Scapular Pain

Bigger Stronger Leaner Competitive Bodybuilding
21

Okay, this is going to seem like a mouthfull, so I’m going to bullet-point it for ease of typing and interpretation…

-Pain along the medial border of the scapula is VERY common.

-The location of the pain is rarely the origin of the pain. Usually, it’s referred from another area.

-The most common “other area” is the cervical spine (more on this below). It may also be related to inflammation/injury in the shoulder (probably the case here - examples include rotator cuff strains, tears, tendonosis, or even transverse humeral ligament rupture), and even gallstones.

-There’s no obvious anatomical link between the cervical spine and the location of the pain along the scapula, as odd as it may seem. Nonethless, clinical observations have allowed practitioners to theorize about the possibility of two syndromes: Splenius Cervicis Syndrome (medial scapular border pain) and Levator Scapulae Syndrome (superior border, a bit more laterally).

-These terms were coined because of apparent neural distribution patterns and the fact that these two muscles seem to “send” pain to their inferior attachment points.

-Had to research this one…it was Cloward in 1960 who verified that stimulation of different parts of the disc led to different referral patterns. Contrast injections to the posterior aspect of the annulus led to referral to LSS, while anterior injections caused SCS (medial border pain).

-On a related note, this is one reason why periscapular pain is a common consequence of inproper cervical adjustments by a chiro.

-Anyway, specific to your client, the pain is likely located at the T4-T5 junction, and it likely kicks in when she’s been sitting for a prolonger period of time or exercising with poor posture. Cervical rotation or lateral flexion to the same side as the problem may be painful.

-My recommendation is to make sure that she’s super-aware of her posture from now on. Encourage her to move around often; the best posture is one that is constantly changing.

-Have her get to a chiro to check for cervical subluxation just as a precaution.

-Continue to address the obvious issues that she has with shoulder imbalances and scapular dyskinesis.

22

Hi Eric,

You may be right on with your diagnosis, especially in my case. I had a herniated C5/C6 in 1991. It required a fusion and laminectomy. I was under the care of a moron for an Orthopedist after my injury and he thought I was malingering. He refused to request an MRI. He and I battled for about 5 months over my treatment. The loser only wanted to get me hooked on pain killers and muscle relaxers. I refused to take them.

Long story short… This was a worker’s comp case and when my employer got the report back from this quack they immediately called me in for an exam by their Ortho. Well guess what? My employer’s doc found serious neuro deficit’s on my left side and ordered an MRI. The MRI showed the herniation and massive extrusion of disc matter.

I was referred to a Neuro Surgeon and was scheduled in less than a week from the MRI for the surgery.

Unfortunately because of the delay from dinking around with the dumb-ass Ortho the disc had compressed the ganglion nerve root for so long that I have a permanent neuro deficit of about 25% on my left side.

It all makes sense now. Thanks Eric so much for your input.

23

Thanks again for the input! The learn, do, teach format is absolutely invaluable.

Eric and others interested, I had her do chest supported rev flyes with very light weight (2-1/2 lbs) and band pulls in a similar fashion. I had her give a squeeze at the top, making sure the traps and rhomboids were pulling the scapula in its full ROM. We both felt some small “clicks” along that medial border of the scapula, as Eric described. The clicks were most notable as she approached the contracted (top) position of the movement. If this were referred pain, why would we both feel a “click”? While I will print off and keep your responses in file for future reference, upon this exam, I feel the issue is not disc related (unless you still feel it is Eric, please advise).

As to the prognosis, although I really don’t know the diagnosis in full, is for her to stop bench pressing and even heavy lat pulls. Could bent over lat rows be contributing to this pain?? I would think not since they are the antagonist to bench pressing. Anyway, I don’t have a pec-deck nor cables such that she could work the pec without pressing and/or laying down. Therefore, I am thinking of eventually working in push-ups from the knees (to keep them light) and to allow the scapula to move without the restriction of the bench. Any thoughts on technique/hand position? I’m thinking a narrow hand placement, elbows pulled in tight, might be superior to a wider grip.

As to the over-head pressing, she just noticed some clicking in the shoulder joint. Based on the shoulder training info I have read as of late, I have come to the notion the over-head pressing may be in the normal ROM for the shoulder, yet not all trainees are suited to perform such. Moving the elbows anterior, avoiding some external rotation of the joint, seemed to be a safer technique. Also, more of a priority is rotator cuff work. I have my clients warm-up with the Cuban press and other movements, but I shall put more emphasis on the rotators specifically. Any routines from personal experience that you could share? (yes, I will also be studying related articles in the archives).

Again, very much appreciate the input - its greatly helping both me and my clients!

TopSirloin

24

Still awaiting any input from my last post when any of you get the chance - thanks.

An interesting developement - I just found out that the client experienced this pain/injury BEFORE our training sessions! She forgot to tell me a massage therapist found it in the same spot. Looks like my clientel injury rate is still nill, I just hope I can help heal her and/or get her into an ART specialist.

TS

25

After adminstering the light rev flyes with a squeeze, band stretch and pulls, shoulder raises from different positions, stretching and laying off bench pressing and heavy pulls, my client has observed no symptoms as of late. Thanks for the suggestions! I also had her do push-ups, allowing the scapula to move more freely. Those seemed to go well and I will incorporate those more often into my routines.

TS