## 4 Discussion
### Scapular Muscular Activity and Ratio Data  
Considering the results presented above, the changes exhibited by the symptomatic group in muscular activity level, which are expectable in pain conditions and given scapular dyskinesis [93], could have primarily arisen to facilitate the entire shoulder motion necessary to ensure the upper limb function [94]. More specifically, in the present study, the symptomatic group an demonstrated increased muscular activity level for the MT, LT, and LS, which was both statistically significant and higher than the intra-session minimal detectable change values found for some scapulothoracic muscles when normalized by maximal voluntary isometric contraction [95] (with the exception of MT during shoulder lowering with load). Although presenting a muscular activity level below 50% of the SVIC [96] (from 3.67% \(\pm\) 1.69 to 36.65% \(\pm\) 16.01), the observed increased activity of the MT was consistent across all the movements and drinking task phases. Similar results were also found for LT during the drinking task, except during the drinking phase. Additionally, the LS also presented an increased activity level in the symptomatic subjects during the shoulder elevation performed with load (the most demanding shoulder elevation) and during various phases of the drinking task phases, except the drinking phase. All these mentioned changes could potentially be compensatory strategies. MT, LT, and SA collaborate in maintaining scapular stability against the thorax [8; 15; 83; 97], with MT and LT acting as retractors to offset protraction forces produced by SA activation [9; 97; 98]. Furthermore, these muscles contribute to external rotation [8; 98], upward rotation [8; 15], and, in the case of LT, even to posterior tilt [9] and depression [5; 97; 98]. Considering these facts and the presence of scapular dyskines in all symptomatic subjects (17 of 20 subjects presenting a prominent scapular medial border), it seems that the increased activity of the MT and LT could be an attempt to enhance scapular stability [15] and, in certain situations, counterbalance SA muscle activation [93]. Furthermore, although it was not possible to evaluate the Pm in the present study, the increased activity of MT and LT could also compensate for changes in this muscle that, when changed in shoulder pain conditions [8; 99], could favor scapular adaptations such as winging or internal rotation [100]. A previous study comparing overhead athletes with shoulder impingement and healthy athletes during push-up exercises on an unstable surface also reported increased activation of the MT muscle of symptomatic subjects, suggesting that MT may be providing more stabilization in this group [15]. On the other hand, previous studies have reported a decreased MT activity level [37; 98] (particularly related to its timing activation) or no differences in this muscle's activity [30; 83] during other tasks. Although some of these findings were reported for subjects with shoulder pain without reference to the assessment of scapular dyskinesis [30; 83; 83], a study comparing subacromial impingement with and without scapular dyskinesis also did not find differences between groups during shoulder flexion [101]. Moreover, the findings of the present study considering LT muscle activity were consistent with the results of previous studies [38], contradicting what is typically expected in subjects with shoulder pain [8; 14; 20; 21]. So, it seems that shoulder pain conditions may lead to different adaptation strategies, perhaps depending on the presence of scapular dyskinesia or factors such as the muscles affected by pain [102] or those closer to the symptomatic area [103]. Considering the role of LS as a scapular elevator [11; 23; 104], downward rotator [8; 11; 23; 104], and possibly retractor [104], its increased activity could also be a strategy to allow for symptomatic subjects to perform the entire movement/task and/or to minimize pain during motion [94].