Abnormal movement of the shoulder blade (scapula) is known as scapular dyskinesis. This occurs in a variety of shoulder problems. It is an important sign of an underlying shoulder disorder and requires a rehabilitation program to correct scapular rotations. There are 3 main types of scapular dyskinesis:
- Infero-medial scapula border prominence: a type of scapular dyskinesis that becomes more evident in the cocking position of overhead sports such as pitching/throwing. It is often associated with tightness on the anterior side of the shoulder (in flexibility of the pectoralis major/ minor muscles) and weakness of the lower trapezius and serratus anterior muscles. Posterior tipping of the scapula can result in functional narrowing of the subacromial space during overhead movements, leading to pain in the abduction/externally rotated position. This is often noticed in the early stages of shoulder disorders.
- Medial border prominence: this pattern is winging of the entire medial border of the scapula at rest. It becomes more prominent in the cocking position and after repetitive elevation of the upper extremity. It is caused by fatigue of the scapular stabilizing muscles (traps and rhomboids).
- Supero-medial border prominence: this type of dyskinesis is displayed as a prominence of the superior medial border of the scapula and is often associated with impingement and rotator cuff injury.
For an athlete diagnosed with postural imbalances, strength coaches and personal trainers will often drive home the “Down & Back” cue in order to create scapular depression, retraction, and downward rotation. Baseball players are often quite the opposite though. Typically the last thing a baseball player needs is a down and back cue, due to their overactive lats pulling the scapula down constantly during the overhead throwing motion. Eric Cressey said it best, “these athletes have been cued down and back so much that they need to learn to get up, and sometimes forward.” Baseball pitchers typically have an underactive lower trapezius, serratus anterior, and sometimes upper trapezius.
Eric Cressey does a lot of work with baseball players and specifically pitchers. Eric says that in the overwhelming majority of the baseball athletes he sees (and most extension/rotation sport athletes, in general) live in lordotic postures. The lats are a strong extensor of the spine – but they also attach to the rib cage and scapula on the way to the upper extremity. The end result is that many lordotic athletes wind up with a very “gross” extension pattern shown in the picture below.
Eric Cressey says that in these lordotic athletes the rib cage flairs up, and the lower traps do little to pull the shoulder blades back and down on the rib cage – because the lats have already gotten an athlete to the position he/she wants to be in via lumbar extension. You can see from the picture below that the line of pull of these two muscles is actually very comparable – but given cross sectional area and length, the lat will always have the upper hand, especially if it’s constantly being prioritized in a strength training program due to exercise selection and faulty lifting technique.
Eric Cressey says that these athletes need to learn to move the scapula on their rib cage, as opposed to just moving the entire spine into extension. He also adds that having ultra short/stiff lats can cause issues ranging from extension-based back pain (e.g., spondylolysis) to shoulder pain (e.g., external or internal impingement).
Eric Cressey sees a lot of pitchers with low PAS shoulders and incredibly short/stiff lats on that side, as shown in the photo below of a right handed pitcher. A low shoulder can be caused by a depressed scapula or a depressed clavicle.
Eric says that this depressed PAS shoulder is often secondary to faulty rib positioning and the scapular anterior tilt that ensues. Eric’s trainers have found that overhead shrugging variations on the low shoulder athlete have helped these throwers to not only feel better, but minimize these asymmetries. Effectively, they created more stiffness in the upper traps to help counterbalance the aggressive downward pull of the lats on the scapula and humeral head.
The photos below show both a left handed and right handed pitcher with significant scapular downward rotation and depression on the pitching arm side (PAS). This will often cause the spine to go into an extension based pattern and the athlete’s glute function will decrease. The athlete will attempt to get increased velocity by other means and if the scapula is not functioning properly the body will need to get movement from other places, usually through the lumbar spine, anterior shoulder, and/or medial elbow. None of these movement patterns are optimal and will eventually lead to injuries.