If you’ve been diagnosed with scapular dyskinesis then the 4 techniques in this article will help you eliminate pain by restoring proper positioning and movement.
Picture this: it’s a dark winter’s morning and once again you’ve woken up with stiffness in your right shoulder. You anticipate it affecting your morning workout, while dreading the pain of lifting your arm to put your sweater on.
But, how can this pain in your shoulder still be there? Whenever you do your pullups and overhead presses, you’re keeping your shoulders pinched back like you’ve always been told to, so it couldn’t be your form…. Or could it?
There have been many times when I’ve overheard both regular peeps AND trainers say to keep your shoulder blades down and back the entire time while doing overhead exercises like pullups and presses.
Unfortunately, doing so will result in shoulder impingement – even more so when using a significant amount of weight or full bodyweight.
And when pain crops up, I can easily imagine the poor person believing it’s because they’re not keeping their shoulders down and back enough!
The thing is, even though the body will naturally fight this position, continuing to grind it out, because that’s what you think you’re supposed to do, will only make things worse.
That’s why it’s important to understand proper scapulohumeral rhythm and to use it whenever possible during upper body exercises.
Scapulohumeral Rhythm and Scapular Dyskinesis
Scapulohumeral rhythm refers to the coordinated movement of the scapula and humerus in movements like:
- Overhead Pushing and Pulling
- Horizontal Pushing and Pulling
The image below shows how the scapula should be positioned when the shoulder is flexed to an overhead position.
Elevating your arms to an overhead position involves:
- Upward rotation and movement of the scapula over the thoracic rib cage
- Movement of the humerus inside the glenoid
Proper scapulohumeral rhythm is important for shoulder movement because it rotates the glenoid (shoulder cavity) so that the head of humerus can be in an ideal position for overhead movements.
Rotating the glenoid also helps the muscles surrounding the glenohumeral (shoulder) joint to coordinate lengthening and contracting for proper shoulder function.
In the case of abnormal scapula movement, commonly known as scapular dyskinesis, scapulohumeral rhythm is disrupted and can cause problems such as discomfort, shoulder pain and impingements as well as being an indication of some kind of shoulder disorder. 
There are 3 types of scapular dyskinesis that will disrupt the scapular movement pattern.
- Type 1 – Inferior Dysfunction
- Type 2 – Medial Dysfunction
- Type 3 – Superior Dysfunction
Type 1 – Inferior Dysfunction
Inferior dysfunction is characterized by prominence in the inferior angle causing the scapula to anteriorly tilt.
This dysfunction can cause pain when the humerus is abducted and externally rotated in the overhead position.
Inferior dysfunction can be a result of weakness in the musculature of the lower trapezius and the serratus anterior along with tightness in the anterior deltoid, pec major and minor muscles.
Type 2 – Medial Dysfunction
Medial dysfunction is characterized by the length of the medial border protruding, commonly known as scapular winging, and becomes more prominent as the arm is extended in front or elevated overhead.
This can often be caused by weakness in the serratus anterior and the lower trapezius, leading to excessive internal rotation of the shoulder.
This type is common for people with instability in the glenohumeral joint.
Type 3 – Superior Dysfunction
Superior dysfunction is characterized by premature activation and shrugging of the shoulder when lifting the arm.
Image by www.healthfix.com.au
This can be caused by a facilitated upper trapezius muscle or one that is relatively too strong compared to the lower trapezius.
People with undiagnosed or long-standing rotator cuff tears and excessive kyphosis (rounding) of the thoracic spine can also exhibit superior dysfunction. 
And another common cause can be related to technical faults in functional movements and exercises, which I alluded to earlier that involves maintaining the scapulae in a retracted and depressed position during overhead movements like presses and pullups.
Doing so decreases the subacromial space leading to problems like impingement and the resulting rotator cuff tendonitis and/or bursitis.
Normal Scapular Movement vs. The SICK Scapula
As mentioned above, scapulohumeral rhythm is needed for proper shoulder movements both horizontally and vertically in the sagittal plane.
For horizontal movements like pushups, when you’re at the top your scapulae should be protracted and while your chest moves to the floor your scapulae should retract in a coordinated fashion with the glenohumeral joint.
For vertical movements like an overhead press, as your arms travel up your scapulae should elevate and upwardly rotate, then reverse the direction as the arms travel back down.
Faults caused by scapular dyskinesis can be responsible for a syndrome with the acronym name SICK.
SICK was originally used to describe pathological scapular conditions in professional baseball players, who we all know are famous for developing shoulder problems.
