Shoulder pain might not be what it seems. Often, the real culprit is scapular dyskinesis, a common yet overlooked condition that leads to impingement, rotator cuff injuries, and other shoulder issues. It's unique because it's usually not painful on its own, yet it can be a primary contributor to almost every other painful shoulder diagnosis Chiropractors encounter. This blog post will dive into scapular dyskinesis, why it matters, and most importantly, we break down how chiropractors identify, treat, and empower patients to restore proper shoulder function.
Beyond the Pain: Identifying the Functional Problem
When a patient comes into our office with shoulder pain, our primary duty is to identify the injured tissue–the orthopedic diagnosis. Tests like Hawkins-Kennedy or Neer's help pinpoint these specific tissue injuries. However, a deeper question remains: What functional problem led to this injury in the first place?
Imagine a "couch to 5K" program. Starting from scratch, ten people might develop different injuries: Achilles tendinopathy, plantar fasciitis, knee pain, hip pain, or back pain. These are the tissue injuries, but the functional problem might be foot hyperpronation or hip abductor weakness. Similarly, Chiropractors frequently see upper crossed syndrome and scapular dyskinesis in the shoulder.
As early as the 1970s, Neer stated that 100% of people with impingement syndrome had scapular dyskinesis, and 95% of those with rotator cuff syndrome had a predisposing impingement syndrome. While the continuum isn't always linear, these issues are interconnected, and addressing scapular dyskinesis is key to long-term solutions.
Our Role as Chiropractors: Prevention and Empowerment
Pain relief is important, but prevention is key. This involves:
-
Simple, Effective Interventions: Small daily adjustments, like scapular retraction and posterior tilt during routine tasks, can have a big impact.
-
Active Patient Participation: Educating patients about posture, habits, and ergonomics ensures lasting results.
-
Measure and Improve: Tracking progress ensures care plans are effective both now and in the future.
Understanding the "Great White Shark": Scapular Dyskinesis
Management and Exercises: Rebalancing the Shoulder
Our approach to managing scapular dyskinesis is multi-faceted, including soft tissue work, scapular mobilization, and targeted exercise. Strengthening the often-weak scapular stabilizers and restoring balanced muscle activity is key. Exercises that are particularly effective include YTWL Scapular Depression, Trapezius Stretch - Sitting, Low Row and Brugger with Band.
Empowering Patients for Lasting Results
Patients often seek quick fixes, but the forces generated by the body far exceed what a brace or passive support can provide. True scapular mechanics come from learning to use the muscles correctly. Chiropractors can clearly communicate the patient’s diagnosis, outline our treatment plan, provide practical advice for daily activities, and share their personalized exercise program. This helps patients connect short-term goals—like reaching a cupboard or playing baseball without pain—to the functional improvements they’re working toward. By empowering patients with knowledge and actionable steps, Chiropractors ensure lasting results and strengthen the patient-provider relationship.
REFERENCES
Dr. Brandon Steele. Understanding Scapular Dyskinesis: The Root of Shoulder Pain. ChiroUp website and blog. September 18, 2025
