Let’s talk about scapular dysfunction

I will preface by saying all of what you read below is to seek out a medical professional if you are feeling pain or discomfort either lifting or during your daily life!!! If there is interest I wouldn’t mind doing a write up for the rest of the upper body. I thought I would start by reviewing upper back and scapular dysfunction. These muscles contribute to posture and assist the shoulder with motion. Enjoy!

Overview of anatomy and symptoms

The scapula (shoulder blade) is often overlooked when it comes to shoulder strengthening and can often be a cause of referred shoulder pain especially with poor posture and/or poor lifting mechanics. The scapula is an important part of the shoulder complex as it is responsible for stability and mobility when using the arm. The muscles responsible formost but not all of the motion of the scapula are the trapezius, rhomboids, and the latissimus dorsi. A weakness in these muscles can lead to shoulder pain and weakness when moving the arm. The general term for this weakness and/or pain in this region is called scapular dyskinesis. Symptoms generally present themselves as pain around or between the shoulder blades and pain/weakness with raising the arm in front or the side of the body.

Scapular dyskinesis can manifest in two ways. The first is winging where the shoulder blade protrudes outward at rest. This can be attributed to a weak serratus anterior or a tight pectoralis minor. The other is a lack of smooth motion when bringing the arm in forward flexion seen here. Watch how the motion towards the end of the video is not smooth. These motions can be contributed to a nerve injury such as the long thoracic nerve or weakness in the muscles mentioned previously.

How can we tell if it’s a scapular issue instead of a rotator cuff or other glenohumeral injuries?

Testing for scapular issues is different than testing for shoulder. While there can be both scapular and glenohumeral issues such as rotator cuff or shoulder instability that can be seen together, these tests will focus strictly on the scapula. The easiest way to test is to hold a 5-pound weight in each arm and do 5 reps in shoulder flexion followed by 5 in abduction. Have a friend watch your shoulder blades during these exercises and watch for abnormal movement of the shoulder blade. Typically, people who have dyskinesis will struggle to complete the reps or feel pain/weakness during this test. Another way to test is to have a friend assist moving the lower border of the scapula towards the shoulder as you move your arm in flexion. There are obviously more tests however again if you suspect you have scapular issues, its best to be seen by a medical professional for full testing and treatment.

How do we treat this?

Now let’s overview some exercises that will help correct suspected scapular issues. There are obviously many exercises that work the muscles of the upper back that many people are familiar with. Below are going to be exercises that focus specifically of the muscles of the upper back that can be helpful with dealing with scapular muscle imbalance. These will work the specific muscle the most and get the most muscle activation. Some of these are done with dumbbells or bands starting between 3-5 pounds. Progress in two pound increments if this is easy. These exercises don’t need a lot of weight to get the job done especially if you have scapular issues. Scaption is the area between shoulder flexion and shoulder abduction (arm is at 45 if looking down from above. Pic I also like to add stretches such as the cross body and the chest stretch for the pec minor which can be very helpful to relieve tightness and referred pain in the upper back. The cross body stretch also seems to be a better stretch than the sleeper stretch when it comes to posterior tightness. I have people do these stretches in conjunction with the exercises above. Hold these for 30 seconds each.

For the following exercises using dumbbells noted with a D , start at a low weight (5 pounds) and increase in increments of 2-3 pounds. I usually aim for 2-3 sets of 8-10 reps.

Trapezius

D Shoulder Shrugs

D Prone rowing

D Prone horizontal abduction with arm at 135 degrees lifting with thumb up (Known as Y exercise)

D Prone horizontal abduction with arm lifting at 90 degrees with thumb up (known as T Excercises)

D Standing lifting in scaption to 120 degrees with thumb up

D Standing lifting in scaption to 80 degrees with thumb up

Rhomboids

D Rowing excercises for this muscle are best using either dumbbells or rowing machines.

Serratus anterior

Pushups (Basic, Deep pushups, Clap pushups)

D Supine upward scapular punch (Hold weight and push towards ceiling)

Latissimus Dorsi

Pushups Pullups Pulldowns

More excercises can be found here and troublesome’s thread on posture has more exercises and stretches well that are excellent.

Hopefully this overview is helpful. If it is, I can continue with one for the shoulder, elbow, and wrist. Feel free to leave comments, corrections, etc below.

Sources Kevin E. Wilk, Michael M. Reinold, James R. Andrews (eds): The athlete’s shoulder second edition. Saunders Elsevier, Philadelphia, 2009

Skirven T, Osterman AL, Fedorcyzk J, Amadio P. (Eds.), Rehabilitation of the Hand and Upper Extremity, 6th Ed. Philadelphia, 2010.

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