Shoulder pain can be a very common presenting complaint amongst competitive athletes, the elderly or your sedentary desk-workers alike. This is due to the fact that we use our arms a lot during daily activities. Many of you may be familiar with the terms “Rotator cuff injury” or “Frozen shoulder”. But let’s not forget about the “S.I.C.K. scapula (shoulder-blade)”.
Did you know that the collarbone is the only bone that holds your shoulder to your entire body? This essentially means that the muscles associated with your shoulder will play a huge role in keeping your shoulder both moving and stabilized. Akin to the parts of an engine, the muscles of the shoulder must all work together perfectly. These muscles include the rotator cuff muscles as well as the trapezius, rhomboids, levator scapula, serratus anterior and pectoralis muscles. These muscles all have one thing in common; which is that they are all attached to the shoulder blade, helping to keep the shoulder blade in an optimal position to ensure pain-free movement of the shoulder.
When the scapula is misaligned, the affected shoulder may seem to sit lower than the other. Also, the scapula may look “winged”. Furthermore, the top, front or outer shoulder may be painful to the touch. A common cause of shoulder pain comes from winging of the scapula.
Scapular winging is when the bottom tip and/or the inside border of the shoulder blade “sticks out”, or “wings” away from the rib cage at rest and with arm movements. This is often caused by weak muscles, most frequently the middle and lower trapezius and the serratus anterior.
In direct contrast to weak muscles, there are often tight muscles that try to “peel” the scapula off the rib cage. The main muscle that does this is the Pectoralis Minor. This muscle attaches from your ribs to the coracoid process of the scapula (which is on the top and front of the shoulder, a common point of tenderness). A tight muscle can signify that it is weak and therefore is actually in constant spasm in order to maintain function, and is thus on the verge of injury. Therefore, an important part of your rehabilitation program, like any other rehabilitation program, is stretching. An effective stretch for the pectoralis minor muscle is simply bending your elbows to a 90-degree angle, placing your forearms flat on each side of a doorway and then stepping forward. Once flexibility has been achieved, at least twelve weeks of focused rehabilitation can significantly improve shoulder pain.
Now, back to the S.I.C.K. scapula…it is a pneumonic that is used to help describe the above mentioned group of findings. It stands for scapula malposition, Inferior medial scapular winging, coracoid tenderness, and scapular dyskinesia. So if you are experiencing any of these symptoms, your scapula may just need some love and care. This new approach to looking at shoulder problems is re-shaping the way shoulder rehabilitation is conducted.
Author:
Amanda - Physiotherapist at Back In Motion Point Cook
Amanda and Physios at Back In Motion Point Cook & Back In Motion Werribee conduct regular group rehablitation sessions at Werribee & Point Cook.
References;
Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.
Carbone, S., Postacchini, R., & Gumina, S. (2015). Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy, 23(5), 1473-1480.
Provencher, M. T., Kirby, H., McDonald, L. S., Golijanin, P., Gross, D., Campbell, K. J., ... & Romeo, A. A. (2017). Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain. The American journal of sports medicine, 45(1), 173-178.