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Integrated functional anatomy of the anterior, middle, and posterior deltoid. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, and stretches for the deltoid/shoulder muscles.

Deltoids

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes the anatomy and integrated function of the deltoid muscle (a.k.a. the delts, shoulder muscles, or referenced individually as the anterior deltoid or front deltoid, posterior deltoid or rear deltoid, and the middle deltoid, medial deltoid, or lateral deltoid). The deltoid muscle originates on the acromion process of the scapula (shoulder blade) and the lateral 1/3 of the clavicle, all three divisions of the deltoid muscle insert into the deltoid tuberosity, and all divisions are innervated by the axillary nerve. The deltoids are the most superficial muscles of the shoulder and are composed of a relatively even proportion of type I muscle fibers and type II muscle fibers; however, these proportions can vary considerably. The deltoid muscle crosses the shoulder joint (glenohumeral joint) and contributes to shoulder joint actions. The anterior deltoid is the primary shoulder flexor and will contribute to shoulder horizontal adduction and shoulder internal rotation. The middle deltoid (lateral deltoid) is the primary shoulder abductor. And, the posterior deltoid (rear delt) is the primary shoulder horizontal abductor and will contribute to shoulder extension and shoulder external rotation. This course also describes the role of the deltoid muscles in glenohumeral arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the deltoids for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. deltoid pain, shoulder joint pain, “shoulder blade pain,” “uneven shoulder height,” axillary nerve damage, rotator cuff injury, shoulder impingement syndrome, scapula dyskinesis), the synergistic function of the deltoid muscles (e.g. during shoulder exercises like an upright row or a lateral raise the middle deltoid abducts the humerus in synergy with the supraspinatus of the rotator cuff), and deltoid exercises and techniques for enhancing sports performance (e.g. training the deltoids with shoulder exercises to optimize stability, strength, power, and shoulder hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the Deltoids (see videos below):

The anterior, middle, and posterior deltoid muscles

 Course Description: Deltoids

 Anatomy of the Deltoid Muscles Study Guide

Anatomy of the Deltoids Study Guide

Study Guide: Anatomy of the Deltoids  

Introduction

deltoid muscle, so-called for its shape, from Greek deltoeides "triangular," literally "shaped like the letter delta;" see 

The deltoid is commonly divided into 3 parts based on function, fiber arrangement, neural innervation, and separation at the proximal attachment. The 3 divisions are:

 1610s, Latin, literally "former," comparative of ante "before" (see 

Middle Deltoid (there is no such thing as a 

 Old English mid "with, in conjunction with, in company with, together with, among," from Proto-Germanic *medjaz (cognates: Old Norse miðr, Old Saxon middi, Old Frisian midde, Old High German mitti, Gothic midjis "mid, middle"), from PIE *medhyo- "middle" (see 

 (adj.)). Now surviving in English only as a prefix (mid-air, midstream, etc.); as a preposition it often is a shortened form of amid (compare 

 1530s, "later," from Latin posterior "after, later, behind," comparative of posterus "coming after, subsequent," from post "after" (see 

). Meaning "situated behind" is from 1630s. (

Posterior view of the deltoid muscles

"Deltoideus posterior" by User:Mikael Häggström - Image:Gray409.png. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Deltoideus_posterior.PNG#/media/File:Deltoideus_posterior.PNG

Attachment and Innervations

The muscles, blood vessels, and nerves of the shoulder joint

Attachments & Innervation: Deltoids

Relative Location

The deltoid muslces, nerves, and bony structures of the arm in a cadaver

The boney landmarks of the humerus, note the attachment of the deltoid muscles

Where are the Deltoids Located?

Palpation

Note the well-developed delotids on Arnold Schwarzenegger

Palpating the Deltoid Muscles

Introduction to the Deltoids

Actions

Shoulder (glenohumeral joint): Flexion, horizontal adduction, internal rotation, and will contribute to abduction when firing in synergy with the middle and posterior deltoid (8, 11).

The anterior deltoid may be the primary abductor of the shoulder when the humerus is externally rotated, for example, during an 

Shoulder (glenohumeral joint): Abduction (8, 11)

Shoulder (glenohumeral joint): Horizontal abduction, extension, external rotation, and will contribute to abduction when firing in synergy with the middle and anterior deltoid.

Of the 3 parts of the deltoid, the posterior deltoid has the smallest moment arm for abduction) (8,11).

Some texts note a contribution to adduction when the humerus is fully externally rotated and abducted - for example, during a 

Note that the anterior and posterior deltoid are antagonists to one another.

