Scapular setting for chronic neck pain – why?

Why do we care about ‘scapular setting’

If you come to see us for neck pain, you will no doubt be given the scapular setting exercise to help keep your neck pain at bay in between appointments. So I thought I would talk about why we recommend this simple exercise. Many physios recommend the scapular setting exercise for shoulder rehab however I prefer to use it in the management of neck pain, along with a few other specific neck or thoracic exercises.

So what is ‘scapular setting’? In theory, many shoulder problems occur due to scapula dykinetic movement and so if you stabilise the scapular, the shoulder should function more effectively. However, as I said, I prefer this exercise for chronic neck pain and I will tell you why:

I tell my patients , when doing the exercise, is to imagine pulling the scapula downwards and inwards in a type of diagonal direction shown in the diagram.

People will often initially just pull the shoulders backwards but this isn’t correct. To really activate the rhomboids, it must be a very small movement in-between the shoulder blade. Inevitably, if it’s done correctly, your shoulders should gently move backwards and the upper trap is deactivated.

And this brings me to why I love this exercise for those with chronic neck pain. Generally, the rounded shoulder caused by weak rhomboids and tight pecs, will pull the tethered upper trapezius muscle into tension. This constant tension will lead to referred pain similar to a one sided headache, or the dysfunction of the C5 facet. Either one, will inevitably lead to loss of function and pain.

In the first three treatments for postural related neck pain, we free up the facet joints to allow them to move effectively and stretch out the tight and tensioned muscles around the neck. I often trial posturally taping the shoulder backwards, relieving the trapezius muscle and if this really helps ease pain, then it’s quite conclusive that the scapular setting stretch is perfect for you!

The other reason why I love this exercise is you can do it any time anywhere. You don’t have to make time to do it, you just have to remember. So I usually recommend doing it at least every 10 minutes when at the computer and throughout the day such as when you are cooking dinner or watching TV.

This little gem of an exercise can also put the shoulder in the most effective position prior to exercise so if you like doing overhead work such as weights or lifting, then doing this prior to the lift, can help limit any unnecessary stress on your rotator cuffs of the shoulder