Perspective Article for Scapular Stabilization

[Erik Lineberry]

I came across this article while looking for my monthly review in PTJ this past month. It was interesting to me after our talks on the way we have approached core stabilization and “scapular stabilization” is something I find myself using clinically on a daily basis. I finished reading through it yesterday and thought it brought up greats points to critically assess my use of this thought process and intervention.

The big take home points for me were that evaluation of kinematics is important, but dyskinesia by itself is not necessarily indicative of impairment. It also stated that exercises to target one specific muscle are probably not as effective as functional exercises designed to address limitation of the scapula to respond to perturbations. I think that both of these points line up with some of the things we discussed during the shoulder OMPTS course. This last topic this article brings up that I liked was that we should think about the robustness of the scapulothoracic joint more that how “stable” it is. Robustness was defined as how much of a challenge the scapulothoracic joint can accept without symptom provocation or dysfunction. I though this was a good way to look at thing and calling someones shoulder robust is a good change of verbiage in my opinion.

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[Kyle Feldman]

Good read
Very much an article on opinion and trying to play devils advocate to how people are practicing.
I agree with a lot of what they are saying, but I also disagree in some ways.
He walks about how gait is another thing that is hard to assess objectively and it is based on the eye and “motor control”. I feel that just because the research is poor on it, I don’t think we should bail on it. We are movement experts and it should still be a piece of the clinical practice and intervention. I feel the scapula is the same. It is not everything, but something we should address along with the transfer of load and what they talked about in this paper.

Any more thoughts?

[Erik Lineberry]

He was definitely playing devil’s advocate with the article. I thought it was a great article to start a thought process within myself to begin critically thinking about the interventions I am prescribing for pnt’s with shoulder dysfunctions.

I am with you, we definitely shouldn’t bail on it. As with everything else, we need to make sure that our assessment of the scapula and its movement is individualized to the pnt. The research reviewed in the commentary show that the motion of the scapula is hard to measure and appears to be wildly variable across pnt populations. I have noticed that I have definitely fallen into a trap with some pnts by generalizing findings or assuming that certain limitations are present (winging, dec. upward rot, etc) when they are normal for the pnt.

[Kyle Feldman]

Great points. Its easy to “see” something when you want to see it or someone else tells you they see it too.

Great reflection. I am trying to do the same with other parts of the body too

[Scott Resetar]

Very interesting article that makes me rethink the scapula. It really just reminds me of the growing body of evidence about “posture” and how it’s not as big of a player in dysfunction as previously thought. For example, the article I linked below shows little to no correlation between thoracic spine posture and shoulder pain.

I like the author’s advice to consider a that the scapular muscle work more as a global synergy, therefore strengthening individual muscles may not have the intended effect. The author then suggests giving the scapula more movement options by lengthening tight muscles and the T-spine, and then doing more global retraining on load transfer of the scapular muscles, regardless of scapular position.

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[August Winter]

Thanks for posting the article Erik. A few things stood out to me. The article talks about variability in scapular position and scapular motion and how there is redundancy in the degrees of freedom. I think this certainly is true, but my thoughts are that if multiple combinations of motions or muscle activations are less than optimal, you effectively shorten your list of total combinations. I think for someone doing a repetitive overhead motion a lack of movement variability options might lead to overloading tissues that become pathological. Restoring the total variability of motion is important, and strengthening potentially weak muscles may play a role in that.

Where I run into trouble with some shoulder patients is getting down a rabbit hole of focusing on ST strengthening and motor control when I don’t have overwhelming results when treating other deficits. I think it can be easy to get tunnel vision on these impairments and not focus on retraining functional movements. This article does a nice job summarizing the potential issues with that approach. In my mind, I try to jump to the things that make the biggest impact on pain and function, namely scapular repositioning.

Really liked this quote in reference to our discussion for the achilles last weekend: “Using various levels of resistance, speed, or both can be considered to challenge the robustness of the system to perform tasks.” The highlight on function throughout the article might be the most important thing I took away.

[Erik Lineberry]

I definitely took away some of the same things from this. I too fall down the rabbit hole with some patients and tend to focus too much on impairments in strength/NM control without providing a more effective functional intervention.

I am looking forward to providing more robust interventions for people.

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