I’ve been having trouble with my shoulder for a few weeks and don’t know what’s going on. I have a deep, aching pain around my shoulder blade, and my shoulder blade grinds and pops when I move my shoulder around. What could be causing this and what can I do about it?
Thanks for reaching out! It’s always hard to say for certain what is going on without taking a look at you; but, it sounds like you’re describing what is referred to as scapular dyskinesis or SICK scapula.
The acronym SICK refers to the findings seen in this syndrome:
Remember that the shoulder is a ball and socket joint, with a great deal of range of motion, often at the expense of stability.
The malpositioned scapula produces altered kinematics of both the glenohumeral (shoulder) joint and the acromioclavicular (AC) joint, and the muscles that attach to the scapula. Pictured: the anterior view of the shoulder (view from the front), and posterior view of the shoulder (view from the back).
The patients I have treated with complaints like yours tend to have the hallmark presentation of someone with SICK scapula:
The photo on the left (A and B) shows a person presenting with the right shoulder depressed, meaning it is sitting lower than the left shoulder, which is a common sign of SICK scapula.
Patients with scapular dyskinesis often complain of pain in the front of the shoulder, pain at the top edge of the shoulder blade, a grinding sensation under the shoulder blade with arm movements, and a deep aching sensation under the shoulder blade.
Some patients may also complain of neck pain on the same side. Patients are often tender to touch on the coracoid process, at the insertion of the pectoralis minor, which has become tight due to the anterior tilt and protraction of the scapula.
Treatment for scapular dyskinesis is focused on scapular muscle rehabilitation.
An initial evaluation with a physical therapist will identify alterations in normal scapular positioning and determine if muscles are tight, weak, and/or mistimed in their firing patterns.
Physical therapists will also identify weakness or restrictions in the low back and non-dominant leg, which may contribute to scapular dyskinesis in overhead and throwing athletes.
We will also assess the cervical and thoracic spine.
In the initial stages of rehab, patients need to avoid the activities that induce pain. Leg, back, and trunk flexibility should be normalized and exercises that emphasize kinetic chain activation of the leg, trunk, and scapula will be introduced.
Scapular exercises such as scapular punches and isometric scapular retractions will be part of the program. Progression moves on to closed kinetic chain exercises such as scapular clocks with the hand on the wall, wall push-ups, seated push-ups, and then open chain exercises such as prone T, Y, and I exercises.
Stretches for the pec minor will be included as well as stretches for the posterior capsule of the shoulder. (For more information on this condition and photos of the exercises, see here.)
With proper rehab, this condition can be treated non-surgically to get you back to the activities you enjoy. Physical therapists use a combination of manual techniques to get the joints moving better, exercises to address muscle weakness and firing patterns, and patient education to help you understand the condition.
Adherence to your home exercise program is vital, even once you are no longer in pain, and will decrease the chances of reoccurrence of this issue.
We strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.
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