Scapular dyskinesis (SD) describes the altered position or abnormal movement of the shoulder blade during arm motion. This disruption in the shoulder’s natural rhythm compromises the foundation for upper extremity function and is frequently associated with shoulder pain and injury. SD is highly prevalent, affecting individuals with chronic shoulder issues and those involved in repetitive overhead activities. Addressing SD requires a structured approach that first restores flexibility to tight muscles and then strengthens the key stabilizers that control the shoulder blade’s motion.
Recognizing Scapular Dyskinesis
SD is visually classified by the pattern of altered motion or static positioning of the shoulder blade relative to the rib cage. Type I dyskinesis is characterized by the noticeable prominence or “winging” of the scapula’s inferior angle. Type II involves the prominence of the entire medial border of the scapula, indicating a lack of control.
This mechanical dysfunction stems from a muscular imbalance around the shoulder girdle, where some muscles become overactive or shortened while others become weak. The muscles most commonly tight are the pectoralis minor and major, which pull the scapula forward into a protracted and anteriorly tilted position. Conversely, the primary muscles implicated in weakness are the serratus anterior and the lower trapezius, which stabilize the scapula against the rib cage and control its upward rotation.
Strategies for Restoring Mobility
The first phase involves releasing tension in the anterior chest and neck muscles that pull the shoulder blade out of its optimal position. The pectoralis minor, which attaches to the front of the scapula, is a primary target for lengthening to allow the shoulder to retract naturally. The Doorway Pectoralis Stretch is performed by standing in a doorway with forearms resting against the frame, elbows bent at 90 degrees and aligned with the shoulder.
To perform the stretch, slowly step one foot forward, leaning the chest gently through the doorway until a comfortable stretch is felt across the front of the chest and shoulder. Hold this stretch for 20 to 30 seconds and repeat for three to five repetitions daily to encourage soft tissue change.
Tension in the upper trapezius and levator scapulae muscles, which often elevate the shoulder blade, must be addressed to restore proper scapular resting position. To isolate the upper trapezius, sit upright and anchor the shoulder by sitting on the hand of the side being stretched. Gently bring the opposite ear toward the shoulder, then add a slight rotation of the head toward the shoulder being stretched.
The levator scapulae requires a different head position for an effective release. Turn the head away from the side being stretched, then tuck the chin toward the chest. Hold both the upper trapezius and levator scapulae stretches for 30 seconds for three repetitions on each side to maximize the release of chronic tension.
Essential Scapular Stabilization Drills
Once mobility is restored, the next step is to strengthen the weak stabilizing muscles, primarily the serratus anterior and the lower trapezius. The serratus anterior is responsible for protracting the scapula and holding it flush against the rib cage, preventing medial border winging. The Scapular Push-Up Plus is the most effective exercise to target this muscle.
Start in a push-up position, keeping the elbows straight. The exercise focuses solely on shoulder blade movement: first, allow the chest to drop by squeezing the shoulder blades together (retraction). Then, actively push the body away by spreading the shoulder blades apart (protraction). This final pushing action, the “plus,” is the concentrated contraction of the serratus anterior; perform three sets of 10 to 15 slow and controlled repetitions.
The lower trapezius works to depress and retract the scapula, which is necessary for controlled overhead movement and maintaining upright posture. Prone exercises are effective for isolating the lower trapezius while minimizing upper trapezius compensation.
Begin with the Prone T exercise: lie face down with the forehead supported, and lift the arms straight out to the sides, forming a “T” shape. Focus on squeezing the shoulder blades together and down without shrugging the shoulders. The Prone Y exercise involves lifting the arms at a 45-degree angle, and the Prone W uses bent elbows tucked toward the sides.
All three variations should be performed with slow, deliberate movement, holding the contracted position for two to three seconds before slowly lowering the arms. Aim for two to three sets of 10 to 12 repetitions for each variation, ensuring the movement is initiated by the shoulder blades and not just the arms.
Integrating Correct Movement Patterns
The final stage moves beyond isolated muscle drills to integrate newfound strength and awareness into functional activities. This phase focuses on motor control, teaching the nervous system how to use the stabilized scapula automatically during complex tasks. Practice mindful posture correction throughout the day, maintaining a neutral spinal alignment with the shoulder blades gently depressed and retracted.
Incorporate the awareness of scapular control into functional activities, such as lifting objects or reaching overhead, by ensuring the shoulder blade moves smoothly before the arm initiates a major movement. When moving the arms, the shoulder blade should protract smoothly when reaching across the body, and upwardly rotate without excessive winging when lifting overhead.
While self-management with these exercises is effective, professional guidance is necessary if pain increases or if the abnormal movement pattern remains persistent. Consulting a physical therapist is advisable. A therapist can provide a formal diagnosis, employ manual therapy techniques to release soft tissue restrictions, and offer advanced, tailored programming that incorporates core and hip strength for stability.