Scapulothoracic dyskinesis: causes, symptoms, and exercises for relief

Scapulothoracic dyskinesis may sound alarming, but it’s a very treatable condition that often improves with targeted exercises and physical therapy. In simple terms, it means your shoulder blade isn’t moving as smoothly or efficiently as it should.

Let’s break down the name:

• Scapulo refers to the scapula, or shoulder blade

• Thoracic refers to the thoracic spine, or mid-back

• Dyskinesis means abnormal or altered movement

“It just means the scapula, or shoulder blade, isn’t sliding and gliding smoothly along your rib cage the way it usually does when you lift, reach, or rotate your arm,” says Nicholas Mercer, PT, DPT, a physical therapist at Hinge Health. “Your shoulder blade and upper arm bone are designed to move together like a team so that motion is shared and your shoulder joint stays in a comfortable position. When that coordination is a bit off, some muscles can end up working harder than others, which can make your shoulder feel weak, stiff, or sore.”

Also called scapular dyskinesis, this condition includes a range of shoulder blade movement issues. Some people notice pain, weakness, popping, or stiffness, while others may simply see that one shoulder blade moves differently from the other. In some cases — especially with repetitive activities like swimming, throwing, lifting, or painting — symptoms may gradually develop over time.

One common sign is scapular winging, where the shoulder blade sticks out more prominently from the back instead of lying flat against the rib cage.

Strengthening weak muscles, improving mobility, and changing movement patterns can help restore smoother scapular motion and reduce pain. Learn which targeted exercises recommended by Hinge Health physical therapists can help improve scapulothoracic dyskinesis symptoms.

Causes of scapulothoracic dyskinesis

There’s rarely one single cause of scapular dyskinesis. Instead, it usually develops from a combination of muscle weakness, tightness, posture habits, repetitive activities, injuries, or nerve irritation — many of which can improve with exercise therapy.

Here are some of the most common contributors:

• Muscle imbalances. When certain muscles are weaker or stronger than others, it can change the way your shoulder blade moves. Weakness in stabilizing muscles like the serratus anterior or trapezius is especially common, since — based on typical posture habits and training routines — these muscles are often overlooked or undertrained. Imbalances in surrounding shoulder, arm, chest, and back muscles may also contribute.

• Posture habits. “The problem isn’t good versus bad posture,” says Dr. Mercer. “It’s more so about staying in one posture all the time.” Spending hours with rounded shoulders (a natural position when looking at a computer, phone, or holding onto a steering wheel) can tighten chest muscles and weaken your upper back muscles, which may alter shoulder blade mechanics over time.

• Muscle tightness. Tight muscles can restrict normal movement and affect how the shoulder blade rests and moves against the rib cage. Tight muscles can change your overall posture and the way your trunk and rib cage are positioned, which then influences how your shoulder blade rests and moves. Tightness in the pectoral (chest) muscles is a common example. The scapula also serves as an attachment point for many muscles — including the rotator cuff, trapezius, and deltoids — so tightness or imbalance in any of these can affect its resting position and how it moves during upper body motions.

• Repetitive overhead activity. Sports and jobs that involve frequent overhead motion — such as swimming, tennis, baseball, painting, or lifting — can place repeated stress on the shoulder blade muscles. “Dyskinesis isn’t always caused by overuse, but it can be revealed by it,” says Dr. Mercer. “In other words, your shoulder blade might already be moving a little differently without bothering you, and once you layer on a lot of repetitive overhead work, that’s when pain or discomfort can start to show up.”

• Previous shoulder injuries. A past or recent shoulder, collarbone, or neck injury may cause your body to compensate with different movement patterns, which can affect scapular motion.

• Nerve irritation. In some cases, nerve irritation from a sports injury, fall, surgery, or car accident can interfere with the muscles that control the shoulder blade. Nerve-related weakness is a common cause of scapular winging.

Symptoms of scapulothoracic dyskinesis

As with many musculoskeletal conditions, scapulothoracic dyskinesis can look and feel different from person to person. Some people mainly notice popping or weakness, while others experience pain or visible changes in shoulder blade position. And not everyone with scapulothoracic dyskinesis has scapular winging or pain.

Common symptoms may include:

• Snapping, popping, grinding, or clicking around the shoulder blade

• Pain or tenderness, especially with overhead activities

• Shoulder weakness with lifting, pushing, or reaching

• Limited shoulder range of motion

• A feeling that the shoulder blade is “sticking out” or “coming off” the back

• Visible asymmetry between shoulder blades

• One shoulder sitting higher than the other

• Symptoms that usually affect one side more than the other

How movement can help scapulothoracic dyskinesis

It may feel counterintuitive to move more when your shoulder blade pops, grinds, or feels uncomfortable. But movement is one of the best treatments for scapulothoracic dyskinesis.

“Again, dyskinesis means improper movement, so the way we treat that is by reinforcing proper movement,” says Dr. Mercer.

Targeted exercises help strengthen the muscles that stabilize the shoulder blade while improving mobility in tight areas. Over time, this can improve shoulder blade tracking, reduce strain, and restore smoother movement patterns.

Movement also increases blood flow to muscles and connective tissues, which supports healing and can reduce stiffness. Avoiding movement altogether may actually slow recovery and lead to more weakness and tightness.

That said, you may need to temporarily modify certain activities that increase your pain — especially repetitive overhead movements — until you rebuild strength and control.

