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Scapula Dyskinesis: its impact on shoulder stability, pain, and rehabilitation outcomes

Jul 26, 2021

The scapula plays an essential role in optimising the shoulder’s function, offering a position of support and motion of stability (Kibler & Sciascia, 2010). The scapula position enables muscle activation and strength development to enable force and energy transfer of the kinetic chain. The role of scapula plays a pivotal in injury management and rehabilitation for multiple shoulder pathologies (Kibler & Sciascia, 2019).

Scapula dyskinesis is a term that describes the dysfunctional movement of the scapula (Paine & Voight, 2013). Normal scapulohumeral rhythm is the synchronised movement of the scapula and humerus to shoulder motion, which is an essential factor for efficient shoulder function. Scapula dyskinesis interrupts normal scapulohumeral rhythm, which can lead to the scapula’s position and stability being put in a vulnerable situation. There is evidence to suggest that poor scapula rhythm can lead to shoulder pain and instability or be an underlying issue of overuse injuries (Pain & Voight, 2013; Moseley et al., 1992; Kuhn et al., 1995). Thus, implementing exercises addressing the scapula’s mechanics plays an important role.

Rehabilitation for scapula dyskinesis

Rehabilitation of scapular dyskinesis requires addressing the causative factors that create the individual’s abnormalities, then focussing on the restoration of the balance of muscle forces that allow for optimal position and motion (Kibler et al., 2013). Implementing exercises to address the causative factors and the mechanics of the scapula is an effective strategy to offer a position of support and motion of stability for rehabilitation.

  • Causative factors can include:
    • Neurological factors: thoracic, spinal/dorsal scapula nerve palsies.
    • Joint derangement: labral injury, glenohumeral instability, bicep tendinitis, rotator cuff tears.
    • Bone factors: clavicle and scapula fractures.
    • Mobility and flexibility issues.

When looking at the current literature, multiple clinical studies have reported that the incorporation of scapula exercises in rehabilitation programmes has led to positive patient-rated outcomes in patients with impingement syndromes and self-reported instability (Kromer et al., 2013). Another study concluded that patients who had suffered full-thickness rotator cuff tears showed that a rehabilitation programme comprised of scapula exercises reduced overall symptoms and resulted in up to 80% of patients opting for no surgery (Kuhn et al., 2013). These studies demonstrate that implementing exercises addressing the underlying issues of scapula dyskinesis can improve patient-rated outcomes and overall symptoms. Therefore, addressing the causative factors of scapula dyskinesis and prescribing exercises targeting the scapula’s kinematics is an important contributor to providing a holistic approach to shoulder rehabilitation.

If you would like more information on shoulder injuries or other rehabilitation programmes that Absolute Balance can provide, please do not hesitate to contact us at info@absolutebalance.com.au.

 

David McClung  (B.Sc. Exercise Science and Rehabilitation (AEP, AES) (ESSAM))
Regional Manager – NSW/ACT – Accredited Exercise Physiologist

 

References:

Kibler, W. B., & Sciascia, A. (2010). Current concepts: scapular dyskinesis. British Journal of Sports Medicine , 44(5), 300-305.

Kibler, W. B., & Sciascia, A. (2019). Evaluation and management of scapular dyskinesis in overhead athletes. Current Reviews in Musculoskeletal Medicine, 12(4), 515-526.

Kibler, W. B., Ludewig, P. M., McClure, P. W., Michener, L. A., Bak, K., & Sciascia, A. D. (2013). Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. British
Journal of Sports Medicine , 47(14), 877-885.

Kromer TO, Tautenhahn UG, de Bie RA, et al. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med 2009; 41:870–80.

Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., … & Ma, C. B. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study.  Journal of Shoulder and Elbow Surgery ,  22 (10), 1371-1379.

Kuhn, J. E., Plancher, K. D., & Hawkins, R. J. (1995). Scapular winging. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 3(6), 319-325.

Paine, R., & Voight, M. L. (2013). The role of the scapula . International Journal of Sports Physical Therapy, 8 (5), 617.

Moseley JR, J. B., Jobe, F. W., Pink, M., Perry, J., & Tibone, J. (1992). EMG analysis of the scapular muscles during a shoulder rehabilitation program. The American Journal of Sports Medicine , 20(2), 128-134.

We live in a 3D world, it's time to start training that way!

By Alison Absolute Balance • 24 Apr, 2024
The human body is designed to move in a three-dimensional plane divided into the following segments: Sagittal Plane: Cuts the body into left and right halves. Forward and backward movements. Frontal Plane: Cuts the body into front and back halves. Side to side movements. Transverse Plane: Cuts the body into top and bottom halves. Twisting/rotational movements. Too often we get caught training mostly in a sagittal plane, think running, squats, bicep curls etc. While these are all good exercises, in day-to-day life we don’t only move along a sagittal plane. What happens when you need to quickly get out of the way of the e-scooter flying towards you on the foot path or make a quick sidestep to avoid a pothole – these movements are along the frontal plane. While movements such as turning to check your blind spot while driving or turning to talk to the person next to us are in the transverse plane. When it comes to injury prevention and movement efficiency it is important to incorporate exercises from all planes of movement into training programs. Sagittal If a line ran down the middle of the body splitting it from left to right, movements parallel to this line are within the sagittal plane of movement. The sagittal plane is the most common plane of movement and is trained overwhelming more than the frontal and transverse planes of movement. Movements/exercises considered to be in the sagittal plane include running, squats, deadlifts and bicep curls. Now while all these exercises are good, with the way our lives having evolved into many desk sitting roles, driving from place to place etc, to then go to the gym and focus heavily on movements that are predominantly up – down, and forwards – backwards we can end up reinforcing these pathways and becoming somewhat robotic, heavily limiting our natural movements. Frontal If a line ran down the middle of the body splitting it into front and back, movements parallel to this line would be within the frontal plane of movement – essentially any movement that involves moving away from or towards the midline. Often neglected in strength programs, frontal plane exercises include Cossack squats, lateral lunges, and side raises. Transverse If a line split the body in half separating it into top and bottom with the pelvis being the point of division, any movement parallel to this line would be considered to be in the transverse plane of movement. Movement along/through a transverse plane is generally more rotational such as a Russian twist or trunk twist. By focussing largely on sagittal plane movements, we are risking developing muscle imbalances, limited mobility and uncoordinated movements in the neglected planes. Our body is designed to move on a 3-dimensional plane so make sure to train in a way that will allow it to move the way it’s supposed to. Katie McGrath Injury Prevention Specialist Injury Prevention Services

Stretching and mobility benefits

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Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA

Meet a Team Leader at AB

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Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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