Rehabilitation for Complex Scapular Dysfunction: Considerations of Pain and Altered Motor Patterns

Developing treatment plans for patients with chronic scapular dysfunction can be challenging. Some of the obstacles clinicians may experience in patients with chronic or complex scapular dysfunction include moderate to severe pain and possibly altered pain processing characteristics, altered muscle activation patterns, and an overall deficit in motor control capability which may limit the patient’s ability to perform therapeutic exercise. These patients tend to require individualized care consisting of a patient-specific assessment of pain, tissue mobility, and motor control dysfunctions. Standard application of therapeutic regimens often require significant modifications to meet the level of dysfunction and may need to address the body as a unit, using the kinetic chain rehabilitation framework. This chapter will introduce the concept of altered pain processing and the impact it can have on scapular function, provide details of the kinetic chain approach for rehabilitation, and offer modifications of the kinetic chain approach for complex cases of scapular dysfunction.