Scapular Dyskinesia

Phase 1: Acute Phase (Week 1-2)

Goals: Reduce pain, improve posture, and initiate gentle activation of scapular stabilizers.

1. Pain Management:
   • Rest/Activity Modification: Avoid aggravating movements, particularly overhead activities, pushing/pulling, or lifting.
   • Heat/Ice: Use ice for 10-15 minutes if inflammation or swelling is present, or heat for 15-20 minutes to reduce muscle tightness.
2. Posture Correction:
   • Postural Awareness Training: Maintain neutral spine alignment, focusing on proper shoulder blade positioning. Use a mirror to ensure correct posture during activities.
   • Chin Tucks:
     • How to perform: Sit or stand, gently tuck the chin without flexing the neck forward.
     • Reps: 10-15 repetitions, 3-4 times/day.
3. Scapular Retractions:
   • How to perform: Gently squeeze the shoulder blades together without shrugging. Hold for 3-5 seconds.
   • Reps: 10-15 repetitions, 3-4 times/day.
4. Gentle Range of Motion (ROM) Exercises:
   • Pendulum Swings:
     • How to perform: Lean forward and let the arm hang down, gently swing the arm in small circles or side-to-side.
     • Duration: 1-2 minutes, 2-3 times/day.
   • Wall Walks:
     • How to perform: Gently slide your hand up a wall, stopping if pain or discomfort increases.
     • Reps: 10-12 repetitions, 2 times/day.

Phase 2: Subacute Phase (Week 3-6)

Goals: Increase range of motion, activate key muscles (serratus anterior, lower trapezius), and strengthen scapular stabilizers.

1. Scapular Control and Stability:
   • Scapular Clock:
     • How to perform: Visualize a clock on the scapula, and perform gentle motions mimicking the hour positions (12, 3, 6, 9).
     • Reps: 2 sets of 10-15 repetitions.
2. Serratus Anterior Activation:
   • Wall Slides with Serratus Punch:
     • How to perform: Stand with your forearms against the wall, slide them upward while pushing through your shoulder blades (protraction).
     • Reps: 10-15 repetitions, 2 sets.
3. Strengthening the Lower Trapezius:
   • Prone Y’s:
     • How to perform: Lie face down with arms extended in a "Y" position. Raise arms slightly off the ground while squeezing the shoulder blades downward.
     • Reps: 10-12 repetitions, 2 sets.
4. Resisted Scapular Retractions:
   • How to perform: Using a resistance band, pull back with both arms while squeezing the shoulder blades together.
   • Reps: 2 sets of 12-15 repetitions.
5. Stretching:
   • Pectoralis Minor Stretch:
     • How to perform: Stand in a doorway, place your arm at a 90-degree angle, and gently lean forward to stretch the front of the shoulder.
     • Hold: 20-30 seconds, 3-5 repetitions.

Phase 3: Strengthening and Coordination Phase (Week 6-10)

Goals: Improve strength, coordination, and endurance of the scapular stabilizers.

1. Progress Scapular Stability Exercises:
   • Dynamic Hug:
     • How to perform: With a resistance band around your back and held in both hands, push your arms forward in a hugging motion while engaging the serratus anterior.
     • Reps: 2-3 sets of 10-15 repetitions.
2. Closed Kinetic Chain (CKC) Exercises:
   • Push-up Plus:
     • How to perform: Perform a standard push-up, but at the top of the movement, push further to fully protract the shoulder blades (serratus anterior activation).
     • Reps: 2 sets of 8-10 repetitions.
   • Scapular Wall Push-ups:
     • How to perform: Stand facing a wall with your hands at shoulder height, perform a push-up by focusing on moving the shoulder blades as you push away from the wall.
     • Reps: 2 sets of 12-15 repetitions.
3. Advanced Strengthening:
   • External Rotation with Resistance Band:
     • How to perform: Attach a resistance band to a stable object at elbow height, keep your elbow close to your side, and rotate your arm outward.
     • Reps: 2 sets of 10-15 repetitions per side.
4. Scapular Depression Exercises:
   • Lat Pull-downs (using a band):
     • How to perform: Perform a pull-down motion using a resistance band, focusing on pulling your shoulder blades down toward your back pockets.
     • Reps: 2-3 sets of 10-12 repetitions.

Phase 4: Return to Full Activity (Week 10-12 and Beyond)

Goals: Restore functional movement patterns, prevent recurrence, and optimize scapular strength and mobility.

1. Functional Strength Training:
   • Overhead Activities: Progress into overhead movements, ensuring proper scapular mechanics during each motion (e.g., shoulder presses or overhead reaches).
   • Reps: 2-3 sets of 8-10 repetitions.
2. Sport/Occupation-Specific Exercises:
   • Tailor activities based on specific functional needs (e.g., overhead athletes, manual laborers, etc.).
3. Maintenance Exercises:
   • Continue scapular stability exercises 2-3 times per week to prevent recurrence and ensure proper movement patterns.
4. Core Strengthening:
   • Incorporate core stability exercises such as planks and side planks to improve overall body mechanics and reduce compensatory movements.

Important Considerations:

• Avoid Compensatory Movements: Ensure proper shoulder mechanics during all exercises. Watch for compensations like excessive upper trapezius activation or shoulder shrugging.
• Progress Gradually: Begin with lower resistance and range of motion, increasing intensity and complexity as tolerated.
• Monitor Pain: If pain increases during exercise, reduce intensity or pause the activity.

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