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Best Scapular Dyskinesia Treatment in Delhi

Scapular Dyskinesia treatment and cure
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What is Scapular Dyskinesia ?

An alteration or deviation in the normal resting position or dynamic motion of the scapula (shoulder blade) during shoulder and arm movements. It means the shoulder blade is not moving smoothly or in sync with the arm, often leading to shoulder pain or dysfunction. Also known as “SICK scapula syndrome” (Scapular malposition, Inferior medial border prominence, Coracoid pain.

Causes
  • Muscle Weakness/Imbalance:
    • Weakness or fatigue of key scapular stabilizers: Serratus Anterior (responsible for protraction and upward rotation) and Lower Trapezius (responsible for depression and upward rotation).
    • Overactivity or tightness of other muscles: Pectoralis Minor (pulls scapula into anterior tilt/protraction), Levator Scapulae, Upper Trapezius (often overused).
  • Poor Posture: Rounded shoulders (thoracic kyphosis) and forward head posture can alter scapular resting position and movement patterns.
  • Overuse/Repetitive Motions: Common in overhead athletes (e.g., throwing, swimming, tennis, volleyball) or occupations requiring repetitive arm elevation, leading to muscle fatigue and altered mechanics.
  • Shoulder Injuries/Pathologies: Often a consequence or contributing factor to other shoulder problems, such as:
    • Rotator Cuff Injuries (tendinitis, tears)
    • Shoulder Impingement Syndrome
    • Glenohumeral Instability (laxity or dislocations)
    • Labral Tears
    • AC (Acromioclavicular) Joint injuries.
  • Nerve Injuries (Less Common, More Severe): Damage to nerves supplying scapular muscles (e.g., Long Thoracic Nerve leading to severe “winged scapula” if serratus anterior is paralyzed, Spinal Accessory Nerve affecting trapezius).
  • Bony Injuries: Clavicle fracture, scapular fracture that alters mechanics.
  • Joint Stiffness: Tightness in the posterior shoulder capsule can indirectly affect scapular motion.
Symptoms
  • Pain: Often a dull ache around the shoulder blade, top of the shoulder, or neck. Worsens with arm movement, especially overhead.
  • Audible Sounds: Clicking, clunking, or popping sensation around the shoulder blade with movement.
  • Weakness/Fatigue: Perceived or actual weakness in the arm, especially with repetitive or overhead activities. Easy fatiguability.
  • Visible Alteration:
    • “Winging”: The medial (inner) border or inferior angle of the scapula may protrude significantly away from the rib cage, especially when pushing against a wall or raising the arm.
    • Asymmetry: One shoulder blade may appear lower, more prominent, or move differently than the other.
    • Dysrhythmia: Jerky, uncoordinated, or uneven movement of the scapula during arm elevation (loss of smooth scapulohumeral rhythm).
  • Limited Range of Motion: Difficulty raising the arm fully overhead.
  • Compensation: Shrugging of the shoulder to achieve arm elevation.
Advanced Physiotherapy
    • Muscle Strength & Length Testing: Identify specific muscle weaknesses (Serratus Anterior, Lower Trapezius) and tightness (Pectoralis Minor, Levator Scapulae, Upper Trapezius, Posterior Capsule).
    • Postural Analysis: Identify contributing postural deviations (e.g., thoracic kyphosis).
  • Pain & Inflammation Management
    • Manual Therapy: Gentle soft tissue release for tight muscles (Pectoralis minor, rhomboids, upper trapezius) and joint mobilization (thoracic spine, glenohumeral joint) to improve mobility.
  • Scapular Muscle Retraining (Key Focus):
    • Activation Exercises: Initially focus on isolating and activating weak muscles (e.g., Serratus Anterior: Wall slides with protraction, Push-up Plus; Lower Trapezius: Prone “Y” or “T” raises).
    • Neuromuscular Control: Emphasis on quality of movement over quantity. Using mirrors or biofeedback to help patients “feel” the correct scapular motion.
    • Graded Strengthening: Progress from low-load, controlled exercises to higher resistance and more dynamic movements as control improves.
      • Open Chain: E.g., resistance band rows, external rotations, prone “Y”s, “T”s, “W”s.
      • Closed Chain: E.g., wall push-ups, kneeling push-up plus, quadruped exercises.
    • Endurance Training: For sustained scapular control during repetitive tasks.
  • Postural Correction & Thoracic Mobility:
    • Thoracic Extension Mobility: Exercises (e.g., foam roller thoracic extensions) to improve mid-back flexibility, which directly impacts scapular position.
    • Postural Re-education: Education and exercises (e.g., chin tucks, core stabilization) to promote an upright, neutral spine and shoulder girdle alignment.
  • Integrated Functional Rehabilitation:
    • Scapulohumeral Rhythm Training: Exercises that emphasize smooth, coordinated movement between the scapula and humerus during arm elevation.
    • Sport/Occupation-Specific Drills: Gradually reintroducing activities unique to the patient’s sport or job, focusing on optimal movement patterns and preventing recurrence.
    • Plyometrics: For suitable athletes, once stability and strength are restored, to improve power and dynamic control.

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