New Pearl for Resolving Shoulder Pain
Shoulder pain is the second most common diagnosis seen in a musculoskeletal provider’s office. Treating shoulder dysfunction should constitute a significant portion of every chiropractor’s day. Not because it is quick and easy, but because it is challenging.Unfortunately, providers often fail to address every component necessary to alleviate shoulder pain and prevent re-occurrence. Research points to one essential theme in the rehabilitation of shoulder pain—scapular stability.Want a new trick to improve your scapular rehab? Watch this video tutorial that applies new research from Physical Therapy in Sport. (1)
1. Shoulder Mechanics
Normal scapulohumeral motion maintains the humeral center of rotation directly above the concave scapular glenoid throughout the shoulder’s range of motion. This integrated motion between the scapula and humerus provides efficient function and joint stability. Lack of scapular stability or mobility leads to a predictable cascade of dysfunction.
Abnormal scapular motion results in disproportionate anterior and superior humeral shift during arm flexion and abduction.
Glenohumeral dysfunction increases stress on the shoulder capsule and rotator cuff.
Poor scapular control diminishes subacromial space and leads to decreased rotator cuff strength, impingement symptoms, and future rotator cuff damage.
One hundred percent of patients with shoulder impingement demonstrate scapular dyskinesis.
Uncoordinated movement of the scapula and humerus leads to a loss of dynamic stability in the glenohumeral joint via excessive strain on the anterior glenohumeral ligaments, with concurrent diminished rotator cuff strength.
2. Identifying Dyskinesis
Scapular instability is a universal problem that is directly responsible for many orthopedic diagnoses. Recognizing scapular dyskinesis is simplified by two tests:
Scapular Dyskinesis Test
Quadruped Rock Test
3. Resolving the Problem
Correcting scapular mechanics improves the load-sharing ability of the glenohumeral joint and prevents subacromial impingement. The new study from Kim et al. found that employing a scapular setting exercise produced added benefits:
Increased subacromial space in patients with subacromial impingement syndrome
Increased activities of scapula muscles
Improved outcomes for patients with subacromial impingement syndrome
After reading the study, I decided to try educating my patients with one key difference—teaching posterior tilt of the scapular instead of scapular retraction. In the past, I attempted to have all patients with scapular dyskinesis retract their scapula with 10-20% of their force during their rehab. Now, I focus on a slight difference—posterior tilt.
While this may not seem like a big difference, I think it is a worthwhile change. Focusing on posterior tilt allows patients to feel free to go through the needed upward rotation of the scapula while performing their exercises. Focusing on retraction may restrict upward rotation contrary to the purpose of improving scapular mechanics.
4. Changing What is Comfortable
Why make this change? Abandoning the status quo is how we grow as clinicians. I have recipes for treating every condition, but that doesn't make them the best. If I can help one more patient resolve their pain or reduce the number of visits, my value increases. Continually refining “best practices” steps up your game and improves the perception of our chiropractic profession.
One way to refine your practice today is to check out ChiroUp’s Scapular Dyskinesis webinar. You can expect to take away best practice tips that you can apply in your treatment moving forward. 💪
5. One More Thing
Measure your clinical results! Which—shameless plug alert: you can track patient outcomes & satisfaction rates per condition with ChiroUp! We do this automatically, all day—every day, for more than a thousand of our profession’s top providers. Isn’t it about time for you to join that list? Try it for free now.
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Kim SY, Weon JH, Jung DY, Oh JS. Effect of the scapula-setting exercise on acromio-humeral distance and scapula muscle activity in patients with subacromial impingement syndrome. Phys Ther Sport. 2019 Mar 18;37:99-104.
