The secret of scapula dynamics

Discover the underlying, most undetected, never-corrected scapula clavicle subluxation and the roots of treatment

NUMEROUS REFERENCES CLAIM THE SHOULDER IS ONE OF THE MOST COMMONLY-INJURED JOINTS IN THE BODY. Various resources also state that there are estimates of 200,000+ shoulder surgeries per year, many involving the scapula, with an average injury age range between 18-88.

Anatomically, it is recognized that the shoulder sits on a very mobile platform, the scapula, which is anchored to the chest wall, cervical and thoracic vertebrae. The unique anatomy of the shoulder accounts for the greatest ranges of motion — but because of this it’s highly vulnerable, frequently injured, and considered by many to be the most unstable joint.

Discovering the root of the problem

For nearly 40 years I have treated patients from amateur to professional athletes, celebrity to geriatric patients. Even orthopedic surgeons and physical therapists refer patients who have sustained shoulder injuries, failed traditional allopathic and chiropractic treatment, and remain otherwise hopeless and clinically recalcitrant. For many, restored hope comes from discovering the root of their shoulder complaint, as well as neck and upper-back complaints.

The following is a brief overview of the discovery of the underlying most-undetected, never-corrected scapula-clavicle subluxation. I term this condition, based on the positional misalignment, as the “protracted antetilted scapula.”

Stabilization and anchoring of the humerus

What makes it so “humerus”? The anatomy of the glenohu-meral fossa favors a normal anatomically-retrotilted glenoid fossa, affording the most stable alignment of the humerus within the glenoid fossa as a very shallow trough.

Yet, if anchored by the strong rotator cuff muscles functioning as the collective downward stabilizers of the shoulder, then why is the shoulder the most unstable and one of the most frequently injured joints?

My 40 years of research in arthrokinematics of the shoulder led to an amazing personal discovery which is in fact supported by numerous references. That is, if the most stable alignment is humeral-head centering in the normal anatomically-retrotilted glenoid fossa, then what happens when the glenoid fossa antetilts? This biomechanical alteration creates anterior instability of the humerus and resultant changes in range of motion, function and strength. In addition, this results in a profound change in the anchored muscles affixing the pectoral girdle to the torso, resulting in anterior instability of the humerus. This is my explanation for recurring shoulder dislocations and uncorrected other shoulder conditions, injuries and syndromes that have failed all other approaches.

The resultant complaints for this sequential aberration range from chronic headaches, upper and middle back and neck pain, rotator cuff impingement syndrome, frozen shoulder, thoracic outlet syndrome, and a myriad of other conditions, injuries and syndromes.

Scapula sports and slip-and-fall injuries

The biomechanics of slips, falls, throwing action, golf, tennis, pickle-ball, bowling, etc., are similar in that scapula rhythm (scaption) favors protraction of the scapula laterally on the thorax. This results in an elevated coracoid process and the attaching pectoralis minor develops a stretch reflex, thereby contracting and pulling the acromion inferiorly. The retro-pec minor space becomes reduced (Wright’s Hyperabduction Syndrome) as does the subacromial space (normal 8-10 millime-ters), often resulting in the symptoms and ultimate diagnosis of rotator cuff impingement syndrome (RCIS).

Often, patients are misdiagnosed, leading to inappropriate and unnecessary surgical and therapeutic procedures and most commonly ensuing erroneous results. Prime examples include the rhomboid muscles attaching the scapula to the thoracic spine, such that a misaligned scapula will result in torque on the thoracic spine and hence referred symptoms, much like a weed rarely disappears when not pulled from its root. The cervical spine has anchoring muscles in the clavicle (SCM) and scapula (levator scapula), hence a misaligned scapula and clavicle remains undetected and not corrected and the patient suffers recalcitrant neck pain and instability. This holds true with a history of an acute ipsilateral and/or a chronic contralateral clinical manifestation with supporting patient history, radiographic, orthopedic and examination findings.

Additionally, how many patients suffer the signs and symptoms often misdiagnosed with Thoracic Outlet Syndrome (TOS), have endured and suffer from failed first-rib resection, sympathectomy and selective denervation procedures for TOS? Imagine the invalidated findings from subclavian angiography and anticoagulation therapy, all to no avail. Surgery is next and most often fails to eradicate the patient’s condition. The patient is then referred to the physical therapist and they find that the pectoralis minor is a precipitating “cause” — or is it actually a “result”
— of said neurovascular occlusion? A rehab program is now implemented to stretch an already overstretched muscle, further exacerbating the patient’s symptomologies.

More over-stretching mistreatments

Similarly, the plantar fascia is often mistreated by stretching the fascia with whatever technique is employed by DCs, PTs or LMTs. I have found that this is a clinical oxymoron, as the collapse of the longitudinal arches results in overpronation, hence already over-stretching the fascia.

Another fallacy is to stretch the piriformis muscle and IT band, as well as psoas that are each contracted due to a misdiagnosed stretch reflex. These are just a few examples clinicians of various disciplines, including DCs, are taught to stretch the muscle. Are we not taught musculoskeletal adaptation and that muscles are controlled by direct innervation? In lieu of the aforementioned discussion, I further elucidate that we do not hit the head for a headache, we do not massage the leg for sciatica; when a foot is numb it could be the leg is crossed, and a heart attack refers messages to the left arm and TMJ.

Think about the ‘what ifs’

All disciplines should investigate the “what ifs:”

• What if you are stretching the plantar fascia and then contradict your rationale by taping the arches, then prescribe the patient orthotics to build and support the collapsed arch
• What if you are massaging the left arm and treating the TMJ and the patient is having a heart attack?
• What if you are massaging and stretching the piriformis, pec minor, etc., and the “root” eliciting the contracting muscle remains undiagnosed and untreated?
• What if you continue to do what you and the patient have always done and achieve the same negative results?

Sir Albert Einstein has a theory for that action (insanity).

Do not hit the dashboard to make the gas light go off! Sound ridiculous? That happens daily. Chiropractic philosophy says clearly to look for the cause to correct the result.

Mitch Mally, DC, has been a speaker and educator for nearly 40 years, and has instructed post-graduate courses for Palmer College, Northwestern, Cleveland, Logan, Palmer West and Life West, Anglo European Chiropractic College (England), and Denmark School of Medicine (NIKKB). “Learn The Mally Method” techniques and become the leading spinal and extremity expert in your community. For more information go to training.drmitchmally.com or email mrmally@live.com.