As I begin another round of PT next week with a new group, this time with a different diagnoses, I wonder if any of the ST-PT’s could comment on their experiences? My shoulder has actually felt really good and I’ve been swimming a ton, but having been told my scapular motion is horribly ‘dyskinetic’ I want to get that fixed. Apparently with the old injury I learned to compensate with other muscles…so let’s get it fixed I said! First PT’s got me on a track to strengthen all my shoulder girdle muscles which were horribly weak. Lot’s of soft tissue work an 95% of the discomfort gone, back to swimming. Funny how my body just learned to make do even with this scapular dyskinesia?sp
More or less what I’m looking for is something to compare to what these PT’s prescribe. Good exercises? Ones to avoid? FWIW my MRI showed nothing remarkable other than pretty healthy case of bursitis.
I’m not a PT but will respond anyway.
The strengthening exercises you need depend upon what scapular muscles are weak and what muscles are tight. The two most likely areas of weakness are winging of the medial border of the scapula or the inferior-medial tip of the scapula. You can see where the weakness is by pushing against a wall with both hands while someone observes for scapula winging or videotapes from behind. More severe weakness will be evident if you have scapula winging from simply raising your arms to overhead position.
Your PT will choose exercises depending upon the severity of the weakness, advancing from isometric to closed kinetic chain to open kinetic chain exercises. You may also have been prescribed exercises to resolve capsular tightness or thoracic or lumbar spine tightness.
I would ask the PT what each exercise is intended for so you will know why you should do it. This condition is common in swimmers, its often asymptomatic though. Maybe your PT will also look at your swim technique and help you avoid further problems.
Ok thanks man. Ordinarily I just defer to the ‘pros’, but the longer I deal with MD’s, PT’s…the more I realize you inspect what you expect. As in they all have the same letters behind their name whether they were first of dead last in their graduating class:/
both will help to keep your scapula from “jumping”. Do them slow and controlled, trying to allow both scapula’s to rotate/move symmetrically and smoothly.
One thing that stuck out to me is it sounds like you are currently asymptomatic. If this is true I am curious as to why you are pursuing more therapy. Don’t get me wrong, as a PT, I LOVE a motivated patient. BUT as someone who has struggled with shoulder complaints my whole life (and am currently recovering from my third reconstruction) my shoulders don’t necessarily move in the most perfect way, but as long as they are function and pain free I dont think about it. Does that make sense?
Having said all that: my personal bias for people who are fundamentally strong are to do lots of weight bearing exercises: 360 planks, transitions from down dog - lowering to low push-up - push to cobra, plank position ‘step-up’s’/step overs onto variable height step. Think of strengthening your shoulder to tolerate cycling (weight bearing) as much as swimming. For external rotation strength - sidelying external rotation has tested as the highest muscle activity, the other great rotator cuff exercise is the empty can. I also second wall angles, wall slides, mid-trap isometrics.
Can you post the exercises that your PT prescribed?
If you want one to avoid then avoid the empty can motion that is often recommended as a rotator cuff strengthener, it will cause impingement. And you don’t need rotator cuff strengthening, you need scapular stability.
