SICK scapula the prehab guys

Does SICK Scapula Equal Pain?

Scapular dyskinesis (aka SICK scapula syndrome) is an alteration or deviation in the normal resting or active position of the scapula during shoulder movement. This observation of “abnormal” or “erratic” movement is often associated with pain. But does scapular dyskinesis actually cause a painful shoulder? Does SICK scapula equal pain?

 

SICK Scapula: What Is It?

What is a SICK Scapula? The acronym stands for:

S – Scapular Malposition

I – Inferior Border Prominence

C – Coracoid Process Pain

K – Dyskinesis

A recent study in the Journal of Orthopedic and Sports Medicine set to find out if this “SICK” scapula actually leads to pain. They looked at 135 participants, in which approximately half had painful shoulders and the other half had non-painful shoulders. They had two experienced clinicians determine if a shoulder demonstrated scapular dyskinesis or not. And can you guess what they found?

They found that there were NO significant differences in the prevalence of SICK scapula between the group with shoulder pain and the group without shoulder pain.

 

SICK Scapula Does NOT Equal Pain

Does sick scapula equal pain

 

Exercises For Scapular Control

The implication of these findings is that the presence of scapular dyskinesis does not necessarily mean that it will be the cause of your shoulder pain. It also means that the presence of SICK scapula may NOT be a relevant impairment for those with shoulder pain and may actually represent a NORMAL movement variation. But, that doesn’t mean that we just ignore scapular position entirely, it still matters! Below we will share a handful of scapular stabilization exercises that provide a ton of benefits! Below are some exercises to work on to improve scapular control!

Supine Serratus Scoop – Band

Sample Shoulder [P]Rehab Program Exercise Video

  • HOW: Begin by lying on your back with a band wrapped around your back. Cross the band over your chest. With a band in each hand, bring your arms up and overhead as much as you can against the resistance of the band and return to the starting position. 

 

  • FEEL: You should feel your shoulder muscles working. 

 

  • COMPENSATION: Don’t arch your back.

 

Prone Row – Off Table

Sample Shoulder [P]Rehab Program Exercise Video

Lay on your stomach on a bench or table with an arm hanging down at your side. Use your shoulder blade muscles and act like you are pulling weight off of the ground bringing your elbow up to your side, return to the starting position and repeat for the prescribed amount of reps. You should feel your shoulder muscles working, particularly your scapular retractors.  Keep your upper trap relaxed, only use your shoulder blade muscles.

 

Learn More Scapular Stabilization Exercises and Improve Your Shoulder Health!

shoulder program sick scapula the prehab guys

In some instances, poor movement of our shoulder blade may lead to issues at the shoulder joint itself. We have a solution for you to help optimize your shoulder health! The Shoulder [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your shoulder health. This 4-phase program will expose you to various scapula and shoulder strengthening and stabilization exercises supported by science. This program will bulletproof your shoulders for anything life throws at you! Learn more HERE! 

 

Prone Ys

Lay down on the ground with a towel roll under the forehead. Or, lie on the corner of an elevated surface like your bed. Put your hands out in front of you in the shape of a “Y”. With your thumbs up, slowly lift your hands up in the air. Think of pulling your shoulder blades into your opposite back pockets. You should feel the muscles in the back of your shoulder blades working. Don’t shrug with your shoulders to lift your hands up. Your neck muscles will be active, but you shouldn’t feel like you are primarily relying on them to lift your hands up.

 

Push Up Plus

Sample Shoulder [P]Rehab Program Exercise Video

Start in the tall plank position. Drive your hands into the ground and also imaging driving your elbows into the ground. This is your stable base position. Keeping the core and shoulders engaged and strong, slowly let your shoulder blades come together. Then drive your hands into the ground again and separate your shoulder blades. You should feel all the muscles in your shoulder working, especially in the front part of your shoulder and under your shoulder blades. You will also feel your core working. Do not lose your serratus engagement. Keep strong through the shoulder the entire time. Also do not let the elbows bend. This is a push up plus, not a full push up.

READ: Evidence-Based Shoulder Exercises

evidence based shoulder exercises the prehab guys

 

When And When Not Does Shoulder Blade Position Matter With Exercise?

