Scapula dysfunction

[HATE]

I've been dealing with shoulder issues for a long time now. I use to think it was weak rotator cuffs but after years of research I now realize that the problem is that I lost the ability to properly upwardly rotate my scapula. I have other posts on here and I probably am coming off like a broken record. And I'll admit it is probably annoying. But I've been learning more on the issue and I wanted to see if anyone else has any input on what I'm gonna post. I have no tears but the problem is when impingement occurs. Because both scapula anteriorly tilt, my supraspinatus gets irritated during almost all movements. I've been to PT a few times and the last time I went the symptoms seemed to go away and I was able to get back to pushups, rows and planks but I could still feel that something was wrong. This summer my shoulder got re-irritated and now I'm back to square one. At PT I was cued to pull my scapula down and back for most movements but I've been looking into this practice and supposedly that's not how the scapula should function. Even the push up plus supposedly isn't that great of an exercise for properly activating the SA. Most of what I have learned has come from the ideas of Eric Cressey and Dr. Evan Osar. I've been using a lot of forearm wall slides but I haven't really noticed any improvement from doing that. I have an assumption that my problem isn't muscle weakness but rather I just cant activate proper movement. Does anyone have any input? Is anyone familiar with Cressey or Osar on how the scapula should function?

 

[Sean1332]

I've been to Cressey Performance and Tony Gentilcore assessed me. He said the same crap. Depressed scapula and anterior tilted shoulders. I still do forearm wall slides and all of the other Cressey mobility drills for my thoracic. Cressey's self-assessment and correction manual is pretty good.

I've incorporated some band traction as per Sterrett and SuperD as well. Weekly Graston treatment and daily MFR helps a lot of it.

I'm still learning about shoulder function as well so I'm subbed for more advice. @ZirRed Rodja @braskiba and a few others should definetly know more.

 

[NattyForLife]

I've been dealing with shoulder issues for a long time now. I use to think it was weak rotator cuffs but after years of research I now realize that the problem is that I lost the ability to properly upwardly rotate my scapula. I have other posts on here and I probably am coming off like a broken record. And I'll admit it is probably annoying. But I've been learning more on the issue and I wanted to see if anyone else has any input on what I'm gonna post. I have no tears but the problem is when impingement occurs. Because both scapula anteriorly tilt, my supraspinatus gets irritated during almost all movements. I've been to PT a few times and the last time I went the symptoms seemed to go away and I was able to get back to pushups, rows and planks but I could still feel that something was wrong. This summer my shoulder got re-irritated and now I'm back to square one. At PT I was cued to pull my scapula down and back for most movements but I've been looking into this practice and supposedly that's not how the scapula should function. Even the push up plus supposedly isn't that great of an exercise for properly activating the SA. Most of what I have learned has come from the ideas of Eric Cressey and Dr. Evan Osar. I've been using a lot of forearm wall slides but I haven't really noticed any improvement from doing that. I have an assumption that my problem isn't muscle weakness but rather I just cant activate proper movement. Does anyone have any input? Is anyone familiar with Cressey or Osar on how the scapula should function?

Most likely have tight pec minor and inhibited serratus anterior. A good SA exercise is lay on a flat bench and punch the wall while holding a db in hand. Keep elbow locked. Bascily just protract your shoulder as much as you can. It can be done on an incline bench also.

 

[NattyForLife]

@kjetil1233 Get in here!

 

[HATE]

Sean, I might look into cresseys self assessment. And how much did you progress with the wall slides? I still cant get my arms overhead.

Natty, My PT pointed out that I had tight pecs and eventually they did loosen up from stretching. I also use a lacrosse ball on my pecs. And the SA dumbbell exercise is something I did in PT. Idk, maybe my pecs got tight again and my SA aren't working either. I was also told that my mid and lower traps are weak. And I do notice that I have a difficult time depressing my scapula. The exercise my PT had me do for my lower traps was awkward and I really couldn't do it o my own because I don't have the proper set up so maybe that is why I'm back to where I started. The exercise was prone on a table with my arms over the edge and I would pull my arms back I a rowing motion while retracting my scapula and then externally rotate my arms while keeping them bent and then straighten them out almost like im doing an overhead press and then do the whole movement in reverse before doing another rep. That was pretty much my lower trap work and I guess my PT got it rom that P90x thing advertised on tv.

 

[Sean1332]

Sean, I might look into cresseys self assessment. And how much did you progress with the wall slides? I still cant get my arms overhead.

