The scapula acts as a crucial "bridge" between the complex shoulder region and the cervical spine, providing indispensable stability and mobility to the upper quadrant. Chronic neck and shoulder pain show a significant correlation with scapular movement dysfunctions. Notably, patients suffering from rotator cuff impingement and glenohumeral instability often manifest altered scapular movements (Ludewig PM et al. 2000; Kibler WB et al. 2009).
In a state of rest, individuals experiencing neck pain frequently display noticeable postural changes, particularly during extended periods of sitting, such as prolonged computer use (Szeto GP et al. 2002). Studies on subjects with shoulder pathologies demonstrate elevated clavicle positions, reduced retractions, and limited upward rotation and posterior tilt of the scapula. Recent research by Helgadottir et al. (2010, 2011) additionally reveals decreased clavicle retractions on the dominant side, prevalent among individuals with neck pain and those who have endured whiplash injuries.
These alterations in scapular movements can be attributed not only to changes in muscle recruitment patterns (impacting the activity of the serratus anterior muscle) or muscle performance (resulting in imbalances between the strength of the upper and lower trapezius) but also to restricted soft tissue flexibility, impeding the proper motion of the scapula during movement. For instance, increased stiffness in the pectoralis minor muscle may lead to heightened internal rotation and anterior tilt of the scapula, while shortened posterior capsule structures could cause reduced glenohumeral internal rotation and an increased anterior tilt of the scapula.
Studies focusing on patients with impingement indicate reduced strength and alterations in the timing of serratus anterior activation, coupled with hyperactivity or early activation of the upper trapezius and diminished strength or late activation of the middle and lower trapezius fibers. However, the precise causative relationship between altered scapular movements and neck/shoulder pain remains enigmatic, as irregular scapular movements can predispose individuals to pain, yet pain itself can exacerbate scapular kinematics.
To aid clinicians in developing appropriate treatment strategies for scapular dyskinesis, researchers have devised an algorithm, pinpointing issues related to flexibility loss and compromised muscle performance. Regarding flexibility concerns, specific attention is warranted for scapular muscles, particularly the pectoralis minor and the elevators of the scapula. Furthermore, thorough assessments of stiffness in posterior shoulder structures, such as the capsule and external rotator muscles, are essential. For muscle-related problems, the authors propose three steps designed to address neuromuscular disorders or deficits in strength.
The exercise programme included five exercises targeting scapular and rotator cuff muscles.
A1-A2: sidelying external rotation (ER) in neutral, B1-B2: prone horizontal abduction, C1-C2: prone ER in 90° of shoulder abduction, D1-D2: supine scapular protraction, and E1-E2: seated shoulder elevation in the scapular plane
The first phase centers on enhancing muscle control awareness, fostering improved proprioception, and restoring the scapula's resting position. For example, patients might be instructed to touch their contralateral coracoid with their finger and then subsequently move it backward, aligning the scapula correctly.
During the second phase, clinicians decide whether to enhance scapular strength or motor control through simple or complex exercises based on clinical evaluations. Achieving scapular function correction is achievable in both open and closed kinetic chain exercises, training muscles to respond optimally in various situations while maintaining the scapula's proper positioning using free weights or resistance.
Finally, the third phase emphasizes advanced control during athletic movements, requiring the automation of scapular control during sport-specific gestures through plyometric and eccentric exercises. As supported by existing literature, a comprehensive exercise program ranging from 6 weeks to 6 months is recommended for optimal results.
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