 

Eccentric Shoulder Y

In a standing position, grab a theraband with both hands. With your thumb up, bring one arm up over your head in a diagonal direction (make sure there is no resistance bringing this arm up). The other hand should pull the band down at your side creating resistance for the arm that is up. Then, slowly lower the arm back down in a diagonal direction. You should feel your shoulder muscles working. Don’t bring your up next to your head or up at your side, it should be up overhead in diagonal position.

 

Avoid These Common Mistakes With Shoulder Rehab!

 

Quadruped/Prone Scapular Cueing

This is different than looking at scapular positioning while performing exercises to try and recruit the scapular stabilizers (i.e. serratus anterior). In that sense, scapular position is used as a sign of muscle function/recruitment during exercise, not necessarily as a test to diagnose pain or pathology.

MAIN POINT: Humans are not robots, and we are NOT programmed to all move the same! While we might like to categorize an “optimal” form of movement, it is unrealistic to expect EVERYONE to move the same way when our anatomy is so uniquely individualized! SICK scapula does NOT equal pain!

LISTEN: SHOULDER INSTABILITY WITH DR. MAKHNI 

shoulder instability dr makhni the prehab guys

 

Closing Thoughts

As we have discussed in this article, a SICK scapula may not be the source of your shoulder pain. However, if you are having significant shoulder pain, it is best to have a thorough evaluation from a skilled clinician who can assess your entire clinical picture and decipher what is the underlying cause of your pain. In some instances, the musculature that helps support and stabilize the shoulder blade during movement may be weak and/or under facilitated, leading to potential pain. Performing exercises similar to some of the examples we have shown in this article can help strengthen and promote improvements in facilitation of these muscles that help provide shoulder blade stability, ultimately leading to an improvement in shoulder health!

 

References

  1. Plummer, Hillary A., et al. “Observational Scapular Dyskinesis: Known-Groups Validity in Patients With and Without Shoulder Pain.” Journal of Orthopaedic & Sports Physical Therapy, vol. 47, no. 8, 2017, pp. 530–537., doi:10.2519/jospt.2017.7268.

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

8 Comments
  • matt
    Posted at 10:06h, 25 April Reply

    correct name of journal please

    • Michael Lau
      Posted at 15:28h, 28 April Reply

      Journal of Orthopedic and Sports Physical Therapy

  • mp
    Posted at 11:08h, 25 April Reply

    this also is not news…. Kibler acknowledged this and discussed it in detail in the 2013 consensus document. It is found at the end of article. I suggest you read all of that. You are correct in what you write here but Kibler’s points are much more complete view of the issue.

    • Michael Lau
      Posted at 15:29h, 28 April Reply

      Of course, we are writing for the general pop. Appreciate your comments!

  • Marta
    Posted at 23:29h, 25 January Reply

    I am a physiotherapist from Poland. Your articles are very helpful to me. I like watching and listening to you. GREETINGS! 🙂

    • Sherif Elnaggar
      Posted at 05:10h, 26 January Reply

      Greetings!! Thank you very much for your support, we really appreciate it!! :). Sending our best to Poland!

  • Sarfaraaz Zahid
    Posted at 02:54h, 22 September Reply

    Hi I have on going shoulder impingement associated with a SICK scapula as diagnosed by my shoulder consultant after exam/mri.
    I am yet to come across any rehab programme to try and correct this so I can do my daily activities such as lift weights without restricting myself, also be able to work without pain.
    If you could help me with this I will very much appreciate it! Thanks in advance. Saf

    • Team [P]Rehab
      Posted at 08:19h, 23 September Reply

      Hello Sarfaraaz!

      Sorry to hear about your shoulder issues currently. Thank you for your question as well as taking time to view this article! In regards to a rehab program, our Shoulder Program is evidence-based and strategically designed to enhance the overall function of the shoulders. Many individuals with shoulder impingement have utilized this program with excellent results. Below is the link where you can learn more about the program and get started! Please feel free to email us @theprehabguys.com if you have more specific questions about the program or any other pressing questions, as we are more than happy to assist you in anyway we can. All the best!

      Shoulder Program: https://theprehabguys.com/shoulder-prehab-program/

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