Manual Therapy 16 (2011) 155e160

Contents lists available at ScienceDirect

Manual Therapy
journal homepage: www.elsevier.com/math

Original article

Scapular positioning and motor control in children and adults: A laboratory study
using clinical measuresq,qq
Filip Struyf a, b, Jo Nijs a, b, *, Stijn Horsten a, Sarah Mottram c, Steven Truijen a, Romain Meeusen b
a

Division of Musculoskeletal Physiotherapy, Department of Health Sciences, Artesis University College Antwerp, Antwerp, Belgium
Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
c
Kinetic Control, UK
b

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 14 May 2009
Received in revised form
9 August 2010
Accepted 14 September 2010

Introduction: The scapular muscular system is the major determinant of scapular positioning. In addition,
strength and muscular endurance develops from childhood through adolescence. It is not known
whether differences in scapular positioning and motor control between adults and children may exist.
Methods: Ninety-two shoulders of 46 adults (mean 39.4; 18e86 years; SD 22.5), and 116 shoulders of
59 children (mean 11.6; 6e17 years; SD 3.5), were included in the study. Scapular positioning data
were collected using a clinical assessment protocol including visual observation of titling and winging,
measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic
Medial Rotation Test (KMRT).
Results: The observation protocol for scapular winging and tilting did not show signicant differences
between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm
(0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were signicantly
smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward
rotation (18.6 ; SD 9.6 ) than adults (14.5 ; SD 10.9 ) at 90 shoulder abduction. No signicant differences
were seen between children (19% positive test) and adults (24% positive test) using the KMRT.
Conclusion: Children and adults show signicant but small differences in scapular upward rotation and
forward shoulder posture. These data provide useful reference values using a clinical protocol.
2010 Elsevier Ltd. All rights reserved.

Keywords:
Scapula
Shoulder
Assessment

1. Introduction
Abnormalities of scapular positioning have been shown in
patients with shoulder impingement syndrome, anterior shoulder
instability, and postoperative shoulder complaints (Paletta et al.,
1997; Lukasiewicz et al., 1999; Ludewig and Cook, 2000; Hbert
et al., 2002; Wilgen van et al., 2003). The complex kinematic
behaviour of the scapula and shoulder has typically been studied
(McKenna et al., 2004), using three-dimensional motion tracking
systems. However, these are costly and not readily available for
clinical practice (Sugamoto et al., 2002). There is a need for clinical
q We certify that no party having a direct interest in the results of the research
supporting this article has or will confer a benet on us or on any organization with
which we are associated AND, if applicable, we certify that all nancial and material
support for this research (e.g., NIH or NHS grants) and work are clearly identied in
the title page of the manuscript.
qq The study protocol was reviewed and approved by the medical ethics
committee of the University Hospital Brussels (2006/138).
* Corresponding author. Campus HIKE, Dept G, Artesis Hogeschool Antwerpen,
Van Aertselaerstraat 31, 2170 Merksem, Belgium. Tel.: 3236418265.
E-mail address: jo.nijs@artesis.be (J. Nijs).
1356-689X/$ e see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2010.09.002

indicators of known reliability and validity that allow clinicians to

assess static and dynamic scapular positioning and motor control.
These measurements are available, but should generate reliable and
valid data, and should have strong clinical utility (Sugamoto et al.,
2002; Nijs et al., 2007).
Decreased scapular upward rotation, reduced posterior tilting,
and excessive scapular internal rotation have been identied as
altered scapular positioning patterns in patients with shoulder
disorders (Lukasiewicz et al., 1999; Ludewig and Cook, 2000; Hbert
et al., 2002). It has been shown that people with short pectoralis
minor muscle length demonstrate similar scapular positioning as
patients with shoulder impingement syndrome (Lukasiewicz et al.,
1999; Ludewig and Cook, 2000; Borstad and Ludewig, 2005; Smith
et al., 2006). This observation supports the use of a pectoralis
minor muscle length test for analyzing scapular positioning.
In addition, a lack of scapulothoracic muscle control has been
identied as a characteristic of people with shoulder disorders (Host,
1995; Schmitt and Snyder-Mackler, 1999; Hess, 2000; Ackerman
et al., 2002; Cools et al., 2003; Nijs et al., 2007). When assessing
scapular positioning or motor control, clinicians must be attentive
for patterns that are often seen in patients with shoulder disorders.

