Treatment of Scapular Dyskinesis with Reflexive Neuromuscular Stimulation: A Case Report

Abstract

Introductory: Scapular dyskinesis is an abnormal movement of the scapula due to poor motor control of the surrounding musculature and can lead to other glenohumeral pathologies. The pathology results in the lateral tilting of the scapula during many glenohumeral joint movements and weight-bearing activities of the upper extremity (i.e. plank). The typical conservative treatment protocol focuses on strengthening surrounding musculature and is often a lengthy protocol. The problem with strengthening protocols is the failure to address the motor functioning of targeted muscles. Reactive Neuromuscular Stabilization (RNS) is a novel treatment that targets the central nervous system (CNS) to address that motor firing problem to restore the normal muscular and joint function. Purpose: The purpose of this case study is to demonstrate the efficacy and the outcomes of using RNS as a treatment for dysfunctions such as scapular dyskinesis. Clinical Diagnosis: A 20-year-old female intercollegiate swimmer presented with significant mid-back pain that failed to resolve without treatment. The patient tested positive for scapular dyskinesis as well as presented with a number of postural concerns, trigger points, and pain with multiple activities. The initial protocol for treatment for this patient was the typical conservative treatment protocol focused on strengthening. After six weeks of treatment without improvement, the clinician modified care to include RNS. Outcomes: Following three treatment across seven days, the patient’s symptoms significantly decreased and the patient met discharge criteria. At an eleven-month follow-up, the patient’s improvements were maintained. Clinical Bottom Line: The patient in this case report demonstrates the effectiveness of RNS while treating scapular dyskinesis and the importance of recognizing the cause of the dysfunction early within the evaluation.