The problem may not be the rotator cuff, you may have a S.I.C.K. scapula!

Here’s what to look for:

  • Are you an Overhead Athlete? (Swimming, Tennis, Weightlifting etc)
  • Do you have heaviness in your arm when doing overhead activities?
  • Have you ever experienced dead arm or sensations travelling down the arm?
  • Do you suffer from Shoulder Impingement or Rotator Cuff injury?
  • Do you have a desk job and suffer from sore shoulders when exercising?


If yes to any of these questions, you may have a S.I.C.K. Scapula.scapular-winging

Also, if you are diagnosed with a rotator cuff injury that is not getting better, despite the rotator cuff exercises you are doing, it maybe your scapula that is the problem.


S.I.C.K. Scapula:

S: Scapular malposition on the rib cage
I: Inferior medial border winging from weak middle and lower trapezius muscles
C: Coracoid pain and malposition from the attachment of a tight Pectoralis minor muscle pulling on the coracoid
K: Scapular dyskinesis from alterations in muscle recruitment patterns

Many of the above findings are also present in recreational athletes, office workers and those working with computers. The typical posture when sitting at your desk is the head tilted forward and down, shoulders rolled forward and arms stretched out in front of you.

This posture causes tightening of the pectoralis muscles in the chest, the shoulders are pulled and rolled forward. The lower trapezius muscle are weakened due to the lack of use and being under constant stretch from the rounded shoulders.

As a result of these tight and weak muscles, the shoulder blades do not sit properly on the rib cage, thus there will be poor movement patterns of your shoulders, when you move your arms.

Now you can see why it is not only athletes that can suffer from this type of condition. A SICK scapula will result in Scapular Dyskinesis, which is an alteration in the normal position or motion of the scapula during shoulder movements. It occurs in a large number of shoulder injuries and appears to be a nonspecific response to shoulder dysfunction.


How to treat a SICK Scapula?

If you have been doing rotator cuff strengthening exercises with rubber tubing and you stillScapula Movement Pattern have shoulder pain, you may need to address the muscles that help hold that shoulder blade on your ribcage.

The trapezius, rhomboid and serratus anterior muscles must be properly synchronised to ensure smooth scapular motion during arm movement. Without a strong base of support to work from, the rotator cuff will not be able to fully recover. The shoulder and arm can only get as strong as the muscles that hold the shoulder blade onto your body.

The best treatment for this condition is physical therapy that incorporates soft tissue techniques, dry needling and rehabilitation that includes corrective exercises.

Some sample exercises that help focus strengthening the muscles around the scapula are what are called Y’s T’s W’s.

Y’s T’s W’s Exercises: 

While strengthening these muscles it is important to stretch the tight muscles; posterior shoulder capsule and Pectoral muscles.

If you want to learn more about this issue or want to book an assessment and treatment, please contact  Range of Motion Physical Therapy, Lucan Co Dublin.