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F. Struyf et al. / Manual Therapy 16 (2011) 155e160

Movement skills in children may be inuenced by strength and

muscular endurance. Hence, movement patterns develop from
childhood through adolescence (Branta et al., 1984). Since the
scapular muscular system is the major contributor to scapular
positioning, differences in scapular positioning and motor control
between adults and children may exist (Nijs et al., 2005; Dayanidhi
et al., 2005). In fact, signicant differences in scapular kinematic
patterns between children (4e9 years) and adults (25e37 years)
have previously been reported (Dayanidhi et al., 2005). The authors
reported that children have a greater contribution of the scapulothoracic joint to upper limb movements (Karduna et al., 2001). A
previous study using radiographic evaluation identied a decrease
in the range of the posterior tilt and upward rotation as an ageing
effect (Endo et al., 2004). Numerous studies have investigated the
applicability of clinical tests for assessing scapular positioning in
adults. Given the fact that differences in scapular positioning
between children and adults are present, the use of these clinical
tests to assess children requires additional study.
The primary aim of the study was to provide clinicians with data
for interpreting clinical tests when assessing scapular positioning
and motor control in adults and children. The secondary aim of this
study was to examine whether clinical measures revealed differences in scapular positioning (i.e. scapular upward rotation, tilting,
winging, forward shoulder posture, and scapular motor control)
between adults and children.
2. Methods
2.1. Subjects
Both shoulders of 105 subjects were measured yielding data for
a total of 210 shoulders for further analysis. Children (n 59; mean
age 11.6; 6e17 years; 30 \; 83% right handed) were recruited from
local schools. The adult group (n 46; mean age 39.4; 18e86 years;
17 \; 93% right handed) comprised of a sample of convenience. To
be included in the trial, subjects had to be at least 6 years of age. The
exclusion criteria for all subjects were shoulder pain, neck pain and
a history of injury or surgery to the shoulder complex, upper
thorax, upper back or humerus during the previous year. The
exclusion criteria for all subjects were shoulder pain, neck pain and
a history of injury (in the previous year) or surgery (life-time) to the
shoulder complex, upper thorax, upper back or humerus.
Prior to clinical assessment, all participants received an information leaet and provided written informed consent. Minors
provided their verbal agreement and a written informed consent
from their parents or responsible adult. The study protocol was
reviewed and approved by the medical ethics committee of the
University Hospital Brussels (2006/138). The male subjects and all
children (<12 years) were tested with their trunk bare. Female
subjects wore a sports bra or a halter-top so that the scapula
remained visible and shoulder movements were not hampered by
clothing. All reference points that were used during the inclinometry and acromion-table distance were palpated (Lewis et al., 2002;
Morrissey et al., 2008).

Fig. 1. Winging of the right scapula.

Prior to the study, the assessor (holder of a bachelor degree in

physiotherapy) underwent a 4-h training session. The training
session was used to instruct the assessor in performing an accurate
measurement of scapular positioning and scapular dynamic control
including pilot testing on healthy subjects. The assessor was trained
by two instructors, one manual therapist, with 10 years of clinical
experience, and one sports physical therapist with 5 years of clinical experience. Both assessor and instructors performed test
evaluations without knowledge of each others outcome. When all
three (both assessor and instructors) nished the evaluation,
results were compared and discussed.
2.3. Outcome measures
2.3.1. Visual observation for tilting and winging
The observation was performed with the subject instructed to
stand relaxed (barefoot). The subject was observed from dorsal
(frontal plane) and lateral (sagittal plane). Ideally, the inferior angle
should be at against the chest wall (Mottram, 1997) and the
scapula should be 30 internally rotated with respect to the frontal
plane (De Groot, 1999). Scapular positioning was deemed impaired
when: (1) the inferior angle of the scapula became prominent
dorsally (rotating about the horizontal axis e tilting); (2) the entire
medial border of the scapula became prominent dorsally (rotation
about the vertical axis e winging: Fig. 1). If one (or more) of the
criteria listed above were fullled, then we judged scapular positioning as impaired (score 1). If none of the criteria were met,
then scapular positioning was judged normal. Next, in standing the
subject performed active maximal range of abduction. No differentiation in the amount of abduction was specied. The same
criteria as above were used to check for winging and tilting.
Systematically, both upward and downward upper limb movements had to last 5 s each. Scapular positioning was only deemed
abnormal if there was a clear observation of the positioning fault.
Each position was observed and evaluated once.