These exercises help strengthen the scapular stabilizers, improve shoulder blade tracking, and reduce pain and popping. Scapular squeezes and shoulder rows strengthen the muscles that retract your shoulder blades — pulling them slightly back and toward your spine — while the push-up plus improves protraction, moving your scapula away from the spine. Banded rotation pull-apart helps keep your rotator cuff muscles strong, helping protect against injury. Doorway stretches open your chest, preventing tightness and improving posture.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for scapulothoracic dyskinesis

Most cases of scapulothoracic dyskinesis improve with simple, at-home treatments, especially when you consistently work on strengthening, mobility, and movement patterns. “You can get some mild relief right away, and that continues to build over time, if you’re consistent,” says Dr. Mercer. 

Many people start noticing improvement within four to eight weeks, and surgery is rarely needed. Consider these treatments recommended by Hinge Health physical therapists:

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help improve your strength and mobility in your shoulder and surrounding muscles. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Modify activities. If certain activities, like overhead movements, increase your symptoms, try adjusting the movement to a comfortable range of motion. This will promote healing without aggravating symptoms.

• Stay active. Any type of movement, such as walking, stretching, or even household chores, can increase blood flow and support healing. Be sure to pace  your activities so you don’t overdo it. 

• Switch your positions. Avoid staying in one position for long periods, such as sitting at a computer desk. “Modify your desk setup so it encourages posture changes, such as sitting versus standing,” says Dr. Mercer. “It’s not that one is better than the other; they’re different and give your body different inputs throughout the day.”

• Take movement snacks. Short, frequent bouts of movement throughout the day can help prevent stiffness and reduce strain on your shoulder blade muscles. “Your body appreciates variety,” says Dr. Mercer. Try standing up, stretching, walking around, or doing a few scapular squeezes every hour — especially if you spend long periods sitting at a desk or working in one position. These quick “movement snacks” can help keep your shoulder blade muscles active and improve posture and circulation without overwhelming the area.

• Apply ice or heat. Ice can help reduce swelling and inflammation and numb pain, whereas heat helps ease stiffness and tightness around the shoulder blade. Choose the method that works best for you or alternate between the two.

• Take over-the-counter (OTC) medication as needed. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have shoulder pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments, such as massage, dry needling, acupuncture, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like scapulothoracic dyskinesis. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent scapulothoracic dyskinesis

While some abnormal movement is common, you can minimize it and reduce your risk of scapulothoracic dyskinesis leading to pain or impairing your everyday movements via simple prevention strategies. Here’s what Hinge Health physical therapists recommend:

• Keep your shoulders and scapulae muscles strong. Exercises that strengthen the muscles around your shoulder blades help improve stability and movement control. “Strengthening these muscles helps control the scapulae and keep them moving in a nice rhythm,” says Dr. Mercer.

• Start with a warm-up. Preparing your muscles for sports or tasks like swimming, tennis, baseball, painting, or lifting can help reduce irritation and strain.

• Stretch your chest and shoulders regularly. Chest stretches and mobility work can help counterbalance the rounded-forward posture many people spend hours in. “Doing some chest stretches and scapular squeezes doesn't take a lot of effort, but they make a big difference,” says Dr. Mercer.

• Increase activity gradually. If you’re starting a new workout routine, sport, or hobby, build up slowly to give your muscles and joints time to adapt.

When to see a doctor

Scapulothoracic dyskinesis often improves on its own with targeted exercises and at-home treatment. But if your shoulder pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Weakness in your arm or shoulder

• Numbness or tingling in your arm, shoulder, neck, or hand

• A shoulder blade that’s starting to stick out more (winging) or sit at a noticeably different height than the other side — and is becoming more noticeable over time

• Pain that wakes you up at night or interferes with daily activities

PT tip: Address symptoms early

You don’t have to wait until your shoulder hurts to address movement issues. “If your shoulder blade doesn’t feel like it’s moving right, or you have grinding or popping without pain, you can work on it today,” says Dr. Mercer. Addressing symptoms early may help prevent them from becoming more serious over time.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Aibinder, W. R. (2010). Scapular (Shoulder Blade) Problems and Disorders - OrthoInfo - AAOS. Aaos.org. https://orthoinfo.aaos.org/en/diseases--conditions/scapular-shoulder-blade-disorders  

2. Cruz, Fagundes, M. C., Lucas, Araújo, F. F., Dâmaris V C Gonçalves, Schor, B., Nico, M. A. C., Rhodes, N. G., Guimarães, J. B., & Ormond, G. (2024). Scapulothoracic Disorders: Anatomy, Kinematics, Clinical Assessment, and Multimodality Imaging. Radiographics, 45(1). doi:10.1148/rg.240097   

3. Frank, R. M., Ramirez, J., Chalmers, P. N., McCormick, F. M., & Romeo, A. A. (2013). Scapulothoracic Anatomy and Snapping Scapula Syndrome. Anatomy Research International, 2013, 1–9. doi:10.1155/2013/635628  

4. Giuseppe, L. U., Laura, R. A., Berton, A., Candela, V., Massaroni, C., Carnevale, A., Stelitano, G., Schena, E., Nazarian, A., DeAngelis, J., & Denaro, V. (2020). Scapular Dyskinesis: From Basic Science to Ultimate Treatment. International Journal of Environmental Research and Public Health, 17(8). doi:10.3390/ijerph17082974  

5. Panagiotopoulos, A. C., & Crowther, I. M. (2019). Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT-J, 5(29), 29. doi:10.1051/sicotj/2019029