Tabassum Ali, DC, CCSP, CCCN
Shoulder pain can be attributed to a variety of conditions; one that is overlooked is SICK scapula.
Inferior medial border prominence
Coracoid pain and malposition
dysKinesis of scapular motion
Anatomically the scapula, commonly known as the shoulder blade, is found on the posterior side of the rib cage and the only osseous structure it is attached to is the clavicle, the collar bone, at the acromioclavicular joint. On the most lateral part of the scapula there is a socket that allows the humerus to sit in and creates the glenohumeral joint, shoulder joint. The rotator cuff muscles and a few other muscles are the associated soft tissue involved with stabilization and motion of the shoulder. The shoulder muscles include: supraspinatus (predominate shoulder stabilizer and adductor), infraspinatus (external rotation), teres minor (external rotation), and subscapularis (abduction), trapezius (retraction, elevation, and depression), rhomboids (scapula retraction), levator scapula (elevation of scapula), serratus anterior (protraction and scapula stabilization), and pectoralis major (adduction of humerus).
The scapula and the rotator cuff muscles are what make the shoulder a functional joint- they must all work in conjunction biomechanically. Patients who have difficulty moving their shoulder through range of motion or have pain upon motion can possibly have a restricted shoulder joint, but the main cause is due to poor biomechanics from a previous overuse injury and fatiguing of the soft tissue. Although the supraspinatus is the first muscle susceptible to a strain within the shoulder and can be painful, a disorganization in motion of the serratus anterior, trapezius, and levator scapula can also be painful and restrictive in motion. Once the scapula is malpositioned, the pectoralis major becomes shortened and tight in efforts of preventing dysfunctional movement. Shoulder strains are usually caused by intense, repetitive movements applying too much pressure to the muscles and joints. Softball, baseball, swimming, and tennis are all sports with repetitive overhead motions of the arm and can lead to injury. Symptoms of a SICK scapula:
Pain ranging from slight to severe
Dropped shoulder on affected side
When observing the shoulder for motion, the patient may experience pain through the ranges of motion, which is a good indicator of a SICK scapula and there is some sort of restriction in the soft tissue or in the joint. To fully diagnose dyskinesis of a SICK scapula a functional assessment should be conducted. If trauma was indicated, imaging should also be considered in diagnosis to rule out any osseous fracture, joint degeneration, impingement from an osseous structure, or arthritis in the joint. If a strain is concluded another source of imaging would be a musculoskeletal ultrasound to further evaluate the scar tissue in the muscles preventing full range of motion in addition to pain upon exertion. Possible treatments for a SICK scapula:
Active Release Technique
Eccentric rehabilitative exercises
RICE (rest, ice, compress, elevate)
Surgery based on the severity of the tear to reattach the muscle
Non-Steroidal Anti-Inflammatory medications
Addressing the scar tissue and rehabilitation of a SICK scapula is very important. Skipping out on stretching can lead to further advanced conditions. A misconception that many athletes have is, a tight muscle indicates a strong muscle- this is incorrect! Although a tight muscle can be strong, it is more common that the muscle is weak and spasming in hopes of remaining stable, but probably on the verge of an injury. Warm up of the shoulder muscles is important before beginning any strengthening protocol and can be done with stretching. An example of a shoulder pectoralis major stretch would be placing the forearm flat on a wall or doorway with elbow bent and stepping forward, inducing a stretch on the pectoralis major. Eccentric exercises to strengthen the muscles associated with a SICK scapula and stimulate healing within the first 6 weeks of injury will produce the best prognosis. Approximately 8-12 weeks of treatment will be needed, depending on the severity of the injury, to decrease the pain and strengthen the muscles.
At Lone Star Sport & Spine, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. We examine the patient and determine the most efficient and quickest treatment plan for them. Our goal is not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance. We address the scar tissue that is built up from micro tears in the tissue due to overuse or previous injuries and develop a program to strengthen and train the muscles to be used functionally. Most all of our patients find results within a few treatments with decreased pain, and increased range of motion, strength, and balance. We then move into the second phase of treatment with strength and conditioning which is the most important aspect of the treatment, to prevent future injuries.
In summary, to address a SICK scapula:
Address the scar tissue in primary involved muscle, and any
Warm up and stretch the shoulder muscles
Strengthen and condition the scapula to prevent future injury (sport specific functional training)
Check our website for more information and to book an appointment today at www.lonestarsportandspine.com
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