2.2. Study design

After measuring the subjects body mass and height, clinical
assessment was performed in the following order: observation of
forward tilt and winging, measurement of forward shoulder
posture (the acromial distance), scapular upward rotation (inclinometry) and scapular dynamic control Kinetic Medial Rotation Test
(KMRT)). After the assessment protocol, height and body mass were
measured using a measurement tape and a digital scale (Exacta,
Germany).

2.3.2. Forward shoulder posture (acromial distance)

The Acromial Distance was dened as the measurement of the
posterior border of the acromion to the table in supine (measured
vertically with a sliding calliper e Manutan, accuracy 0.03 mm)1,
intended to represent forward shoulder posture. The assessor
repeated this procedure while the subject actively retracted both

Manutan nv, 19 Doverstraat, Brussels, 1070, Belgium.

F. Struyf et al. / Manual Therapy 16 (2011) 155e160

157

shoulders. The subject was instructed to keep the thorax still in

relation to the examination table. The data collected with this
measurement were adjusted by dividing the measured distance by
the body length (BL), which resulted in a score entered as cm/cm.
Each position was measured once.
2.3.3. Scapular upward rotation (inclinometry)
A gravity referenced inclinometer (Plurimeter-V, Dr. Rippstein,
Switzerland; accuracy to 1 )2 (Green et al., 1999) was used to
measure shoulder elevation, and a second inclinometer was used to
measure upward rotation of the scapula. Again, all subjects were
assessed in a relaxed, standing (barefoot) position. Subjects were
asked to perform full extension at the elbow, neutral wrist position,
and with the thumb leading in the coronal plane. The inclinometer
was attached perpendicular to the humerus, just under the deltoid
insertion, with use of a Velcro tape. Subjects were then asked to
actively move both arms into abduction and to hold at 45 , 90 and
135 of humeral abduction (measured with an inclinometer)
(Fig. 2). The resting position of shoulder abduction was taken as
zero. The degree of upward rotation of the scapula was measured
using the second inclinometer. This was achieved by manually
aligning the base of the inclinometer along the spine of the scapula.
Each subject underwent one test-rehearsal before the test was
performed. The scapulohumeral rhythm was calculated by dividing
the shoulder elevation (humerothoracic) by the scapular upward
rotation (scapulothoracic).
2.3.4. Kinetic medial rotation test
The KMRT was used to indicate movement faults at the scapula
and glenohumeral joint associated with glenohumeral medial
rotation (Comerford and Mottram, 2001, 2003; Morrissey et al.,
2008). The test has been developed based on the combination of
clinical experience and research results addressing shoulder girdle
movement (Mottram, 1997, 2003; Comerford and Mottram, 2001;
Morrissey et al., 2008). The subject was positioned supine with
the humerus abducted to 90 in the scapular plane (hand to the
ceiling with the humerus in the plane of the scapula). The subject
was taught to perform medial rotation at the glenohumeral joint at
90 abduction whilst keeping the scapula still in its neutral position. The assessor then palpated the humeral head and coracoid
processes for translation (Fig. 3). The KMRT was performed up to
60 of medial rotation. Normative research data suggested that
during medial rotation to 60 e in non-painful shoulders e the
glenoid did not translate anteriorly more than 4 mm, and the
scapula did not translate more than 6 mm (Morrissey et al., 2008).
For this experiment test scoring was twofold: rst, this test was
scored positive (score 1) when the assessor felt that the scapula
tilted forward or when elevation occurred. Second, the test was
scored positive when the subject showed difculties in performing
the test (alteration of breathing pattern, feedback needed, support
needed, effort needed) (Comerford and Mottram, 2001). Each
subject underwent one test-rehearsal before the test was
performed.

Fig. 2. Measurement of scapular upward rotation at 90 humeral abduction by means

of 2 inclinometers.

