At the beginning of my career the shoulder scared me. It was complex and there were so many things at play that I found it difficult to treat well and manage. Shoulder cases are a very common problem among us mortals. We really would like to be more resilient, so is there a way we can do that?
The issue at hand is there are so many reasons and causes of shoulder pain that it feels like you are better off at not leaving the house and staying away from activities that could cause injury, but that is not a way to live. So let’s talk about a rather common shoulder complaint and how we manage them. It’s a rather annoying name but scapular dyskinesis is what we are going over. So strap yourself in and here we go.
Okay Scapular dyskinesis: what is it? The term really means inappropriate movement of the shoulder. Truly the cause of this condition is aligned unfortunately with a previous injury. Injuries like rotator cuff tears, shoulder labrum lesions, AC joint instabilities, even fractures in the arm or in surrounding bones and nerve injuries.
So this inappropriate movement of the shoulder is a lack of rhythm of the shoulder movement and scapula at the same time. In general we see a smooth movement of the shoulder or glenohumeral movement while the scapula moves as well. If you lift your arm up into the arm from the side the hand raises quicker than the scapula, but it does move in an externally rotated fashion. For the shoulder that doesn’t have the issue the movement looks clean and the arm should be able to reach overhead.
What we see with the shoulder with dyskinesis is the poor motion, possible rounding of the shoulder forward. An orthopedic exam shows tenderness of the muscles around the shoulder in the front.
The causes of scapular dyskinesis can be from three categories: 1. Shoulder related injuries, 2. Neck related complaints, 3. Posturally related.
Let’s go over these in brief to at least understand why. Shoulder related injuries are all too common. Injuries to soft tissues that are unattended to develop a change in the soft tissues and the abilities of the shoulder changes, or in other words, the way the shoulder sits, moves and functions changes. Scapular dyskinesis is a secondary condition where it is the effects of other issues like before mentioned.
Neck related complaints such as joint degeneration, nerve root compressions can cause issues down to the intended muscles. Mechanisms of the spine can alter how the shoulder functions. In working with patients with shoulder and arm complaints I discuss the relevance of paying attention to the region of the neck and spine as that is where the nerves come from that control and manage movements of the shoulder.
Posture can be way oversold as the biggest problem with all that ails you. I have a difficult time going down that rabbit hole, however a quick scan of someone’s posture can speak volumes on areas that are under biomechanical stress and can be an area that needs attention. The excessive rounding of the spine and hard crease lines in the neck where most movements of the neck are happening are two big areas that we attend to.
So what to do about it?
With all that you now know about scapular dyskinesis and the problems that cause it and the issues involved what can be done about it?
Every patient is different and the injuries or history a person has makes treatment different from person to person. With that said we are able to focus on principles of treatment and not protocols.
A scapular dyskinesis shoulder complaint or primary objective is to decrease any pains around the movement of the shoulder. This can be done using several methods, ie, dry needling, class IV laser, myofascial release, cupping method and scrapping or FAKTR methods. With pain subsiding we begin to focus on joint stability exercises that can help to improve strength imbalances seen at the shoulder. Exercises such as these shown here.
As posture is a potential part of this some focus may be towards both standing and sitting posture. A difficulty I know is that we must pay attention to work and personal environments that we are in from day to day. This may be more of a needed and conscious effort to change how you stand or sit from utilizing outside implements or tools, different sitting work options and even different shoes as well. This part is not the most pleasant to hear, but when the environment you are in is part of the problem you may have to face some hard truths and make that change.
We know that the shoulder is capable of a lot of movements and needs a wide variety and ability of strengths to accomplish all within your day. The initial objective is to provide you with stability in the shoulder blade, that the muscles that should be holding the scapula where it should are doing so. And beyond that we work on movements of your everyday use, for example: brushing or combing your hair, general needs for at your home or work. Beyond that we begin to look into more specifics within sports and recreation or even competition. Skilled and or detailed movements are complex but can be improved upon through repetition and internal control.
We are able to do more than just adjust here at ChiroMovement Muscle & Joint Clinic. We can utilize techniques such as joint manipulation, Dry Needling, Class IV Laser therapy, Cupping Method and Myofascial Release therapy to treat your shoulder.
From your initial visit to your last, our goals stay the same. We are working towards improving how you move and how you feel by providing you with feeling stronger and being a better human.
We offer a variety of options for your health. Chiropractic, Strength Training and Rehab, Nutrition and Dietetics, and Massage. When working with our team at ChiroMovement Muscle & Joint Clinic we strive to help you feel your best and be at your best.
Citations:
- Panagiotopoulos AC, Crowther IM. Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT J. 2019;5:29. doi: 10.1051/sicotj/2019029. Epub 2019 Aug 20. PMID: 31430250; PMCID: PMC6701878.