Scapular Dyskinesis in Crossfit Athletes
Scapular dyskinesis... a fancy term to say that the shoulder blade isn't moving properly. Poor upward scapula movement and scapular winging are two of the most common scapular dysfunctions. Scapular dyskinesis and shoulder impingement typically occur together but can be separate issues.
What is Scapular Dyskinesis?
When the shoulder moves around, the scapula is meant to follow to create the foundation for the shoulder. By design the scapula is a floating bone on your midback. The only bony attachment to the skeleton is the acromioclavicular joint. Other than that one joint, the scapula is attached by muscles.
The main muscles that control the scapula are the upper trapezius, lower trapezius, and the serratus anterior. Together these muscles upwardly rotate the scapula when the arm moves overhead. When there is an imbalance between these three muscles, it can lead to reduced upward rotation and irritation of the muscles and tendons around the shoulder.
Does Scapular Dyskinesis Mean Pain?
Not necessarily. While it was thought that there was a specific way for the scapula to move, turns out there is quite a bit of normal variations in scapular movement. The way the scapula moves also depends on the load on the shoulder. It will move differently when raising your hand overhead compared to when you are doing a push press. This means that scapular movement is context specific and difficult to attribute directly to pain syndromes.
When is scapular movement the problem?
A physical examination of the shoulder and scapula will help differentiate which is causing the shoulder pain. Different muscle activation and movement strategies will help determine whether it is the upper traps, lower traps, serratus anterior, or a different muscle that can help reduce shoulder pain.
Treating Scapular Dyskinesis in Crossfit Athletes
Scapular dyskinesis is almost always treated conservatively. The physical examination mentioned above helps to direct where the treatment should focus. Sometimes strengthening the upper traps, lower traps, or serratus anterior can help alleviate the shoulder pain. Other times manual therapy (self myofascial release, massage, Graston, etc) to the levator scapula or rhomboids can decrease the pain. Each case of scapular dyskinesis is different which means that treatment will vary even with the same diagnosis.