is imbalanced strength and flex- ibility between anterior (front) and posterior (back) muscles. Too much emphasis on the development of anterior muscles combined with in- adequate flexibility and insufficient development of posterior muscles can adversely affect control of the scapula during shoulder movements. Shoulder strength training programs need to include exercises for scap- ula stabilizing muscles (trapezius, serratus anterior, rhomboid major, rhomboid, minor, levator scapulae and latissimus dorsi), which main- tain proper scapula position. The rotator cuff muscles (supra- spinatus, infraspinatus, teres minor and subscapularis) should also be included. Weakness of the rota- tor cuff can lead to Glenohumeral Internal Rotation Deficit (GIRD), which can increase susceptibility to a tear of the labrum (i.e., fibro- cartilage ring around glenoid fossa) or rotator cuff.
Basically, an athlete with GIRD
exhibits rounded shoulders, uneven shoulder height, muscle tightness, scapular winging (outward protru- sion of the inner margin), muscle soreness or a “dead arm” sensation. To reduce susceptibility to the many different possible injuries to the shoulder, the SICK scapula needs to be recognized and ad- dressed. Ideally, an athletic train- er or sports medicine physician should assess the strength, flexibil- ity and alignment of overhead ath- letes to identify those who would benefit from specific training. If the front of the shoulder is tight, then the scapula will be pulled forward, thereby compromising proper alignment of the articular surfaces of the shoulder joint. Some athletes become so fo- cused on the muscles that they can see in the mirror, they forget about the muscles in the back, which also need to be strengthened. Having
muscle balance between the front and the back facilitates maintenance of optimal shoulder joint position- ing and movement patterns. To address the needs of an athlete
with a SICK scapula, the first step is to recognize the existence of the problem. The next step is to initiate a proper rehabilitation program. There needs to be a balance of strength and flexibility between the front and the back of the shoulder. In the July/ August Sports Medicine Spotlight, a detailed description of beneficial ex- ercises will be provided.
References 1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain and rehabilitation. J Arthro Relat Surg. 2003;19:641-661.
2. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012:20:364-372.
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