A strong and healthy back goes beyond the weight you can pull. It encompasses a solid range of motion, proper posture, identifying weaknesses or imbalances and correcting them. Considering that the back has 40 muscles, large and small, starting at the top of the neck and up to the tailbone; when something goes wrong, it can sometimes be difficult to identify the culprit. But not in the case of a winged scapula.
A winged shoulder blade (although it should be treated to prevent further pain or even injury) is easy to identify. And with a little help from a qualified physical therapist, a protruding shoulder blade and surrounding affected muscles can be corrected and strengthened.
Facts About Scapula Anatomy You Probably Didn’t Know
Surprisingly to most, the shoulder blade is inherently very unstable. “In fact, its only attachment to the posterior trunk is through muscle attachment, and the only articular attachment to the axial skeleton is through the clavicle,” says Cord DeMoss, physical therapist and co-owner of Vitality and Performance Therapy in Tulsa, OK.
This is an important note because the scapula is the site of attachment for 17 different muscles, many of which are heavily involved in dynamic stability.
“So what we have is relatively unstable bone which is the basis of stability for a lot of movement.” Says DeMoss. It’s no wonder the winged shoulder blade is so prevalent today.
What is winged scapula and how to identify it
According to DeMoss, “The winged scapula, traditionally speaking, occurs when the medial edge of the scapula protrudes, essentially coming off the ribcage.”
Rather than laying flat, the shoulder blade sticks out from your back. “In the orthopedic rehabilitation world, this is usually classified as scapular dyskinesia, which is a fancy way of saying that the movement of the shoulder blade is inadequate to how it’s designed,” DeMoss explains.
So, when one has a winged scapula, it is because the supporting musculature is not doing an adequate job of stabilizing the scapula. “It usually happens when there’s some sort of load on the arm, like in a push-up, overhead press, etc.,” DeMoss explains. Ideally, the entire shoulder blade should sit close to the rib cage as it moves forward and back. “However, we get a winged scapula when the muscles, especially the serratus anterior (also known as the boxers muscle), do a poor job of holding it down,” he further explains.
This makes identifying a winged shoulder blade quite easy as you will notice your shoulder blade protruding forward rather than lying flat on your back. Seeking the professional opinion of a physical therapist is a great way to be one hundred percent sure that your shoulder blade is bulging.
Symptoms of a winged shoulder blade
It is important to note that having a winged shoulder blade does not automatically mean that you will be in pain. In fact, if you walk around your gym, you’ll start to notice how many people have it.
“The increased prevalence is generally correlated with postural defects that pull the shoulders forward,” says DeMoss. Anterior chain tightness (think chest muscles) coupled with posterior chain weakness contributes to moving everything forward, which can lead to:
- Scapula protrusion
- Pain in the shoulder, arm and upper back
- Discomfort around the shoulder blade area
- Limited function of the affected arm and shoulder
- Discomfort in sitting position.
Why it is important to treat a winged shoulder blade
Since the scapula is a relatively unstable bone that is the basis for the stability of many movements, it is important to develop the musculature that stabilizes our scapula. This adds more strength and stability to a not so 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 do heavy squats on a surfboard in a pool,” he says.
However, if you can build the musculature that stabilizes our shoulder blade, it’s more like doing squats on the same surfboard, but with the surfboard sitting on the concrete path next to the pool. “It’ll be a lot easier to perform our squats and we’ll be a lot more powerful when the surfboard is on concrete,” DeMoss says. It’s a somewhat basic metaphor, but it gets the job done.
In DeMoss’ experience as a performance therapist, while a winged scapula does not always equate to shoulder pain, shoulder pain from someone who has a significant wing of the scapula indicates an imbalance and even a reduced ability to activate the right muscles.
“When this happens, the amount of free space in the glenohumeral joint (aka the shoulder joint) decreases, and that’s when we feel pinching pain, irritation excessive and even the early stages of tearing,” says DeMoss.
He adds, “As a performance physiotherapist, my job is not necessarily to fix their winged shoulder blade, especially the wing at rest, but it’s to optimize the movements they perform on a daily basis.”
An example of this would be – In an overhead press, rather than the scapula rotating upwards and extending, it will remain in a downward facing and inward facing position. This causes a
decrease in the space the upper arm must travel before effectively colliding with other irritating structures.
For example, the shoulder blade area as a whole serves best to be strengthened and mobile.
How to Treat a Winged Shoulder Blade (Don’t Do It Yourself)
When looking to treat winged shoulder blade, working one-on-one with a physical therapist is your best bet. Flying it yourself could cause more harm than good.
That being said, the main exercises/movements that DeMoss focuses on at least in the early stages of rehab are the activation of the serratus using:
- Serratus wall slides
- Serratus Half Knee Kettlebell Press
- Activation of the rotator cuff during arm movement
- Periscapular activation (especially medium and low trap).
“These are best started under the supervision of a PT as most athletes can’t tell if they are pulling in the right areas, but with some feedback they can learn what it should be like and then perform these drills by themselves.” said DeMoss.
So while it would be nice to be able to treat a winged shoulder blade on our own, professional guidance is the best way to heal and get stronger in this area until you know how to perform the movements correctly and you know what you are looking for. .
