The British Journal of Sports Medicine released a systematic review examining the relationship between shoulder impingement and scapular orientation and positioning. I think this will be interesting to discuss, due to the recent ‘postural mobility deficits’ post and examining the above relationship. First off only 10 articles were reviewed from an original 7445 articles, does that seem like just a little too much inclusion and exclusion criteria? None the less, “the findings were inconsistent. Some studies reported patterns of reduced upward rotation, increased anterior tilting and medial rotation of the scapula. In contrast, others reported the opposite, and some identified no difference in motion when compared to asymptomatic controls.”
Also their conclusion: “The underlying etiology of subacromial impingement (SIS) is still debated. The results of this review demonstrated a lack of consistency of study methodologies and results. Currently, there is insufficient evidence to support a clinical belief that the scapula adopts a common and consistent posture in SIS. This may reflect the complex, multifactorial nature of the syndrome. Additionally, it may be due to the methodological variations and shortfalls in the available research. It also raises the possibility that deviation from a 'normal' scapular position may not be contributory to SIS but part of normal variations.”
This is wonderful news and goes along with the previous post for multiple reasons:
- Not all shoulder pathologies/SIS are postural. This goes well with the SFMA, among other assessments. Multiple factors may exist including motor control (muscle timing and recruitment) deficits. When we blame only posture for example than we’ll only try to use one technique to fix it. However, this short sided view will end poorly.
- When pathology is related to posture, they won't be “common and consistent”. Meaning each person has a threshold when posture will affect them (especially those with beaked arcomions) and more importantly, that posture deficits will affect each one differently; as in which specific patterns it will impair. We need to assess each pattern along with subjectivity seeing their functional patterns that are limited. Therefore, a standardized postural program will have minimal effectiveness. Injuries are multifactorial and so should our assessments!
- Posture can affect in different ways & severity; take the venn diagram example below. Sometimes postural issues will affect just as much as other issue like pain changes and motor control. Other times its not even part of the issue. Conversely, it can also be a huge portion of the center. The SFMA can allow us to know some of the effects of each with DP, DN, FN, FP. Try to keep this idea in the back of your head during your eval and slowly deduce the play of each circle in the patient's impairment.
