The Missing Piece of Shoulder Health
Scapular dyskinesis: What does that mean?
So you've been told you have scapular dyskinesis. The diagnosis can bring more questions than answers for individuals experiencing chronic shoulder aches and pains. In the physical medicine field, we sometimes use terms that refer to general movement dysfunctions. For example, upper trap syndrome, SICK scapula or scapular dyskinesis. These terms are helpful for understanding how an area of the body may not be moving well but there is debate as to whether this is a medical diagnosis. What is clear is that whenever there are abnormal movement mechanics, physical therapy and rehabilitation can help.
Note: Scapular dyskinesia can have several causes. Cervical nerve root compression and long thoracic nerve palsy are underlying diagnoses that are important to establish before looking at postural and movement-related causes of dyskinesia because, in these two conditions, scapular dyskinesia is not a just a movement-related dysfunction, but a symptom of an underlying problem that needs to be addressed. In this post, we are going to focus on scapular dyskinesia as a movement dysfunction.
Understanding the shoulder
The shoulder is a complex joint. The joint itself is formed by the top of the humerus, or the upper arm bone, and a projection off your scapula, or your shoulder blade, called the glenoid fossa. Because of its structure, the shoulder joint is extremely mobile and allows us to have impressive range of motion for reaching and grasping. The trade for its mobility is that the shoulder joint is more unstable than other joints in the body. It relies on the position and stability of the scapula, its base of support, for proper positioning.
The scapula, or shoulder blade, is the connection between the arm and the trunk of the body. It is a floating joint connected to the trunk by muscle attachments and the small acromioclavicular joint. The muscles that hold the scapula against the trunk, the periscapular muscles, are important not just for providing a stable base for arm movement but also for transmitting force from the core into the arm.
Why scapular dyskinesia develops
The rotator cuff, deltoid, middle and lower trapezius and serratus anterior are some of the most important periscapular muscles. They function in force ouples, meaning their opposite lines of pull are used in coordinated contraction to stabilize and move the scapula, which impacts available shoulder range of motion. When raising the arm, the upper arm bone and the scapula move together in something called scapulohumeral rhythm. When the periscapular muscles are imbalanced, it can often cause alterations to scapulohumeral rhythm, creating dyskinesia which can impact mechanics for the scapula and the upper arm.
If the periscapular muscles are not functioning properly, it can contribute to the development of symptoms such as:
- Anterior, superior or posterior shoulder pain
- Lateral upper arm pain
- Neck pain
- Asymmetrical posture
- Snapping or popping with shoulder movement
- Loss of strength
It can also lead to shoulder injuries, including rotator cuff tendinitis, subacromial bursitis, impingement and labral tears.
Movement dysfunction dyskinesia typically develops from postural abnormalities, motor control deficits, muscle imbalances or repetitive movements that disrupt force couple balance -- think poor posture, chronic pec tension and repetitive overhead movements. The key to getting rid of the symptoms from dyskinesia is restoring proper movement of the scapula by addressing periscapular imbalances. The specific imbalances involved in scapular dyskinesia vary per person. Here are some examples of how our clinicians might work with you to improve scapular dyskinesia.
Reduce upper trap tension
When the upper traps are tight, the shoulder blade remains stuck in an upwardly rotated position, which can lead to chronic shoulder and neck stiffness. Reducing upper trap tension involves both soft tissue, to loosen chronic tension and knots, but also strengthening to remind the upper traps how to function effectively.
Open the chest
A tight chest pulls the shoulder blade into internal rotation, which can cause compression and pinching in the front of the shoulder and make overhead movements painful. Opening the chest can help to restore resting shoulder position and improve rotator cuff muscle function.
Restore thoracic mobility
Poor thoracic extension can make it more challenging for the shoulder to move efficiently, especially overhead, because it changes the shoulder blade's resting position on the trunk. Focusing on proper upright posture and the ability to extend from the spine allows the periscapular and shoulder muscles to work less when moving the arm.
Activate the serratus anterior
An inactive or weak serratus anterior muscle can cause problems with protraction and retraction of the scapula, causing the thoracic spine to compensate and flex and extend to move the shoulder blade side-to-side on the trunk. Restoring serratus activation ensures the shoulder blade can move on the trunk in a way that supports pain free movement.
Rebalance the periscapular muscles
When the muscles around the shoulder blade are imbalanced, it pulls the scap out of proper position on the trunk and impacts how the shoulder
Scapular dyskinesia can be complicated, but is shouldn't be scary. Here at FIXXED, we're your partner in health. Our commitment to excellence and our comprehensive approach ensures that we're looking at the root cause of why your scapula isn't moving well and addressing those to unlock pain free movement.
Ready to get started? Book your appointment today.
