Are you or have you experienced shoulder pain and don’t know why? You do not have to have a traumatic injury to your shoulder(s) to experience shoulder pain. In fact, what you may have is Scapular Dyskinesis, or “an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements.” To keep things less confusing, a scapula is another word for your shoulder blade and dyskinesis is defined as abnormal movement or control. Scapular dyskinesis can further be broken down into three types, but for the sake of this article we will talk about scapular dyskinesis as a whole.
Proper anatomical positioning of your shoulder blade should be approximately 2.5-3inches from the medial border of the scapula to the spine. It generally extends the distance from T2 to T7 of your thoracic spine. It should sit in a retracted, depressed position, and slightly posteriorly tilted. I do want to note that this is just a general guideline and that a person may have their scapulae sit in slightly different anatomical positions and may not experience any shoulder pain. It can also be noted that there may not be perfect symmetry between the two scapulae and this is not uncommon as well.
The movements of the scapulae include elevation and depression, upward and downward rotation, and protraction and retraction. If a person has abnormal movement or control in one or more of these movements, pain can occur over time. Someone with scapular dyskinesis may show that one or both scapula sit in an elevated and protracted position, with anterior tilting (think of winging of the shoulder blade). However, a person does not have to have all three deviations to experience shoulder pain.
How or why does Scapular Dyskinesis occur? There are many different reasons why a person may be diagnosed with Scapular Dyskinesis. Here are the top 3 reasons that I see in the clinic:
1. Sport Muscle Imbalances/Overuse- This is prevalent with most overhead or throwing sports such as volleyball, baseball, and swimming. Certain muscles become very strong and other muscles can become very weak providing an imbalance in the shoulder joint stability and improper movement of the scapula.
2. Nerve- The long thoracic nerve supplies the Serratus Anterior muscle. One of its functions is to keep the scapula close to the rib cage. If the long thoracic nerve is not functioning properly, the scapula can “lift” off the rib cage and cause winging of the scapula.
3. Posture- Incorrect posture over time can also be a source of shoulder pain. Typically in someone with less than ideal posture we would see their head extended forward, rounding of both shoulders forward, and an increase in thoracic kyphosis. This altered position can affect where the scapula sits on the rib cage and how the arm sits in the shoulder joint.
Treatment options for scapular dyskinesis should focus on rehabilitation. This may include manual stretching of the soft tissue and mobilization of shoulder joint capsule, coupled with increasing neuromuscular control, and strengthening the weaker muscles. Re-teaching proper breathing and manual massage on the neck and upper back are also options that may be beneficial. As always, the rehabilitative process is based on what dysfunction was seen in the assessment. If you are experiencing shoulder pain and want to discover why, an Athletic Therapist is qualified to assess, diagnose, and treat!
By Marina White, BSc. HK, CAT(C), CSCS
Certified Athletic Therapist