Your Scapula- Its More than Just a Shoulder Blade
Dysfunction of the scapular complex (shoulder blade) can result in in overuse injuries in the cervical spine, shoulder and elbow, as well as distal injuries that can include dysfunction in the low back, knees and foot/ankle complex.
The scapular complex allows shoulder movement to take place beyond the 120 degrees provided by the glenohumeral (shoulder) joint. It is also essential in providing motion and stability through the 17 muscles that attach to the scapula.
Proper functioning of the scapular complex provides a stable base, allowing for optimal length-tension relationships of muscles and tendons, nervous system coordination of movement and joint motion.
This stability allows for optimal neuromuscular efficiency at the shoulder joint as well as allowing for efficient transfer of force from the lumbo-pelvic-hip complex and lower extremities, which are connected by the latissimus dorsi muscle and influenced by postural changes.
A decrease in neuromuscular efficiency due to kinetic chain imbalances in the scapular region can disrupt muscle balance, nervous system coordination of movement and joint motion.
Dysfunction of the scapular complex and the Upper Crossed Syndrome (UCS)
The classic Upper Crossed Syndrome (UCS) was identified by the late neurologist Vladimir Janda MD.
Specific postural changes seen in UCS include: forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae.
These distortions are commonly brought on by altered length-tension relationships in soft tissues, altered force couple relationships by the nervous system and altered joint motion.
Some causes of the UCS can include: aging, decreased recovery and regeneration following an activity, repetitive movement, lack of core strength, immobilization, cumulative trauma, lack of neuromuscular control and postural stress.
These can initiate the cumulative injury cycle- Tissue trauma, inflammation, muscle spasm, adhesions, altered neuromuscular control and muscle imbalance.
The classic UCS is characterized by tightness of the upper trapezius and levator scapula, which crosses with tightness of the pectoralis major and minor.
The pattern also includes weakness of the deep cervical flexors (longus coli and longus capitis) which crosses with weakness of the middle and lower trapezius. Additionally there can be weak/underactive: Rhomboids, posterior deltoid, teres minor, infraspinatus and serratus anterior.
UCS can cause Injuries to the neck and upper extremities:
Common injuries: Rotator cuff impingement, shoulder instability, biceps tendinitis and thoracic outlet syndrome.
As mentioned, the UCS can cause Injuries below the shoulder:
Because of the connection of the latissimus dorsi between the shoulder girdle and lumbo-pelvic-hip complex, over-activity of this muscle can exacerbate or facilitate an anterior pelvic tilt, resulting in under activity of the gluteus maximus, hamstrings and core stabilizers. This can result in low back pain, and injuries to the hamstrings, knee joint and foot and ankle complex.
1. Identify the classic postural distortions- forward head and rounded shoulder; Anterior pelvic tilt
2. Identify the over an under active muscles through range of motion testing, muscle testing and palpation
3. Identify the joint dysfunction
1. Lengthen over active muscles with trigger point therapy and stretching
2. Strengthen under active muscles with trigger point therapy and strengthening
3. Restore joint motion through joint mobilization
4. Re-educate with corrective exercises and postural education using self-myofascial release, stretching, isolated strengthening and integrated dynamic full body movements
A dysfunctional scapular complex, due to its anatomical connections to cervical, thoracic and lumbar spine as well as both the upper and lower extremities, can result in dysfunctional movement patterns, such as those categorized in the upper and lower crossed syndromes. This in turn can lead to a number of injuries both local and distal to the area of dysfunction.