Scapular dyskinesis (SICK scapula)

What it is

The shoulder blade is not bolted to the ribcage by a joint. It is slung on muscle, and it has to rotate upwards, tilt backwards and turn outwards as the arm goes overhead so the socket stays underneath the ball. Dyskinesis means it is not doing that properly. The pattern most often seen in hitters is a blade that tips forward, so the inner edge and bottom corner lift off the ribs and the whole shoulder sits lower and further forward on the hitting side.

How volleyball causes it

Serratus anterior and lower trapezius are endurance muscles doing an endurance job, and hundreds of swings plus repeated blocking press fatigues them long before the big movers give out. As they fade the blade tips forward, which closes down the space the cuff moves through and forces the arm to find range the blade should have supplied. It shows up late in tournaments and late in a season. It is also more consequence than cause in many players, since pain, a tight posterior shoulder, or plain fatigue will produce it, and it then makes everything else worse.

ServingSettingAttackingBlocking

What it feels like

• The inner edge or bottom corner of the shoulder blade lifts away from the ribs, clearest when lowering the arm slowly from overhead
• In a photo from behind, the hitting shoulder sits lower and rolled further forward than the other side
• A tired, heavy, unstable feeling in the shoulder late in sessions rather than sharp pain
• Tenderness at the front of the shoulder near the bony point of the coracoid, and along the top inner edge of the blade
• Your reach drops. You are not getting as high on the ball late in matches
• Clunking or grinding as the blade slides over the ribs

Stop and get it seen if

• Winging that appeared suddenly and dramatically, especially after a viral illness, a heavy blow to the shoulder or neck, or an operation. Sudden true winging is a nerve palsy until proven otherwise.
• Winging together with numbness, burning pain, or weakness in the arm.
• Being unable to raise the arm fully overhead at all, or the blade lifting off dramatically on a simple wall push.
• Painful grinding with swelling over the blade, or pain that is present at rest and at night.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Finding the driver

   1 to 4 weeks

   Work out whether the blade is the problem or a symptom of a stiff mid back, a tight chest and posterior shoulder, pain elsewhere in the shoulder, or plain fatigue

   • A clear picture of when the pattern appears, fresh or only once fatigued
   • Mid back and shoulder range assessed
   • Any painful structure in the shoulder identified rather than assumed

2. 2. Rebuilding control and endurance

   6 to 12 weeks

   Restore the ability to position the blade, then make that position last as long as a match does

   • The blade holds position through a slow arm lowering
   • The pattern is still correct at the end of a training session, not only at the start
   • Front of shoulder tenderness settling
   • Overhead reach feels supported rather than heavy

3. 3. Integrating it into the swing

   4 to 8 weeks

   Carry that control into fast, loaded, fatigued overhead sport, which is a different skill from doing it well in a gym

Ready to play again when

• Symmetric blade movement raising and slowly lowering both arms, watched from behind
• Blade control still present at the end of a full training session
• No tenderness at the coracoid or the upper inner edge of the blade
• Reach height and swing mechanics holding across a whole match

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Serratus anterior work such as banded wall slides, push up plus, and bear crawls. That is the muscle that fatigues first in hitters.
• Lower trapezius work such as prone Y raises and half kneeling landmine presses, so the blade rotates upwards instead of shrugging.
• Mid back mobility with foam roller extensions and open book rotations, because a stiff upper spine forces the blade forwards.
• Row and pull volume that at least matches your pressing volume. Volleyball already loads the front of the shoulder heavily.
• Film yourself hitting at the end of a hard session rather than the start. Fatigued mechanics are the ones that injure people.
• Chest and front of shoulder stretching, for example a doorway pec stretch, so tight tissue is not holding the blade forward.