Is there a link between Chronic Neck Pain and Scapular Dyskinesis?

Chronic neck pain (CNP) affects millions globally and is often associated with dysfunction beyond the cervical spine. A growing body of research highlights the involvement of the scapular region, especially scapular dyskinesis—abnormal movement of the scapula—as both a contributing factor and a consequence of neck pain. According to Janda’s theory of chain reactions, muscular imbalance and faulty scapular kinematics may impact cervical stability and increase strain on the neck, emphasizing the need for integrated assessment and treatment approaches.

Pathophysiology and Muscle Interactions
The scapula plays a key role in shoulder and neck mechanics through its connections with the axioscapular muscles (e.g., trapezius, serratus anterior, rhomboids, and levator scapulae). In individuals with neck pain, studies have consistently shown altered activation patterns and strength imbalances—particularly reduced activity of the lower trapezius and serratus anterior, and increased tension in the upper trapezius and levator scapulae. These dysfunctions disrupt scapular positioning and mechanics, contributing to abnormal loading of the cervical spine and perpetuating pain.

The Systematic Review
A systematic review published in BMC Musculoskeletal Disorders July 2025 following PRISMA guidelines evaluated 19 observational studies with 1,365 participants. These studies explored the relationship between CNP and scapular dyskinesis, using tools such as the Scapular Dyskinesis Test (SDT), Lateral Scapular Slide Test (LSST), and 3D motion analysis. The results consistently indicated a strong association between scapular dyskinesis and chronic neck pain, although causality could not be established due to study design limitations.

Key Findings

• Altered muscle activity: CNP patients commonly exhibit delayed or reduced activation in stabilizing muscles (e.g., lower trapezius, serratus anterior) and increased compensatory activity in the upper trapezius.
• Reduced strength: Bilateral weakness of rhomboid and middle trapezius muscles is prevalent, with potential impact on postural stability.
• Postural adaptations: Forward head posture and rounded shoulders were commonly observed, often linked to changes in scapular alignment and muscle tension.
• Hand dominance effects: Scapular movement differs between dominant and non-dominant sides in patients with CNP, suggesting the need for side-specific assessments.

Clinical Implications
Scapular-focused rehabilitation—including neuromuscular re-education, strengthening of stabilizers, and postural retraining—has shown promise in alleviating pain in CNP patients. However, evidence remains mixed regarding improvements in disability scores or range of motion. The findings suggest that scapular interventions should be integrated into comprehensive neck pain management programs.

Therapists should consider:

• Assessing scapular function routinely in patients with CNP.
• Incorporating low-load neuromuscular exercises targeting the lower trapezius and serratus anterior.
• Minimizing upper trapezius compensation to optimize scapular mechanics.
• Factoring in hand dominance and posture during clinical evaluations.

Assessment Tools: Caution Advised

• Visual inspection has only moderate inter-rater reliability and should be corroborated with other methods.

Conclusion
There is a significant association between chronic neck pain and scapular dyskinesis. While causal links remain unclear, current evidence supports the integration of scapular-focused assessments and interventions in managing CNP. Further high-quality randomized controlled trials are needed to define optimal treatment strategies and better understand the underlying mechanisms.