A physical therapist assesses the posture of a patient with shoulder pain and notes that the patient demonstrates a protracted position of both scapulae. The patient is 36-years-old with an unremarkable medical history with the exception of lumbar spondylolisthesis. The therapist wants to strengthen the rhomboid muscles using a bilateral scapular retraction exercise. Which patient position would be the MOST appropriate to initiate this exercise?

1. Sidelying
2. Seated
3. Supine
4. Prone

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

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A physical therapist assesses the posture of a patient with shoulder pain and notes that the patient demonstrates a protracted position of both scapulae. The patient is 36-years-old with an unremarkable medical history with the exception of lumbar spondylolisthesis. The therapist wants to strengthen the rhomboid muscles using a bilateral scapular retraction exercise. Which patient position would be the MOST appropriate to initiate this exercise?

1. Sidelying
2. Seated
3. Supine
4. Prone

Scapula
The scapula is a flat, triangular-shaped bone located in the upper thoracic region on the dorsal surface of the rib cage. It connects with the humerus at the glenohumeral joint as well as the clavicle at the acromioclavicular joint to form the shoulder joint. The scapula can move in multiple different planes, including elevation and depression, protraction and retraction, and upward and downward rotation.

The question is specifically asking the best position to initiate a bilateral scapular retraction exercise designed to strengthen the rhomboids. The primary muscles responsible for scapular retraction include the rhomboids and the middle trapezius.

Let’s explore each of the options.

Option 1 - Sidelying
A sidelying position may allow gravity to assist the patient to more easily move the scapula into a retracted position. However, this positioning would only allow for unilateral movement; bilateral scapular retraction would not be possible.

Survey Says…. Maybe, but only if we are desperate

Option 2 - Seated
In a seated position, a patient would be able to freely move both scapulae into a retracted position. Since the movement of scapular retraction/protraction occurs in the transverse plane, gravity would have no effect on the patient’s ability to perform this movement when in a seated position.

Survey Says…. Extremely Tempting

Option 3 - Supine
A supine position would require the back to be in direct contact with the treatment surface. This position would impede the patient’s ability to retract the scapulae.

Survey Says…. No chance!

Option 4 - Prone
The scapulae would tend to rest in a protracted position due to the effect of gravity when lying in prone. The position can be effectively used to strengthen the scapula retractors although it requires the muscles to work against gravity. As a result, it would be more difficult to actively retract the scapulae in this position (i.e., moving against gravity) when compared to a seated or standing position.

In addition, the patient’s medical history includes spondylolisthesis. This condition refers to the forward displacement of a vertebra on the vertebra below it.

Prone positioning often exacerbates this medical condition since extension of the spine increases the level of stress on the pars interarticularis.

Survey Says…. Good, but not likely the best option

The correct answer is Option 2

This was a good example of an applied question that required students to debate between two relatively attractive options (options 2 and 4). In this particular case, it was also relevant to consider the patient’s past medical history (i.e., spondylolisthesis). Licensing examination questions often include additional variables that therapists must consider when determining the best course of action.

Let’s explore the all student data:
3% of students selected Option 1, Sidelying
58% of students selected Option 2, Seated, the correct response
8% of students selected Option 3, Supine
31% of students selected Option 4, Prone

System Classification
This question is a Musculoskeletal System question which represents approximately 29% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube – https://youtu.be/AuBtXvw3L-s