Scapular Depression at Rest: Implications for Cervical Pain and Functional Outcomes

Introduction Neck pain is a major global health problem affecting a large portion of the adult population, with a worldwide prevalence ranging from 16.7% to 75.1%. The economic burden associated with neck pain is substantial, manifested through job-related issues, absenteeism, reduced productivity, and elevated treatment costs. In the United States alone, approximately 25.5 million individuals missed an average of 11.4 working days due to neck pain in 2012, and in 2016, healthcare expenditures related to neck pain reached approximately $134.5 billion, making it one of the most costly health conditions in the country.

While pain intensity has its socioeconomic consequences, also neck dysfunction constitutes an equally important dimension of this condition. Impaired neck function has been linked to deficits in cervical range of motion, proprioception, and muscular endurance, all of which can compromise daily activities, work performance, and overall quality of life. Among the multiple biomechanical factors influencing neck pain and function, the scapular position has gained growing attention. The scapula plays a critical role in maintaining postural alignment and providing a stable base for neck and shoulder movement.

Studies have shown initial evidence that individuals with neck pain may demonstrate altered scapular alignment when compared with healthy controls, though the limited sample sizes in such studies constrain the strength of these conclusions and warrant further investigation.

Also altered scapular alignment has been associated with decreased pressure pain thresholds (PPT) in the upper trapezius region, indicating heightened sensitivity to pain. Moreover, it may alter the length-tension relationship of the upper trapezius and levator scapulae muscles, potentially compromising cervical stability and movement efficiency. Such biomechanical alterations may manifest as reduced neck functional capacity, including limited range of motion and diminished performance in daily activities.

Assessment of scapular position and its influence on the cervical region has been carried out through several approaches, including comparisons of scapular resting alignment in individuals with and without neck pain, the analysis of how altering scapular positioning affects both pain and neck function, and the evaluation of pressure pain threshold in the upper trapezius as an indicator of sensitization. Despite these efforts, the relationship between depressed scapular position at rest, neck pain, and cervical function remains insufficiently explored, highlighting the need for further research to clarify this interaction. To our knowledge, the correlation between the mean vertical scapular distance of both scapulae at rest, neck pain and cervical function is not yet investigated or studied.

In this study, the investigator tried to shed some light on the effect of the depressed scapular position at rest on the neck region in terms of pain intensity, cervical function and to understand the correlation between the mean vertical scapular distance of both scapulae at rest, neck pain and cervical function which will help us to explore new measurements to be used in the diagnosis and the prognosis of patients with neck pain and cervical dysfunction.

Study Design: Cross-Sectional Observational study

Study groups

Included subjects were divided according to the vertical scapular position at rest into two groups:

• - Control group (A): 64 subjects with normal scapular position at rest.
• - Study group (B): 64 subjects with depressed Scapular position at rest.

Each participant was assessed once on the same day of enrollment. No follow-up assessments will be performed.

Statistical Analysis Statistical analysis was performed through the statistical package for social sciences (SPSS) version 20 for windows.

Statistical Procedures

The following statistical procedures were conducted:

• Descriptive statistics was used to summarize and describe the main features of a dataset and conducted in terms of mean and standard deviation.
• Unpaired t test was conducted for comparison of the subject characteristics between groups.
• Shapiro Wilktest was conducted for testing normality of data.
• One way MANOVA was used for comparison of the Mean Vertical Scapular Distance of both scapulae at rest (Z), Non-Derangement Mechanical Neck Pain, and Cervical Function between groups.
• Spearman correlation coefficient was conducted to investigate the correlation between the Mean Vertical Scapular Distance of both scapulae at rest (Z), Non-Derangement Mechanical Neck Pain, and Cervical Function.
• The level of significance for all statistical tests was set at p < 0.05.

Inclusion criteria

• - Young adults with age from 18 to 30 years old.
• - Subjects with Body Mass Index less than 30

Exclusion criteria

• - Cervical spine surgeries, fractures or pathologic trauma, Subjects with cervical or shoulder neurological movement disorder, Tempromandibular surgery, psychosocial problem.
• - A documented diagnosis of scoliosis or a posterior rib hump greater than five degrees on forward bending as measured with the scoliometer (ATR ≥ 5°).
• - Known or measured Leg Length Discrepancy (LLD) greater than 1 cm.