Acromial Distance was found to generate reliable data (ICC > 0.88)
(Nijs et al., 2005) and is suggested to be indicative for pectoralis
minor muscle length (Host, 1995). Likewise, the plurimeter-V can
be used in an effective and reliable manner for the measurement of
scapular upward rotation during shoulder elevation in the coronal
plane (ICC 0.88) (Green et al., 1999; Watson et al., 2005). In
addition, excellent intrarater reliability was found for the assessment of scapular upward rotation in four static positions of
humeral elevation (Johnson et al., 2001). Validity has been shown
when comparing an inclinometer to a three-dimensional motiontracking device (Johnson et al., 2001). Finally, the KMRT has been
validated against dynamic ultrasound (Morrissey, 2005).
2.3.5.1. Data analysis. Means, standard deviations, and ranges were
calculated for all measured and corrected (AT-distance) data. A 1sample KolmogoroveSmirnov goodness-of-t test was used to
identify normal distribution. Since the descriptive data revealed
some high ranges, box plots were used to detect possible outliers.
For within subgroup comparisons, a Bonferroni adjustment for the
correction of Type 1 errors was performed. No signicant differences were found between the left and the right shoulder, therefore
both left and right shoulder were analysed together. An independent-samples T-test was used when analysing the difference
between adults and children using the inclinometry and acromial

2.3.5. Reliability and validity

Previous study on the inter-tester reliability of scapular observation concluded that observation of the scapula is a reliable tool
for screening prominence of the medial scapular border (winging)
and prominence of the inferior scapular angle (tilting) during
unloaded movement in healthy musicians (Kappa of 0.48 and 0.42
at rest, and 0.52 and 0.78 during unloaded movement respectively
for tilting and winging) (Struyf et al., 2009). In addition, the

Plurimeter-V, Dr. Rippstein, 1093 La Conversion, Switzerland.

Fig. 3. Kinetic Medial Rotation Test.

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F. Struyf et al. / Manual Therapy 16 (2011) 155e160

Table 1
Differences between adults and children in different scapular parameters.
Test

Observation
AT-distance
Inclinometry

KMRT

Observed position or movement fault

Tilting present
Winging present
Relaxed position (cm/cm)
Retracted position (cm/cm)
Scapular upward rotation at rest ( )
Scapular upward rotation at 45 humeral elevation ( )
Scapular upward rotation at 90 humeral elevation ( )
Scapular upward rotation at 135 humeral elevation ( )
Ratio from 0 to 45 of humeral abduction
SH ratio from 45 to 90 of humeral abduction
SH ratio from 90 to 135 humeral abduction
Negative KMRT
Positive KMRT

Children (n 116)

Adults (n 92)

(SD)

(SD)

17 (15%)
14 (12%)
0.28 (0.06)
0.15 (0.05)
12.4 (6.2)
4.8 (8.4)
18.6 (9.6)
49.9 (14.3)
7.1 (12.6)
2.4 (1.5)
1.6 (0.7)
107
11

18 (20%)
16 (17%)
0.31 (0.07)
0.20 (0.06)
11.8 (6.2)
5.7 (10.3)
14.5 (10.9)
47.3 (19.8)
6.6 (13.9)
3.2 (3.2)
1.6 (2.2)
78
14

P-value

Power

0.51
0.41
0.00
0.00
0.12
0.47
0.01
0.32
0.81
0.04
0.86
0.14
0.14

0.86
0.99
0.21
0.57
0.60
0.54
0.53
0.82
0.63

Abbreviations: SD: standard deviation; SH: scapulohumeral. Bold values: P < 0.05.

3. Results
Table 1 shows all differences between adults and children (Table
1). Overall, 15% of the study population demonstrated tilting, while
11% showed winging. The observation protocol for scapular winging and tilting did not show signicant differences between adults
and children. The BL correlated with the distance of the posterior
border of the acromion and the table (r > 0.46 relaxed; P < 0.01 and
r > 0.40; P < 0.01 retracted). The distance between the acromion
and the table with both shoulders relaxed was signicantly smaller
in children than in adults (P < 0.01). Fig. 4 shows the scapular
upward rotation in the different age categories. First, an decreased
scapular upward rotation is seen up to the 25e55-year-old group.
After that, the scapular upward rotation increased. Combining the
data of all subjects studied here, mean scapulohumeral ratio up to
135 of shoulder abduction was 2.76:1. Children showed greater
humeral elevation angles (158.9 ; SD 7.8 ) than adults (151.4 ; SD
9.8 ) (P < 0.001). In addition, children demonstrated with signicantly smaller scapulohumeral ratios in comparison to adults
(P < 0.05). A total of 11.9% (n 25) of all shoulders showed
a positive KMRT. No signicant difference was noted between
childrens and adults shoulders. A total of 11 children (19%)
demonstrated with a positive KMRT, whereas 14 adults showed
positive results (24%). With the sample of 116 children and 92
adults, power is greater than 0.8 for the AT-distance. Using the
Inclinometry, only the SH ratio from 45 to 90 of humeral
abduction attained sufcient power.

