Understanding Scapular Dyskinesis: The Root of Shoulder Pain
Scapular dyskinesis might sound complex, but it's a crucial, often overlooked, diagnosis for shoulder issues. It's unique because it's usually not painful on its own, yet it can be a primary contributor to almost every other painful shoulder diagnosis we encounter. This blog will dive into scapular dyskinesis, why it matters, and most importantly, how we, as chiropractors, can identify and address it to prevent future degeneration and injury.
Beyond the Pain: Identifying the Functional Problem
When a patient comes into our office with shoulder pain, our primary duty is to identify the injured tissue–the orthopedic diagnosis. Tests like Hawkins-Kennedy or Neer's help pinpoint these specific tissue injuries. However, a deeper question remains: What functional problem led to this injury in the first place?
Imagine a "couch to 5K" program. Starting from scratch, ten people might develop different injuries: Achilles tendinopathy, plantar fasciitis, knee pain, hip pain, or back pain. These are the tissue injuries, but the functional problem might be foot hyperpronation or hip abductor weakness. Similarly, we frequently see upper crossed syndrome and scapular dyskinesis in the shoulder.
As early as the 1970s, Neer stated that 100% of people with impingement syndrome had scapular dyskinesis, and 95% of those with rotator cuff syndrome had a predisposing impingement syndrome. While the continuum isn't always linear, these issues are interconnected, and addressing scapular dyskinesis is key to long-term solutions.
Our Role as Clinicians: Prevention and Empowerment
Pain relief is important, but prevention is key. This involves:
Simple, Effective Interventions: Small daily adjustments, like scapular retraction and posterior tilt during routine tasks, can have a big impact.
Active Patient Participation: Educating patients about posture, habits, and ergonomics ensures lasting results.
Measure and Improve: Tracking progress ensures care plans are effective both now and in the future.
Understanding the "Great White Shark": Scapular Dyskinesis
Scapular dyskinesis is the "great white shark" – the underlying variable that causes a cascade of other problems. It's a functional issue, not inherently painful. Still, it directly leads to painful conditions like impingement syndrome and rotator cuff injuries by affecting the "squishy stuff in the middle" – the supraspinatus, bursa, labrum, and biceps tendon.
Identifying Scapular Dyskinesis
While you won't often have a patient walk in complaining of scapular dyskinesis, you can identify it through specific tests.
Visual Inspection
Look for changes in scapular position, such as migration away from the spine or the bottom piece sticking out. This is often due to overactive anterior muscles and weakened posterior muscles.
Dynamic Assessment
Observe shoulder movement during weighted flexion and abduction.
Scapular Dyskinesis Test
Quadruped Rock Test
Management and Exercises: Rebalancing the Shoulder
Our approach to managing scapular dyskinesis is multi-faceted, including soft tissue work, scapular mobilization, and targeted exercise. Strengthening the often-weak scapular stabilizers and restoring balanced muscle activity is key. The following exercises are particularly effective:
YTWL
Low Row
Trapezius Stretch - Sitting
Brugger with Band
Empowering Patients for Lasting Results
Patients often seek quick fixes, but the forces generated by the body far exceed what a brace or passive support can provide. True scapular mechanics come from learning to use the muscles correctly. With the ChiroUp condition report, we can clearly communicate the patient’s diagnosis, outline our treatment plan, provide practical advice for daily activities, and share their personalized exercise program. This comprehensive, easy-to-understand report helps patients connect short-term goals—like reaching a cupboard or playing baseball without pain—to the functional improvements they’re working toward. By empowering patients with knowledge and actionable steps, we ensure lasting results and strengthen the patient-provider relationship.
Confident care starts here. With ChiroUp and our new EHR, you’ll have the tools, workflows, and patient resources to elevate outcomes, simplify documentation, and focus on what matters most—your patients.
