Successfully treating scapular dyskinesis requires a structured, multi-phase approach that moves beyond temporary pain relief. It involves manually restoring tissue length, neurologically retraining the stabilizers, and addressing global kinetic chain faults. This guide outlines the essential hands-on and rehabilitative strategies for manual therapists to achieve lasting stability and function in the shoulder girdle.

This is Part 3 of our Scapular Dyskinesis series

• Scapular Dyskinesis: A Clinical Exploration for Manual Therapists

• Scapular Dyskinesis: Practical Assessment for Manual Therapists

It is important to remember that effective treatment is often collaborative; no single therapist is expected to perform all the manual, activation, and rehabilitative techniques mentioned here.

Phase 1: Release the Overactive Structures

The first priority is to manually lengthen the hypertonic muscles that are pulling the scapula out of its ideal resting position. Releasing these restrictions allows the scapula to sit properly against the rib cage, which is a prerequisite for activation.

• Target the Pectoralis Minor: A short, tight Pec Minor is a common cause of anterior scapular tilt and protraction. Use deep, sustained Myofascial Release (MFR) techniques to release this muscle, allowing the scapula to retract and sit flush against the chest wall.

• Address Elevators and Retractors: Apply targeted techniques to the Levator Scapulae and Upper Trapezius. These muscles often become overactive and excessively elevate the scapula, especially during early arm movement. Releasing their tension allows the lower stabilizers to engage more effectively.

• Thoracic Spine Mobility: Stiffness in the thoracic spine directly limits the scapula's ability to upwardly rotate during arm elevation. Apply Grade III or IV mobilizations to the thoracic segments, focusing on extension and rotation to restore a proper foundation for the shoulder. The principle of treating remote areas is critical for long-term success.

Phase 2: Neurological Activation and Motor Control

Once the mechanical restrictions are released, the focus shifts to waking up the inhibited stabilizing muscles. Without this phase, the dysfunction will quickly return.

• Serratus Anterior (SA) Activation: The SA is the primary protagonist against scapular winging. Use manual pressure and tactile cueing during exercises like wall slides or scapular push-ups (plus-push-ups) to ensure the client feels the contraction. Focus on achieving protraction and upward rotation without excessive Upper Trapezius dominance.

• Lower Trapezius Facilitation: The Lower Trapezius is crucial for depressing and stabilizing the scapula during overhead tasks. Use Muscle Energy Technique (MET) or post-isometric relaxation to help the client neurologically engage this muscle. The goal is to encourage muscle recruitment to hold the scapula in a more retracted and depressed position.

• Proprioceptive Taping: Applying kinesiology tape can provide sensory feedback to the skin over the target muscles (e.g., Lower Trapezius), acting as a continuous cue to the nervous system to maintain the correct posture and control during movement.

Phase 3: Global Integration and Kinetic Chain Refinement

The final stage integrates the newly acquired stability into functional, complex movements to build resilience.

• Integrated Exercises: Progress from isolated muscle activation to integrated movements that challenge the entire kinetic chain. Exercises should mimic real-life tasks or sport-specific movements. For strategies on integrating movement into the recovery process, refer to our guide on The Remedial Therapist's Guide to Injury Rehabilitation.

• Postural Education: Provide specific, actionable advice on ergonomics and daily habits that perpetuate the dysfunction (e.g., phone use, sitting posture). Addressing the source of the chronic tension is paramount.

• Communication: Clearly explain the "why" behind the exercises. Understanding the kinetic chain and the purpose of the stabilizing muscles empowers the client and improves compliance. Understanding the interconnected nature of the body drives the success of this phase. You can learn more about this connection in our article on The Kinetic Chain: Enhancing Performance & Preventing Injury.