What is it and how can we fix it?
Scapular dyskinesis by definition is the abnormal position or movement of the scapula (shoulder blade), and this is a much more common problem than most athletes or parents know. As a sports chiropractor who specializes in throwing athletes, specifically baseball and softball, most of the players who come into the office complaining of pain anywhere in the arm have some form of scapular dyskinesis. When it occurs, it can cause a decrease in performance of the athlete, including a decrease in velocity, and a higher risk of injury. The longer the dyskinesis occurs, the higher the risk of injury and the harder it is to reverse due to the brain becoming “grooved” to the maladaptive movement pattern.
We can see scapular dyskinesis positionally with scapular winging with the scapula appearing to “stick out” from the back relative to the other side, and can cause the shoulder to appear “forward.” This will cause a decrease in function of the overall shoulder complex while also causing compensation in other areas leading to more dysfunction overall. When the dyskinesis is not so obvious visually, we can test the function of the scapula to see how well or how poorly it is moving. “Clicking” within the scapula can be a sign of dyskinesis as well as a decrease in “smoothness” of movements involving the scapula including shoulder flexion and abduction. Eventually, this could also lead to neck and upper back compensations to make up for the lack of range of motion. These athletes often feel “tight” in their traps and scalenes.
The good news is that it is fixable. The scapula can be trained to move more fluidly through different exercises, treatment, and mechanical changes. Usually in a treatment session, we treat the compensatory musculature first (traps, levator scapulae, lats, pecs, etc.) with Active Release Technique or Graston Technique to get the musculature to calm down and become more pliable. Once this is achieved, we will adjust the spine to also allow for more freedom of movement of the scapula as it lays on top of the spine. Next, we will begin to train to improve scapular stability. Where we start with the training depends on the athlete, but it usually involves a combination of strengthening the middle and lower traps, strengthening serratus anterior, and challenging the scapula with a few Dynamic Neuromuscular Stability exercises. These exercises will help rewire the brain to improve the movement of the scapula. In some cases, we will refer out for mechanical changes either to a pitching coach or to a local physical therapy office as needed.
Test yourself tonight! Make a “snow angel” in the air while sitting down. Does your scapula click? Is the movement jagged? Does your neck move forward or do you hike up one shoulder? If so, you might have some form of scapular dyskinesis. Come see us and we’ll take care of it!
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