Although the anterior and posterior deltoid has a fiber arrangement and moment arm that alludes to the ability to perform internal and external rotation, EMG studies conflict regarding their recruitment during activity including these actions (16)

The anterior and posterior divisions have a fusiform fiber arrangement, suggesting these muscles are more apt to contribute to speed than strength, while the middle deltoid is comprised of multipennate bands of muscle suggesting adaptation to produce more force at the expense of speed (8). The deltoids are composed of a relatively even proportion of type I muscle fibers and type II muscle fibers; however, these proportions can vary considerably (21). Perhaps, the variations in fiber type and fiber arrangement is based on the relative contribution to force for a given joint action - the middle deltoid receives help from far fewer and smaller muscles during abduction of the shoulder than the anterior and posterior deltoid, receives during flexion or extension.

A cadaver dissection of the muscles and bones of the upper arm

Deltoid - Cadaver Disection - https://c2.staticflickr.com/4/3286/3018650468_1566997531_b.jpg

Integrative Function

Integrated Function

Arthrokinematics

Muscles, bones, and connective structures of the glenohumeral joint

Deltoid Muscle Actions

Fascial Integration

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

 The deltoid fascia is fairly superficial, running nearly continuous with a thin lamina covering the surface of the 

 known as the pectoral fascia (20). The division between the pectoral fascia and deltoid fascia is clearly demarcated by the deltopectoral groove and the cephalic vein. Further, the deltoid fascia wraps underneath the anterior deltoid and continues into the complex network of axillary fascia and the superficial fascia covering the biceps brachii (17). The insertion of the deltoid was found to be fused with the lateral intermuscular septum, and a fusion was observed between the anterior band of the deltoid muscle and the insertion of the pectoralis major (20). The synergy of muscles implicated by this continuity of superficial fascia is a functional unit recruited during flexion and horizontal adduction - the anterior deltoid, 

 A fascial continuity exists between the 

 fascia (an extension of the superficial layer of the deep cervical fascia) and the deltoid fascia - consider the link between the origin of the deltoid and insertion of the trapezius muscle on the spine of the scapula and acromion (17). The origin of the deltoid overlaps and mirrors the insertion of the trapezius muscle, from the medial surface of the posterior deltoid fascia and the infraspinous fascia to the anterior deltoid fascia's strong investment into the deep brachial fascia (23). Tom Myers notes this fascial synergy as part of the "Superficial Back Arm Line" (6). The deltoids and 

 work synergistically during elevation of the arm to ensure optimal scapulohumeral rhythm, glenohumeral congruence, and clearance of the acromion shelf as the arm is elevated beyond 90º. The strongest fascial connection is likely between the upper trapezius, superior acromioclavicular (AC) ligament, and the anterior deltoid (8). This relationship is highlighted every time we reach for something – shoulder flexion via the anterior deltoid, stabilization of the AC joint via increased tension on the superior acromioclavicular ligament, and upward rotation of the scapula via the 

A cadaver dissection of the superficial back arm line including the trapezius, deltoids, and extensor mass

Cadaver Dissection of Superficial Back Arm Line (Trapezius, Deltoids, Extensor Mass - Anatomy Trains: 2nd Edition by Tom Myers

Subsystems

Behavior in Postural Dysfunction

Several clinicians and texts have alluded to the propensity of the deltoid to become dominant, short, and over-active (5, 6); however, dysfunction likely results in prime mover inhibition of the anterior and middle deltoid (1, 6, 9, 10, 12, 13, 14), and a relative increase in posterior deltoid activity (13, 15). The internally rotated position adopted by those who exhibit 

 likely has little if any effect on deltoid length and extensibility.

 Although the anterior and middle deltoid are large prime movers of the upper body, their relative contribution to postural dysfunction is small. Relative to other muscles of the shoulder complex, few texts reference techniques specific to release, lengthening, or activation of these muscles. The posterior deltoid does have a propensity toward trigger point development (6, 15) and is often targeted using various release and stretching techniques.  

In a study on swimmers with shoulder pain, an overall decrease in EMG activity was noted in the anterior and middle deltoid (13). Relative to the anterior and middle deltoid, posterior deltoid activity increased (remain unchanged, despite a decrease in performance) (13). Further, in a study on muscle recruitment and latent trigger points, the development of latent trigger points in the posterior deltoid leads to higher levels of EMG activity in the posterior deltoid during shoulder flexion (16).

The increase in posterior deltoid activity may be the result of synergistic dominance, due to 

 reduces force production, the over-activity of the 

 alters reciprocal inhibition leading to relative inhibition, resulting in a relative increase in firing rate of the posterior deltoid and increase in recruitment, force production, and activity during external rotation and during arm elevation to aid in stabilization.

Considering arthrokinematic dysfunction, a study by Lawrence et al. showed that shoulder pain patients exhibited excessive inferior and anterior glide of the humeral head relative to the glenoid fossa (14). This behavior could be at least partially explained by anterior and middle deltoid inhibition and an increase in activity of the posterior deltoid. The resultant change in force couple relationships would result in a decrease in superior translatory force, with the relative increase in posterior deltoid activity contributing to excessive anterior glide.