SICK stands for:
S – Scapula Malposition (Poor Positioning of the Scapula)
I – Inferior Medial Border Prominence (Scapular Winging)
C – Coracoid Pain and Malposition (Anterior Scapular Pain)
K – Kinesis Abnormalities of the Scapula (Abnormal Scapular Movement)
A SICK scapula can be identified when the shoulder is at rest by a perceived drooping of the affected shoulder and protraction (winging) of the medial border.
Everyday Problems Caused by a SICK Scapula
As mentioned above, SICK scapula and scapular dyskinesis can be caused by numerous factors such as tight and inhibited muscles, previous injuries or poor “shoulders down and back” cues from friends and trainers.
Weak and inhibited muscles can cause a number of problems for both athletes and everyday Joes by severely reducing functional strength, range of control and stability in the glenohumeral joint.
Because the shoulder is the most mobile joint in the body, it is also the least stable. Abnormal kinesis combined with poor positioning of the scapula can lead to mobility issues and eventually more serious problems like:
Just because you’re not an elite baseball player doesn’t mean you’re completely safe from these problems.
Muscular imbalances, especially those resulting from rounded shoulders and thoracic kyphosis, seen in office workers and cell phone addicts, can cause scapular protrusion and other symptoms of SICK scapula syndrome.  
So, if you’re getting pain when you reach to grab a book from a high shelf or when you try to put your arm through the sleeve of your sweater, you may be suffering the effects of scapular dyskinesis.
An easy way to find out is to monitor the movement and position of your scapulae as you go into a flexed shoulder position.
It is important that you do this test holding a light weight. This is because, performing it unloaded might not expose the problems in your scapular well enough for them to be identified.
- Stand with your shirt off and position a camera behind you or have a friend watch as you perform this test
- Hold a 5 pound dumbbell in your hands and keeping your arms straight, flex your shoulders (lift them straight up in front of you and then overhead)
- Look for the signs of dyskinesis mentioned above
4 Techniques to Cure the 3 Types of Scapular Dyskinesis
In order to fix your scapular dyskinesis, you’ll need to perform exercises to restore proper mobility, stabilize your scapula, retrain proper movement patterns and strengthen the muscles surrounding the glenohumeral joint.
Below you’ll find the 4 techniques I’ve used to help my clients in the past successfully fix SICK scapula syndrome and promote pain free range of control in the shoulder joint.
Scapular Dyskinesis Technique #1: Overhead Wall Rollout
This is a great exercise for retraining scapulohumeral rhythm and activating the serratus anterior as well as integrating shoulder flexion with core stability.
- Stand leaning against a wall with an ab-wheel in your hands
- Protract your scapulae
- Slowly roll the ab-wheel up the wall and ensure you’re shrugging your shoulders to elevate your scapulae as your arms rise up while keeping tension in your core to avoid lumbar extension
- Roll back down slowly and with control and return to the initial position.
- Breathe naturally throughout the movement
Scapular Dyskinesis Technique #2: Supine Serratus Activator
This activation technique will help reset your scapulae in the correct position, while reactivating the inhibited posterior muscles of your shoulder.
- Lay on your back with legs bent, feet flat and arms by your side
- Bend your elbows so your fingers are pointing up towards the sky with palms facing together
- Drive your elbows into the ground to activate the lats and posterior deltoids without trying to pinch your scapulae together
- Picture your chest opening and the medial border of the scapulae moving up into your body and hold for 5 seconds
- Relax briefly and repeat
Scapular Dyskinesis Technique #3: Horizontal Band Fly
This banded exercise is great for opening up tight pecs and anterior delts while at the same time training the scapulae through protraction and retraction.
- Stand tall with a nice natural posture
- Hold the ends of a strength band in each hand with the length of it passing behind your back
- Keeping your arms straight, open your chest and reach back as if you’re trying to touch the backs of your hands together behind you in line with your shoulders while retracting your scapulae and hold for 3 seconds
- Now sweep your arms around so they’re pointing straight in front of you while protracting your scapulae and hold for 3 seconds then repeat
Scapular Dyskinesis Technique #4: Hovering Pushup
The hovering pushup is a great exercise to train the scapulae in a retracted position, enabling shoulder extension and fixing your rounding shoulders.
- Lie in a prone position
- Place your palms on the ground with thumbs under your armpits or a bit lower
- Raise both your chest and palms off the ground and hold for 10 to 30 seconds keeping your scapulae retracted and hands and fingers extended
By using these techniques to correct scapular movement patterns and build strength and range of control of the shoulder joint can treat your scapular dyskinesis and SICK scapulae and prevent these issues from returning or beginning.