Mid & Upper Back

What It Is

The scapula is the large triangular-shaped bone at the back of the shoulder, commonly known as the shoulder blade. Its only bony attachment to the rest of the body is through the collarbone (Roche et al., 2015). The bone is held in place mainly by the surrounding muscles, many of which attach to it, and these muscles enable most of the movement of the shoulder.

At the outer part of the scapula, a shallow socket forms where the head of the upper arm bone sits, making the shoulder joint. Proper movement and positioning of the scapula is important for normal movement of the shoulder.

SICK is an abbreviation for Scapular malposition (the shoulder blade sits in the wrong position), Inferior medial border prominence (the lower inner edge of the shoulder blade sticks out), Coracoid pain and malposition (pain at the front of the shoulder), and dysKinesis (abnormal movement of the shoulder blade) (Arvesen et al., 2026). Overuse, poor movement technique and problems in the "kinetic chain" (the way the legs, trunk and arm work together) increase the risk (Arvesen et al., 2026).

A SICK scapula occurs when the normal motion or position of the shoulder blade is altered. Many of these problems involve changes in how the stabilising muscles are switched on (Roche et al., 2015). The serratus anterior, rhomboids and trapezius need to work together properly so that the shoulder blade moves smoothly when the arm moves (Roche et al., 2015).

In overhead athletes, such as throwers, a loss of internal rotation of the shoulder (called GIRD, glenohumeral internal rotation deficit) is common (Arvesen et al., 2026). Loss of internal rotation can make it hard to reach behind your back, for example to reach a bra strap.

Abnormal shoulder blade movement has been linked with other shoulder problems, such as shoulder impingement and rotator cuff problems (Roche et al., 2015).

Scapular Rotation Dysfunction Anatomy

The shoulder blade sits at the back, around the part of the spine called the thoracic spine, and on top of the ribs. It is attached to many muscles, and connects with other bones to form several joints.

The shoulder joint can rotate a long way, both inwards and outwards (internal and external rotation, sometimes called medial and lateral rotation). Many normal day-to-day activities involve rotation of the shoulder. These include throwing a ball, washing your hair, reaching behind your back, and putting on a coat.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Scapular Rotation Dysfunction

Rehabilitation focuses on the muscles that control the shoulder blade and on retraining how they work together with the rest of the body (the kinetic chain) (Sciascia and Kibler, 2022; Roche et al., 2015). I can guide you through this with hands-on work and an exercise programme to restore your shoulder's movement, strength and control. See the My Approach tab for how I work.

Tips

Avoid overusing the shoulder so the muscles don't become fatigued and overworked.
Be careful with intense, repetitive overhead activity such as tennis, volleyball and throwing if you have a shoulder weakness or an underlying shoulder problem.
If you do weight training, I can check your technique and help make sure your programme is balanced.

Treatment

My Approach

A SICK scapula is mostly about how your shoulder blade moves and sits: some muscles have become tight, others aren't switching on at the right time, and the shoulder ends up taking the strain. My aim is to ease what's tight, retrain the muscles that steady and turn the shoulder blade, and get your whole body sharing the load, from your legs and trunk to your arm.

I start by assessing your posture, how your shoulder blade moves as you raise and lower your arm, the strength of the muscles around it, and how far your shoulder rotates. If you play an overhead sport, I also look at your throwing or serving action and your training load.

Easing Tight Areas

Hands-on work for tight muscles that pull the shoulder blade forward or hold it up, such as the chest muscles and upper trapezius, and the muscles at the back of the shoulder
Stretches for the back of the shoulder to help restore inward rotation
Gentle joint mobilisation for a stiff upper back and shoulder
Work on the chest wall muscles only with your informed consent and a signed consent form

Retraining Control

Shoulder blade setting and control exercises for the serratus anterior, lower trapezius and rhomboids
Building to wall slides, push-ups with a plus, rows and rotator cuff strengthening
Exercises that link your legs and trunk to the arm, so the whole chain shares the work
Gym-based strength work with technique checks, drawing on my years working with powerlifters, and a graded return to throwing or overhead sport
Taping to support the shoulder blade in the short term, and I'll show you how to tape it yourself
A home programme between visits

If you notice numbness or weakness spreading down the arm, or the pain keeps getting worse, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, then every few weeks as you take over more of the programme, with a reassessment at about 4 to 6 weeks. Expect steady improvement over several months as your shoulder's rotation and control come back.

What I Focus On

Assessment

Release of Tight Areas

Shoulder Blade Control

Kinetic Chain Strength

Return to Overhead Activity

Sources

References

Arvesen, J.E. et al. (2026) 'Physical exam for athletic shoulder injuries in adolescent patients', Journal of the Pediatric Orthopaedic Society of North America, 15, 100361. doi: 10.1016/j.jposna.2026.100361
Roche, S.J., Funk, L., Sciascia, A. and Kibler, W.B. (2015) 'Scapular dyskinesis: the surgeon's perspective', Shoulder & Elbow, 7(4), pp. 289–297. doi: 10.1177/1758573215595949
Sciascia, A. and Kibler, W.B. (2022) 'Current views of scapular dyskinesis and its possible clinical relevance', International Journal of Sports Physical Therapy, 17(2), pp. 117–130. doi: 10.26603/001c.31727

Massage therapy · Kitchener–WaterlooScapular Rotation Dysfunction (SICK Scapula)

What It Is

Scapular Rotation Dysfunction Anatomy

Self-Care & Treatment

How to Treat Scapular Rotation Dysfunction

Tips

My Approach

Easing Tight Areas

Retraining Control

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooScapular Rotation Dysfunction (SICK Scapula)

What It Is

Scapular Rotation Dysfunction Anatomy

Self-Care & Treatment

How to Treat Scapular Rotation Dysfunction

Tips

My Approach

Easing Tight Areas

Retraining Control

Typical Course

References

Related Conditions

Cervical Kyphosis

Cervicothoracic Joint (CT) Dysfunction

Hyperkyphosis

Intercostal Muscle Strain

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