It depends on high tight everything is. Tight subscapularis (sp?) and pec minor is the biggest culprit for me.

 

[kjetil1234]

The wall slides are great for teaching the neuromuscular aspect of your dysfunction (activation). For the general population, this Is usually all that's required. HOWEVER when dealing with heavy weights, the stabilizers also need to be strong. Exercises like band scapular protraction, push ups or scapular push ups (with or without bands) are a superb tool.

In practice this means, that if the stabilizer is so weak that it's almost useless (due to properly being inhibited), it will not be able to support your heavy loaded patterns.

Dr Osar is awesome (and his book too), but it's important to remember that he is mainly writing about the general population; which is why he often says it's a motor control issue and not a strength issue. With a strong athlete, some addition isolation work may be necessary on certain stabilizers.

However there's usually more to the story than just scapular dyskinesis (faulty movement). Exactly where is your pain, and what movement exaggerates it?

Scapula back and down is a horrible cue! (Except when you're on a bench press, because it will stabilize the shoulders FOR YOU) Scapula has to be neutral and "locked in", so in order to do that you need to learn both what it means to keep it in neutral and how to lock it in when you're loading the joint.

If you can't get your arms properly over head, I'm guessing that your lats are either way tight, or the scapula is elevating instead of posteriorly tilting and abducting.

 

[HATE]

kjetil, The pain is always at the top of the scapula. It feels like its under the upper trap. So its more than likely from the supraspinatus being irritated. overhead movements will bug it, but overhead pressing always seemed to bother it more than chin-ups. But almost all exercises will bug it now so maybe I picked up more faulty movement patterns along he way. The thing is that the irritation went away when I started PT and that lasted 6 weeks. I couldn't do some of the prescribed exercises at home so I probably regressed. But now even pushups and horizontal rows make it cranky and I think its because I cant posteriorly tilt my scapula like your assuming. Also I will say that im not too sure how to set my scapula neutral. And my lats are probably tight but I dont know how to loosen them up without impinging my shoulder like with the traditional lat stretch where you grab a post then lean way and bend forward because that forces my arms beyond their current range of motion. I even tried while mobilizing the scaps but I don't think Im doing it right. This whole thing is a mess because Im stuck and I dont know where to start now. And I've been looking into a guy named Andreo Spina. Im not sure if you've heard of him but he seems to work more with the athletic community.

 

[kjetil1234]

Levator scapula tightness. It's because the serratus doesn't work. I'll write more in a few hours

 

[kjetil1234]

Ok,

definitely sounds like your thread title is spot on. Scapular dyskinesis! Faulty movementpattern of the scapula.
The pain you're experiencing underneath your trapz, is the levator scapula. The LS, pec minor, rhomboids etc will OVERACTIVATE to CREATE stability, when the serratus anterior isn't firing properly (inability to posteriorly rotate and abduct the scapula)

My suggestion to you, is to improve the isolated strength of your serratus anterior, lower trapz, and work out triggerpoints in your levator scapula. This will be the FIRST PHASE of your rehab. Once these muscles are strong enough to do their job (potential), you may start incorporating proper scapular movement in your rehab program (phase TWO).

Phase three will be to incorporate your newly acquired scapular function into functional exercises; be it rowing, push ups, pull ups, military presses, etc.

Scapular push ups will isolate the serratus anterior. Make sure that your scapula just protracts, don't let it ELEVATE.

Band pull aparts is a great exercise for lower trapz. Make sure that your scapular locks in posteriorly, don't let it elevate and adduct (wait with this exercise if your serratus is too weak)

This may take a while, especially because you have to figure it all out by yourself. I recommend that you stick to exercises where you are able to keep your scapula stable, like bench press (because the bench will in fact stabilize it for you). Bar/ DB rows should also be ok, because the natural scapular position of that exercise is with a somewhat anteriorly tilted scapula.

Bad exercises: Shoulder presses, pull ups, upright rows, basically any exercise that requires a posteriorly tilted scapula for proper execution.

Hope this helps

 

[HATE]

kjetil, This is definitely helpful. I appreciate that you took the time to get these pics and set me up with a rehab program plus thoroughly explain it to me. It looks like I have some work to do now. Thank you

 

[kjetil1234]

kjetil, This is definitely helpful. I appreciate that you took the time to get these pics and set me up with a rehab program plus thoroughly explain it to me. It looks like I have some work to do now. Thank you

Wish you a smooth recovery bro!

 

[Gutterpump]

Sub'd. Good discussion in here