The internally rotated position of the humerus in those who exhibit UBD may have an effect on length, but given the questionable contribution to internal and external rotation (3), I doubt that many individuals will exhibit adaptive shortening of the anterior deltoid, or require lengthening and stretching techniques for the posterior deltoid. Even if adaptive shortening has occurred, it is likely that stretches used for the 

 will be sufficient to increase or maintain the length of the anterior and posterior deltoid.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD),

 Sacroiliac Joint Dysfunction (SIJD), and 

, the anterior deltoid and middle deltoid have a propensity toward prime mover inhibition and under-activity, and the posterior deltoid has a propensity to become over-active. This implies that release techniques for the posterior deltoid should be part of a human movement professional's repertoire. Based on their negligible contribution to internal and external rotation of the humerus, and the fact that these muscles are lengthened in stretches for other commonly short muscles of the upper body, it is doubtful that specific lengthening techniques for the deltoid are needed. Prime mover inhibition is likely best addressed in a resistance training program using large multi-joint movement patterns. Clinically, I have found that exercises traditionally used for the chest and back are sufficient for maintaining and increasing shoulder strength. The regular addition of exercise specific to the deltoids seems to predispose individuals to pain, inflammation, and chronic shoulder pathologies (such as impingement), especially in overhead athletes. Further, mobilization of the deltoid, pectoral, and trapezius fascia (for example, using Instrument Assisted Soft Tissue Mobilization (IASTM) may be beneficial for restoring mobility and optimal function. Further, the use of mobilization techniques for the glenohumeral, acromioclavicular, and sternoclavicular joints may reduce arthrokinematic dyskinesis and aid in restoring the optimal function of the deltoids. Manual mobilizations should be part of the repertoire of any licensed professional (PT, ATC, DC, DO) treating pathologies related to the shoulder.

Upper Body Dysfunction leading to Scapular or Thoracic Spine Pain

 May be a sign of trigger point development in deltoids

Palpation of active trigger points in the deltoid does not generally refer pain distally but spreads locally in the region of the affected muscle. "The deltoid muscle may develop satellite trigger points from key points in other muscles, such as the 

Common trigger points of the deltoid muscles

Postural Dysfunction & the Deltoids

Techniques and Ending Info

Note: The deltoids play a large role in exercises intended for chest and back (push and pull) strength. Specific exercises for the deltoids may not be necessary

Posterior Shoulder (Self-Administered) Release Technique

Sleeper's Stretch

Modified Sleeper's Stretch (Brookbush Institute preferred method)

Exercises and Techniques for the Deltoid Muscles

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

, Muscles: Testing and Function with Posture and Pain: Fifth Edition

Manipulative Therapy: Musculoskeletal Medicine

Inman VT, Saunders JB, Abbot JC, Observations on the function of the shoulder joint. J Bone Joint Surg 26:1 – 30, 1944

Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. 

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

José Miota Ibarra, Hong-You Ge, Chao Wang, Vicente Martínez Vizcaíno, Thomas Graven-Nielsen, Lars Arendt-Nielsen. Latent Myofascial Trigger Points are Associated With an Increased Antagonistic Muscle Activity During Agonist Muscle Contraction. The Journal of Pain, Volume 12, Issue 12, December 2011, Pages 1282–1288

John V. Basmajian, Carlo J. De Luca. Muscles Alive: Their Function Revealed by ElectroMyography. 1985

Sakoma Y, Sano H, Shinozaki N, et al. (2011). Anatomical and functional segments of the deltoid muscle. 

Gurushantappa PK, Kuppasad S. (2015). Anatomy of the axillary nerve and its clinical importance: a cadaveric study. 

Journal of Clinical and Diagnostic Research.

Wysiadecki G, Polguj M, Zytowski A, et al. (2014). Morphology and proposed model of innervation of the human deltoid muscle: a pilot study. 

Johnson, M. A., Polgar, J., Weightman, D., & Appleton, D. (1973). Data on the distribution of fibre types in thirty-six human muscles: an autopsy study. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged.

Deltoids

Related Courses:

Course Description: Deltoids

Study Guide: Anatomy of the Deltoids

Introduction to the Deltoids
3 Sub Sections

Deltoid Muscle Actions
2 Sub Sections

Fascial Integration
1 Sub Section

Postural Dysfunction & the Deltoids

Exercises and Techniques for the Deltoid Muscles
3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Deltoids

Related Courses:

Course Description: Deltoids

Study Guide: Anatomy of the Deltoids

Introduction to the Deltoids3 Sub Sections

Deltoid Muscle Actions2 Sub Sections

Fascial Integration1 Sub Section

Postural Dysfunction & the Deltoids

Exercises and Techniques for the Deltoid Muscles3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Deltoids
3 Sub Sections

Deltoid Muscle Actions
2 Sub Sections

Fascial Integration
1 Sub Section

Exercises and Techniques for the Deltoid Muscles
3 Sub Sections