Kibler's 1998 Current Concepts review defines the scapula's five functional roles in overhead athletic activity and explains how failure in any role produces shoulder injury. It covers normal and abnormal scapulothoracic biomechanics, clinical evaluation including the lateral scapular slide test, and a sequenced rehabilitation framework.
When you see a throwing athlete with rotator cuff tendinitis or glenohumeral instability, look at the scapula before you focus on the cuff. Scapular inhibition is present in virtually every significant shoulder problem — treating the glenohumeral joint in isolation without restoring scapular control is incomplete management.
In practice: assess scapular symmetry with the lateral scapular slide test in all three positions. Asymmetry above 1.5 cm flags active dysfunction. Do not advance the patient to open-chain rotator cuff work until asymmetry drops below 1 cm in position 3 and scapular motion is smooth in both ascent and descent.
The rehab sequence matters: start with proximal kinetic chain (trunk and leg flexibility, strength, posture), then isometric and closed-chain scapular exercises, then rotator cuff loading. Closed-chain scapular work can begin as early as 3 weeks after labral repair and 5 weeks after rotator cuff repair.
This paper is the conceptual foundation for modern kinetic chain rehabilitation of the overhead athlete. The principle that a shoulder problem is rarely just a shoulder problem.
Kibler's 1998 Current Concepts review defines the scapula's five functional roles in overhead athletic activity and explains how failure in any role produces shoulder injury. It covers normal and abnormal scapulothoracic biomechanics, clinical evaluation including the lateral scapular slide test, and a sequenced rehabilitation framework.
When you see a throwing athlete with rotator cuff tendinitis or glenohumeral instability, look at the scapula before you focus on the cuff. Scapular inhibition is present in virtually every significant shoulder problem — treating the glenohumeral joint in isolation without restoring scapular control is incomplete management.
In practice: assess scapular symmetry with the lateral scapular slide test in all three positions. Asymmetry above 1.5 cm flags active dysfunction. Do not advance the patient to open-chain rotator cuff work until asymmetry drops below 1 cm in position 3 and scapular motion is smooth in both ascent and descent.
The rehab sequence matters: start with proximal kinetic chain (trunk and leg flexibility, strength, posture), then isometric and closed-chain scapular exercises, then rotator cuff loading. Closed-chain scapular work can begin as early as 3 weeks after labral repair and 5 weeks after rotator cuff repair.
This paper is the conceptual foundation for modern kinetic chain rehabilitation of the overhead athlete. The principle that a shoulder problem is rarely just a shoulder problem.