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Have you been experiencing shoulder pain or maybe you just feel like your shoulder is not moving right? You may have what is called Scapular Dyskinesis! Learn all about it in this blog and the best exercises for you to do. 

What is Scapular Dyskinesis?

The scapula (shoulder blade) provides the socket to the ball and socket combination that makes up the shoulder joint. In scapular dyskinesis, however, the shoulder blades are not moving functionally which can present as winging of the scapula.

shoulder blade

Courtesy of Orthoinfo.

In functional movement, the shoulder blade glides against the body with movement of the arm and shoulder. But with scapular dyskinesis, this gliding against the body is not happening. Instead, in movement or even at rest, the shoulder blade does not rest or glide smoothly against the body.

Scapular dyskinesis develops over time and most often as a result of exercise or activities that cause compensation in movement that leads to disharmony of the shoulder blade stabilizers. While it can happen in one or both shoulder blades, it is not something you want to ignore because it can lead to a variety of issues including: 

  • Shoulder pain
  • Pain between the shoulder blades
  • Shoulder clicking
  • Neck pain
  • Mid-back pain
  • Pain down the arm
  • And in more severe cases lead to pain on the side of the torso to the front of the rib cage

The last 2 items on the list involve the Long Thoracic Nerve that gets stretched as a result of the shoulder blade stabilizers not doing their job and accidental stretching of the nerve due to the misuse of the surrounding tissue.

Scapular Dyskinesis and Lifestyle

Now, scapular dyskinesis is very common, especially in those who work behind a computer all day. Dysfunction in the shoulder blades just as with any part of the body comes from improper movement patterns and muscular imbalance. This is explored more in detail in my blog: “How to Do a Functional Movement Self-Assessment”.

When you sit behind a computer typing away all day, the elbows are held close to the body. This combined with slouching from too much sitting results in the shoulders rolling forward and with them goes the shoulder blades.

This is the beginning of dysfunctional patterns of movement and the disharmony of the shoulder blade stabilizers working with the muscles of the arm, rib cage, and front of the shoulder joint and marks the beginning of scapular dyskinesis.

Other contributing factors to shoulder blade issues include: 

  • Bad posture
  • Sedentary lifestyle 
  • Injury 
  • One-sided sports
  • Bad workout form

The key is to do the easy fixes before causing any issues and that starts with proper ergonomic set-ups. For instance, did you know that the size of your keyboard makes a difference in how your posture ends up being? Scapular dyskinesis is ultimately the result of poor posture in the non-active individual and this ergonomics checklist is a great start to assure you don’t fall victim to a problem that can take a long time to fix.

Treatment for Scapular Dyskinesis

In the absence of neurological findings associated with the Long Thoracic Nerve, scapular dyskinesis requires just the right type of exercise. Now, these are exercises that are different from the isolated shoulder exercises done in most physical therapy offices! The issue with those exercises is that the area is isolated and then worked out! But scapular dyskinesis is the issue of the shoulder blades not playing their part in movement with the rest of the body, not in isolation! The signaling of when the shoulder blade stabilizers chime in and phase out in movement is off!

Through Postural Neurology and Developmental Kinesiology we are able to thoroughly assess the functional movement of the area. Then with strategic functional exercises, we bring the muscles back into the game. If movement is a concert, the brain is the musician and the map of movement that we are all born with (Homunculus) is the musical note. The musicians are the body parts that have to be able to play their musical instruments while playing with the rest of the symphony. Right?

The only way to achieve that is through functional movement and in our practice it is the marriage of Postural Neurology and Developmental Kinesiology methods such as DNS, that restores the dysfunctional back to functional.

Best Exercises for Shoulder Pain

When it comes to the shoulder blade winging we need to assess a muscle called serratus anterior! The job of this muscle is to keep the shoulder blades against the body in movement and work with the rest of the stabilizers. This is a big part of the treatment. The exercise shown below is a great way to activate this muscle to start making progress toward correcting the issue. 

In most cases of scapular dyskinesis, the proprioception is off, which is the understanding of how to move the shoulder blades properly.  For this reason, treatment has to involve reinforcing the cortical connection! This is the connection of the brain to the shoulder blades, which the video below demonstrates.

Shoulder blade dyskinesis is a complex issue requiring work done on the neck, upper back, shoulder blades, and arms. This includes disassociation of the arm from the shoulder socket and synchronization of movement. In other words, we focus on shoulder movement without compromising the rest of the body and much much more.

If you think you have scapular dyskenisis or if your treatment for scapular dyskenisis has not been successful, contact us for an evaluation.

Dr. Shakib

Recommended reading:

Movement and Postural Rehab Exercises

Brain Based Neurology and Posture