular-Facilitation Diagonals1
Procedure
AE (D1)
concentric
eccentric
PD (D1)
concentric
eccentric
AD (D2)
concentric
eccentric
PE (D2)
concentric
eccentric
Position
Verbal Command
Scapula begins in posterior depression. Both of the clinician’s hands are placed over the anterior acromion.
Scapula begins in anterior elevation, moves to posterior
depression. Clinician’s hands remain the same.
Pull your shoulder blade up and forward,
toward your nose.
Allow your shoulder to move slowly as I pull
your shoulder blade down and back.
Scapula begins in anterior elevation. The left hand contacts the spine of the scapula, whereas the right hand
frames the inferior border with the thumb and index
finger.
Scapula begins in posterior depression, moves to anterior
elevation. Clinician’s hands remain the same as for concentric movement.
Push your shoulder blade down and back.
Scapula begins in posterior elevation. Clinician’s left hand
contacts the anterior axilla, whereas the right hand contacts the posterior axilla, with the fingers of both hands
providing resistance to protraction and depression.
Scapula begins in anterior depression. Clinician’s hands
remain the same as for concentric anterior depression.
Pull your shoulder blade forward and down.
Scapula begins in anterior depression. Clinician’s hand
placement is similar to that during anterior depression
except that the fingers are extended to avoid contact with
the axilla as the heels of both hands contact the acromion
and spine of the scapula.
Scapula begins in posterior elevation. Clinician’s hand
placement is identical to that for concentric movement.
Push your shoulder blade up and back.
Allow your shoulder to move slowly as I
push your shoulder blade up and back.
Allow your shoulder to move slowly as I pull
your shoulder blade up and back.
Allow your shoulder to move slowly as I
push your shoulder blade forward and down.
Note. The table uses the athlete’s right scapula as reference. AE = protraction combined with elevation; D1 = Diagonal 1; PD = retraction combined with depression; AD = protraction combined with depression; D2 = Diagonal 2; PE = retraction combined with elevation.
Figure 1 Athlete’s position and clinician’s hand placement for concentric
movement from anterior depression into posterior elevation.
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clinician’s hand placement must shift to resist concentric activity of the scapular protractors and depressors.
Clinician hand placement changes to allow proprioceptive input and resistance to the scapular depressors
and protractors. The hand that was previously on the
spine of the scapula now contacts the posterior axilla
while the hand formerly on the acromion shifts to the
anterior axilla (Figure 2). The hand placements in this
diagonal are easier than those in the first diagonal,
especially when performing concentric or eccentric
reversals between posterior elevation and anterior
depression.
Once the proper hand position is attained, the
clinician places the athlete’s scapula in retraction and
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Figure 2 Athlete’s position and clinician’s hand placement for concentric
movement from posterior elevation into anterior depression.
elevation and then instructs the athlete to move the
shoulder downward and forward. Again, it is helpful
to allow several practice movements, which can be
passive or active.
Eccentric Movement
From Anterior Depression to Posterior Elevation
The athlete’s scapula begins in anterior depression and
resists the force of the clinician’s hands, slowly allowing the scapula to move into posterior elevation. This
requires eccentric control of the anterior depressors
and posterior elevators. Again, the clinician’s hand
placements do not change when switching between
concentric and eccentric movements.
Reversals
Reversals require the clinician to change hand placement at the end of a given movement in order to begin
the antagonistic movement. Whereas it was beneficial
to leave one hand in place when performing reversals
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in D1, D2 hand placements are such that the clinician’s
hands can easily shift positions to provide adequate
resistance in the appropriate direction.
In an example movement from concentric posterior elevation with a reversal into concentric anterior
depression, the athlete begins in protraction and
depression with the clinician’s hands over the scapular spine and anterior acromion. Next, the clinician
instructs the athlete to move the scapula upward and
back while providing adequate resistance. As the
athlete achieves scapular retraction and elevation,
the clinician shifts his or her hands downward and
forward to contact the anterior and posterior portions
of the axilla while instructing the athlete to move the
shoulder downward and forward.
Summary
Applying PNF to the scapula assists muscle recruitment
and reeducation and enables functional movement.
This column presented D2; the one in the March 2005
issue presented D1. 
Acknowledgment
Special thanks to Jonathon Shaw and Dr. Dennis Fell
for their assistance in preparing the photographic elements.
References
1. Adler SS, Beckers D, Buck M. The scapula and pelvis. In: Adler SS,
Beckers D, Buck M. PNF in Practice: An Illustrated Guide. 2nd ed. New
York, NY: Springer; 2000:63-74.
Barry Dale is an assistant professor at the University of South Alabama. His areas of interest include orthopedics, neurology, and exercise
physiology.
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