A strong and healthy back goes beyond how much weight you can pull in the lat. It includes a solid range of motion, proper posture, identifying weaknesses or imbalances, and correcting them. When you consider that the back has 40 major and minor muscles, starting at the top of the neck and all the way down to the tailbone; When something goes wrong, it can sometimes be difficult to pinpoint the culprit. But not with a winged shoulder blade.
A winged scapula (although it should be treated to avoid further pain or even injury) is easy to identify. And with a little help from a qualified physical therapist, a protruding scapula and the affected surrounding muscles can be corrected and strengthened.
Scapula Anatomy Facts You Probably Didn't Know
What is frightening to most is that the scapula is inherently very unstable. "In fact, the only connection to the posterior trunk is through the muscular junction, and the only articulation to the axial skeleton is through the collarbone," says Cord DeMoss, physical therapist and co-owner of Vitality Therapy and Performance in Tulsa, OK.
This is an important clue as the scapula is the attachment point for 17 different muscles, many of which are heavily involved in dynamic stability.
"So what we have is relatively unstable bone, which is the base of stability for a lot of movement," says DeMoss. It's no wonder winged shoulder blades are so common today.
What is a winged scapula and how do you recognize it?
According to DeMoss, "The winged scapula, traditionally spoken, is when the medial edge of the scapula protrudes and essentially detaches from the rib cage."
Instead of lying flat, the shoulder blade protrudes forward from your back. "In the orthopedic rehab world, this is typically classified as scapular dyskinesia, which is a fancy way of saying that the movement of the scapula is insufficient compared to its design," explains DeMoss.
So if you have a winged scapula, it's because the supporting muscles aren't stabilizing the scapula enough. “This usually occurs when there is some kind of stress on the arm, e.g. like push-ups, overhead presses, etc.,” says DeMoss. Ideally, the entire shoulder blade would fit snugly against the rib cage as you move forward and backward. "However, we get a winged scapula when the muscles, particularly the serratus anterior (also known as the boxer's muscle), are bad at keeping it down," he continues.
This makes it fairly easy to identify a winged scapula as you will notice that your scapula is protruding forward and not flat on your back. Getting the professional opinion of a physical therapist is a great way to be 100% sure your scapula is swinging.
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Symptoms of a winged scapula
It's important to note that a winged scapula does not automatically mean you will experience pain. As you walk around your gym, you'll notice how many people have it.
"The increased prevalence typically correlates with postural defects that pull the shoulders forward," says DeMoss. Tension in the front chain (think pecs) coupled with weakness in the posterior chain helps everything shift forward, which can lead to:
- prominence of the shoulder blade
- Pain in shoulder, arm and upper back
- Discomfort in the shoulder blade area
- Limited function of the affected arm and shoulder
- discomfort when sitting.
Why it is important to treat a winged scapula
Because the scapula is a relatively unstable bone that provides the base of stability for many movements, it is important to develop the muscles that stabilize our scapula. This adds strength and stability to a less stable area.
DeMoss often compares the shoulder blade to a surfboard. "I tell my patients that if we don't develop scapular stability, it's like trying to squat heavy on a surfboard in a pool," he says.
However, if you can develop the muscles that stabilize our shoulder blade, it's more like doing squats on the same surfboard, but with the surfboard on the concrete walkway next to the pool. "It's going to be a lot easier to do our squats and we're going to be a lot more powerful when the surfboard is on the concrete," says DeMoss. It's a somewhat elementary metaphor, but it gets the job done.
Although a winged scapula does not always equate to shoulder pain, DeMoss' experience as a performance therapist suggests that shoulder pain in someone who has significant winging of the scapula indicates an imbalance and even a decreased ability to fire the correct muscles.
"When this happens, the free space in the glenohumeral joint (aka the shoulder joint) decreases, and this is when we get pinching pain, excessive irritation, and even the beginning stages of tearing," says DeMoss.
He adds, "As a performance coach, my job isn't necessarily to fix their winged scapula, especially at rest, but to optimize the movements they perform on a daily basis."
An example of this would be – On an overhead press, the scapula does not remain in an upwardly rotated and extended position, but in a downwardly rotated and internally rotated position. This causes a
Less space for the upper arm to travel before effectively encountering other structures that cause irritation.
The scapula area as a whole serves best for strength and mobility.
How to Treat a Winged Scapula (Don't Wing It Yourself)
If you want to treat winged scapula, working with a physical therapist is your best bet. Winging it yourself can do more harm than good.
That being said, the main exercises/movements that DeMoss focuses on, at least early in rehab, are the serratus activation with:
- Serratus wall slides
- Serratus Half Kneeling Kettlebell Press
- Activation of the rotator cuff during arm movement
- Periscapular activation (especially mid and low trap).
"These are best started under the supervision of a PT as most athletes can't tell if they're shooting in the right areas, but with some feedback they can learn how it should feel and then perform these exercises themselves." says DeMoss.
Although it would be nice to be able to treat a winged scapula yourself, until you know how to perform the movements properly and know what to look for, professional guidance is the best route to healing and strengthening in this area.