4. Discussion
Shoulder abduction involves a complex variety of movements
that has been the subject of numerous studies and discussions. The
present study has attempted to provide clinicians with indicative
data for interpreting clinical tests when assessing scapular positioning and motor control in adults and children. Secondly, this

study identied a number of statistically signicant differences in

scapular positioning between children and adults.
First, the observation protocol for scapular winging and tilting
did not show signicant differences between adults and children.
We suggest to further explore the observation of downward scapular rotation as this was previously identied as variable with
increasing age (Endo et al., 2004). These results should be taken
into account when assessing scapular positioning in subjects
without shoulder disorders: not all cases of scapular winging or
scapular tilting are related to shoulder impairments.
Second, forward shoulder posture was signicantly smaller in
children than in adults. After controlling for the BL, the mean ATdistance of children in relaxed and with bilateral shoulder retraction was smaller than in adults. Since the AT-distance is closely
related to the pectoralis minor muscle length and posterior tilting,
this nding is consistent with an earlier report of increased
posterior tilt in children compared to adults (Dayanidhi et al.,
2005). Additional comparison to other study results is not
possible: this is the rst study to report body length-corrected data
of the Acromial Distance. These indicative data may assist manual
therapists identifying abnormal forward shoulder posture.

50

40

Scapular upward rotation

distance. The ManneWhitney U test was used to identify potential

differences for the KMRT. A post-hoc power analysis was performed
for identication of possible type-II errors. A power of 80% was set
as standard for adequacy. The power analysis was performed using
SigmaStat 3.1 (Systat Software, Inc., San Jose, CA). Except for the
power analysis, data were analysed using SPSS version 12.0, for
Windows (SPSS, Chicago, Illinois, US)3.

30

20

10

-10
6-11 years 12-17 years 18-23 years 24-56 years 56-86 years

category
3

SPSS Inc., 233 S Wacker Dr, 11th Fl, Chicago, IL 60606, US.

Fig. 4. Scapular upward rotation between the ve age categories.

