Have you been told you have scapular dyskinesis or “SICK” scapular syndrome?

Scapular dyskinesis is an altered position or movement of the scapula (shoulder blade). Another term for this is called “SICK” scapular syndrome. “SICK” scapula is an acronym that stands for scapular malposition, inferior medial border prominence, coracoid pain, and scapular dyskinesis (or abnormal scapular movement). The scapula plays an important role in shoulder function and our ability to reach overhead. The scapula sits on top of the rib cage, and its position is controlled mainly by muscles. Our shoulder and rotator cuff muscles also attach to the scapula. For normal overhead motion, our glenohumeral (shoulder) joint and scapula both need to move appropriately. It’s thought that a malpositioned scapula will alter kinematics of the glenohumeral (shoulder) joint and cause shoulder pain. However, asymmetrical scapular motion is common, and does not always guarantee pain.

A recent study in the Journal of Orthopaedic and Sports Physical Therapy compared the presence of scapular dyskinesis in individuals with shoulder pain and individuals without. The study found no statistically significant difference in prevalence of scapular dyskinesis in individuals with shoulder pain compared to individuals without shoulder pain. They found 60-70% of symptomatic (painful) and asymptomatic (pain-free) populations had scapular dyskinesis¹. This means scapular dyskinesis may be a normal movement variability. The presence of scapular dyskinesis does not guarantee you will have shoulder problems or pain. A physical therapist can help assess your shoulder and scapula to determine what is causing your shoulder pain and show you how to fix it.

If your scapular positioning or function is contributing to shoulder dysfunction (for example, having pain or difficulty reaching overhead), rehabilitation can help by retraining the scapular muscles. Typically, rehabilitation is focused on stretching or lengthening tighter muscles that may poorly influence scapular positioning (ex: pectoralis minor) and strengthening of the muscles that help our scapula move properly for overhead motion (ex: trapezius and serratus anterior). A physical therapist may also perform manual therapy (hands-on) techniques to improve the length of the pectoralis muscles and mobility of the shoulder and shoulder blade.

Here are some examples of exercises that may help your scapula move better. You can check out our YouTube channel for video demonstrations!

1. Pectoralis Minor Stretching (in a doorway or supine on a foam roll)
2. Serratus Anterior Strengthening (Quadruped Serratus Rock-backs)
3. Mid and Low Trapezius Strengthening (Prone T’s and Y’s)

If you have questions about your shoulder pain, don’t hesitate to call and talk with a physical therapist today!

Sources:

1. Observational Scapular Dyskinesis: Known-Groups Validity in Patients with and Without Shoulder Pain (Plummer et al, 2017).
2. The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation (Burkhart et al, 2003).

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By Jacqueline Dagostino, PT, DPT, Cert. VRS