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?

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

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.

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.