F. Struyf et al. / Manual Therapy 16 (2011) 155e160

Third, when comparing scapular upward rotation between

children and adults by means of two inclinometers, signicant
differences were found between the two age groups. Dayanidhi et al.
(2005), previously showed that children display more scapular
upward rotation (43.9 ; SD 6.4) than adults (29.1 ; SD 10.1).
However, they studied scapular upward rotation from 25 to 125 of
humeral elevation, while the present study examined up to 135 of
humeral abduction This explains their lower degrees of upward
rotation in contrast to the present study. Watson et al. (2005) used
the same measurements to study 26 adult shoulder patients. Overall,
their patients demonstrated larger degrees of scapular upward
rotation at rest (3.75 ), 45 (13 ) and 90 (28.3 ) of humeral
abduction than our adult study subjects (rest: 11.8 ; 45 :5.7 and
90 :14.5 ). However, above 90 of humeral elevation, the adults in
the present study demonstrate more scapular upward rotation
(135 :47.3 ) than the patients in Watsons study (135 :43.2 ). The
scapulohumeral rhythm is described as the relative movement
between the scapula and the humerus during arm movements. The
scapulohumeral rhythm is therefore dened as the ratio of the glenohumeral movement to the scapulothoracic movement during arm
elevation. In addition, several studies demonstrated similar scapulohumeral ratios ranging from 1.7:1 (McQuade and Smidt, 1998),
2.1:1 (Graichen et al., 2001), 2.4:1 (Sugamoto et al., 2002), up to 2.6:1
(De Groot,1999). The wide range of reported ratios appears to be due
to differences in measurement techniques and methodologies for
describing and dening scapulohumeral rhythm (McQuade and
Smidt, 1998). As a disrupted balance between scapular upward
rotation and humeral elevation might increase the risk of developing
shoulder disorders, assessment of scapular upward rotation and the
scapulohumeral rhythm are essential for physical therapists
(Sugamoto et al., 2002).
When searching scientic literature for differences between
children and adults, the study by Dayanidhi et al. (2005) reported
the following glenohumeral to scapulothoracic ratios between 25
and 125 of humeral elevation: 2.4:1 for adults and 1.3:1 for children. This is inline with our ndings. However, they did not include
subjects older than 46 years of age. In addition, between 45 and
90 of shoulder abduction, children demonstrated signicantly
smaller scapulohumeral ratios than adults. During this phase of
humeral abduction, a mechanical compression of the rotator cuff is
possible, creating a condition that is related with the subacromial
impingement syndrome (McClure et al., 2006). Thus, adults
demonstrate lesser scapular upward rotation during this phase,
which might explain the greater incidence numbers of shoulder
impingement syndrome in adults. However, direct measurement of
the subacromial space distance is required to conrm this. Finally,
our study found no signicant differences between children and
adults for scapular dynamic control during performance of the
KMRT. Research has provided us with an increased understanding
of motor control and its interactions with pain. The current study
did not show differences in motor control. However, we only
included healthy, (shoulder-) pain-free subject, whereas motor
control is probably mainly affected by the experience of pain.
Further study on the bilateral interactions of pain and motor
control is warranted.
However, some study limitations should be acknowledged. First,
comparing data across kinematic studies is difcult because of
several important methodological aspects that relate to kinematic
shoulder research: the choice of anatomical plane and the range of
motion studied, standardization of thoracic spine position, the
choice of bony landmarks and the method used to calculate angles
and describe motion, and the specic methods used to reduce and
present the data, such as whether the resting position is taken as
zero or is given a value based on a dened zero position. Second,
despite the dynamic nature of the scapulohumeral rhythm, mainly

159

static measurements during various positions of arm elevation were

used to describe the scapulohumeral rhythm, which may not sufciently represent functional movement patterns. Third, the number
of study participants who had experienced a shoulder injury more
than 1 year prior to study participation, was not registered. Fourth,
although concurrent validity of the digital inclinometers is known to
be excellent (Johnson et al., 2001), this has not yet been reported for
the analogue inclinometers. Finally, although previous studies on
the inter-tester reliability of clinical assessment tools (Green et al.,
1999; Johnson et al., 2001; Nijs et al., 2005; Watson et al., 2005;
Struyf et al., 2009) concluded that they are reliable for screening
scapular positioning, no inter-tester reliability analysis was performed to test the assessors accuracy. In addition, all our methods of
measuring and scoring of scapular motion should be validated
against accurate motion analysis. It is clear from the methodological
problems encountered here that, because of the complexity of
assessing three-dimensional motions, it is necessary to train manual
therapists in the difculties and pitfalls in interpreting scapular
kinematics (Baeyens et al., 2005).
The post-hoc power analysis demonstrated sufcient power for
the measurement of AT-distance, and the SH ratio from 45 to 90 of
humeral abduction. The lack of power in the other measurements
can be due to the magnitude of the study sample. However, we
believe a more precise measurement protocol would result in
smaller standard deviations and subsequently increase the power.
In conclusion, our ndings suggest that the clinical assessment
protocol, and more specic the measurement of scapular upward
rotation and forward shoulder posture, has identied a signicant
difference between children and adults: therapists can use these
clinical tools in both children and adults. In addition, manual
therapists can use the data presented here to identify abnormal
scapular positioning: scapular upward/downward rotation or
forward/backward shoulder posture (measured with analogue
inclinometers or the AT-distance) that exceed the presented values
(taking the SD into account), should alert therapists for a possible
scapular position that increases the risk for shoulder pathologies.
However, future work should aim at searching for a cut-off value for
identifying abnormal scapular postures associated with increased
risk for shoulder pathology.
Acknowledgments
This study was nancially supported by a research grant (G826)
supplied by the Department of Health Sciences, Artesis University
College Antwerp, Antwerp, Belgium.
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