The impact of Scapular Repositioning by using the Capular Belt to treat Axioscapular Muscle Inbalance in Patients with neck pain that is not specific to the area: A Case Report - Cureus

A typical cervical spine problem that often interferes with daily activities can be chronic neck pain. The axioscapular muscle imbalance which is caused by increased middle trapezius activities in people who suffer from non-specific chronic neck pain can affect cervical spine stability and can cause the pain. A man aged 67 who had been a retired secretary in the office, suffered from neck discomfort over the course of two years. Within the last four months, the pain increased, affecting his ability to perform and diminishing the quality of his living. In order to correct the axioscapular muscle imbalance, scapular repositioning using the use of a belt around the scapula was utilized to reduce muscle imbalances and aid in correcting posture. The results were computed by using the Numerical Pain Rating Scale (NPRS) as well as the Neck Disability Index (NDI) that showed significant shifts in the intensity of pain from 9 to 4 and disability scores that shifted between 48% and 20% in the treatments, both before and after as well as between the post and pre-treatment sessions. In order to reduce the pain in neck, this study examines the effects of scapular alignment using an scapular belt during the treatment of chronic non-specific neck pain.


Pain from chronic causes is serious medical issue that affects 17-27% of people around the world. The chronic neck discomfort and pain are common causes of impairment in adult (ages 15-74) among whom women are affected by neck pain more often than men . The most common causes of neck pain are poor ergonomics , and maintaining an incorrect position for a prolonged duration of. These issues can lead to myofascial pain syndrome, limited cervical mobility, as well as cervical spine malalignment. These can adversely affect a person’s health and quality of life.

The cervical spine is more prone to compressive and mechanical strains when you spend a lot of time working on laptops, e.g. secretary-types with their heads slanted forward, and the scapulae stretched, twisted and stretched downwards. Axioscapular muscle imbalance caused by these changes in cervical spine alignment can cause discomfort and stiffness in the neck due to changes in the movement and position of the scapulae as well as the thoracic vertebrae [3,43 4. The assessments of the scapular positions suggest the proper usage of the scapular belt. The scapula was evaluated in relation to superior and inferior rotation or abduction, and was rotated more than it should, and then in a downwardly rotated. The changes in the position of the scapula determine the scapular’s belt to allow scapular repositioning which is the process of applying pressure on the scapular muscles using an inverse figure-of-eight to pull the shoulder to correct the incorrect scapular posture which can result in neck pain. For many, excessive use of the shoulder alters the scapula’s posture at rest and can cause scapular dyskinesis and eventually it can cause neck discomfort. The present case report is was designed to evaluate the value that the belt scapular for the establishment of a perfect scapular alignment which is an important purpose of treatment plans for neck pain chronically.

Case Presentation

A man aged 67, a an office secretary who had retired, came into the office with the main complaints of neck pain that has been present for the last two years, that was aggravating for four months and was ongoing in its nature. It was evident that the cervical extension had become totally limited and even the smallest move was causing neck discomfort. On examination, the patient displayed postural deviations that affected the forward posture of the head and extended shoulders. The splenius and semispinalis capitis showed trigger points as well as tenderness of grade 1 on the spinal process that surrounds the spine upon palpation. When assessing the range of cervical extension movement (ROM) was insufficient and painful. Isometrics against cervical extensors were painful and weak. The diagnosis of neck pain not specifically related to the neck was established based on an assessment of the Numeric Pain Rating Scale (NPRS) as well as the Neck Disability Index (NDI). The patient’s level of pain at 9 in the NPRS during exercise with an NDI score of 48 percent recorded.

The scapula was moved by securing a scapular belt over the shoulders , in an eight-in-a-circle pattern. This is lifting the shoulders back while putting tension on the muscles located in the back of the scapula, to correct the forward protraction. As the therapist sits behind the patient while the patient is asked to lie down comfortably on a chair. The fixation portion of the belt put over the posterior part of the scapula. its free portion is then rounded to the left shoulder and then the left shoulder, in a figure-of-8 pattern. The pressure is applied laterally to the scapula, in order to pull it back. The force is then adjusted according to the level of compliance of the patient to position the scapula. The patient was instructed to wear the belt 3 days per every week, for 20 mins over 3 months (Figure 1.) [44].

Three sessions of scapular alignment using an scapular belt shoulders and a neutral chin noticed on the an observation. The intensity of pain decreased between 9 and 5 NPRS with an improvement in scapular alignment. The changes in the posture of the scapula prior to treatment indicated superior abduction, abduction and protraction. However, following treatment showed inferior rotation, adduction, as well as retracting to neutral. The cervical extension was improvements of between 0 and 50 °. It was measured the distance that lies between the medial line of the scapula’s scapula and spinous processes was determined in the level of T4. Prior to treatment the distance measured just 18 centimeters (cm) on both sides but after treatments, the distance was decreased to 8 centimeters on both sides. In addition the NDI score increased from 48 percent to 20%, as seen in Table 1.

Outcome Measures Pre-treatment Post-treatment
Numerical Pain Rating Scale (NPRS) 9 5
Cervical extension 0-10deg 0-50deg
The distance between the border medial of the scapula, and the spinous system at T4 level 18 centimeters (cm) 8cm
Neck Disability Index (NDI) 48% 20%

The patient was cooperative and remained faithful in the course of treatment. The patient did not experience any adverse or unanticipated outcomes.


Axioscapular muscle weakness is a significant cause of neck pain. It is heavily affected by the position that the person adopts and the position between the spine and shoulders. Alterations in the cervical spine’s position, for example, an inclination towards the head or protracted shoulders, can have consequences on movements and position of the scapulae and the thoracic vertebrae. The axioscapular muscles can cause neck discomfort [6,76.7.

Patients with axioscapular imbalance have higher middle trapezius activity than the lower trapezius. The reason for this is the reason that the scapula as well as the neck share similar muscles attachments [8,99].

Barbari et al. developed the scapular repositioning to improve the axioscapular muscles’ activities, which helps in alignment by adjusting the scapula’s posture and improving posture by relaxing the tension of muscles that are too tight. This also aids in decreasing the imbalance in the axioscapular muscles. This impacts the neck muscles and alleviates discomfort as measured clinically [10The study also found that the neck muscles are more relaxed [10.

This case report stands out from previous research studies as it seeks to show scapular repositioning using a scapular belt to treat chronic neck pain that isn’t specific to a particular cause.


This case study highlighted the benefits of a belt scapular for the treatment of chronic neck pain that is not specific to a particular cause and suggests that scapular alignment using an scapular belt can help those with neck pain that is chronic and non-specific in order to speed up the effects of physical therapy because people who suffer from axioscapular muscle imbalance have greater middle trapezius activity than the lower trapezius.