Markelle Fultz and the Mystery of Shoulder Imbalance

Oakville physiotherapy clinic with best Physio's treating sports injuries and MVA's

Basketball nerds like myself were excited this year to watch the finally-not-rebuilding Philadelphia 76ers and their band of young players, including their new draft pick, Markelle Fultz. We paid for our League Pass subscriptions and were pumped to watch Monday night games in Charlotte for any excuse to see Markelle, Ben Simmons, Joel Embiid and co do their thing… except Fultz has only been on the court for 4 games (as of mid-January).


Many theories abound but the team’s explanation is a shoulder muscle imbalance. Unfortunately, as evidenced by my rampant consumption of sports media, nobody seems to know what the heck that means.

The current issue of the British Journal of Sports Medicine features a systematic review and meta analysis (pooling of many studies to create a larger data set) on the subject of scapular dyskinesia (SD), and whether or not it predicts injury. Ask a few therapists and you’ll get an equal number of answers, but SD is basically a catch-all term describing a shoulder blade that doesn’t move exactly the way we might expect it to. This can be due to a number of causes, one of which is muscle imbalances.

The nitty gritty of the study is this:
  • 419 athletes, all of whom played an overhead sport (ie basketball, swimming, tennis etc) and reported they did not have any pain
  • Monitored for a year after initial assessment
  • Mix of teens and adults of both sexes

Gingerbread man showing gift ideas from oakville Physiotherapy clinicThe risk of any large review is that very rarely are two studies structured exactly the same, which makes pooling difficult. In this instance, SD is a highly subjective diagnosis that can vary between clinicians even if they use the same assessment tools. There is no agreement on what exactly constitutes SD and each study examined had a different standard. In addition, the outcomes varied but the researchers only wanted to know if pain did or did not occur within one year. Essentially, as with most research, apply the results narrowly and with caution. This is what they concluded:

  • In one year, overhead athletes with an initial diagnosis of scapular dyskinesia had a 43% chance of developing pain significant enough to keep them out of sport
So what?

Many participants in this study without SD also developed pain, so we can’t just say that fixing SD fixes all problems – if only it were so simple. However, it can help point us in the right direction. For Mr. Fultz, if we assume that 76ers are being honest, he may have benefited from a better structured training program while in high school and college. The shoulder is a naturally unstable joint and depends on the hard work of a bunch of muscles to keep things moving smoothly. While there is some disagreement within our profession on the specifics, we generally agree that mechanical wonkiness in the shoulder can lead to issues. The risk of this generally increases with repeated actions; this is certainly true of any overhead athlete, including a basketball player.

Again, so what?

How does this apply to the weekend warrior or casual athlete like me? A good piece of exercise advice that applies in other fields as well

                Play to your strengths, practice to your weakness


Every time your contract a muscle, another one has to stretch. If our activities are Yoga mat and exercise equipment looking out at Dundas and Bronte from our oakville Physio, massage and foot clinicbalanced, our bodies usually remain balanced (think about this when choosing between summer hockey and soccer, for example). If we repeat the same actions over and over, some muscles are bound to get strong, others are bound to weaken. Examine the movements you make in your chosen activity, and be sure to strengthen in the opposite directions. If you are an established exerciser, be sure to use a mix of bands, pulleys, and free weights in order to challenge those little muscles – bench and bicep curls twice a week ain’t gonna cut it. Have questions? Consult with a professional like a Physiotherapist.

Hikey et al. 2018. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. BJSM:52(2);1-10