What is Scapular Winging and Should I Care?

Shoulder stability is key to building a strong foundation of support for your upper body, especially when the upper extremities are moving like when throwing a ball or weight lifting overhead.  A common imbalance we see in the shoulders is scapular winging.

Many people do not know they even have scapular winging because:

  • It usually does not cause discomfort.
  • It is difficult to see your own back, so you don’t even know you have it.

Failure to correct scapular winging can lead to overuse of other muscles, weakness in the primary movers, nerve damage, shoulder impingement and/or other injuries if left uncorrected.

A winged scapula can be visible upon posterior viewing of the back.  Typically we see protrusion of the inferior angle and vertebral (medial border near the spine) of the scapula protruding outward.

Scapular winging indicates:

  • Instability or weakness of the scapular stabilizers (primarily the rhomboids and serratus anterior (S.A.) that fail to hold the scapula in place
  • and/or tightness in the pectoralis minor muscle.

In a normal, healthy back, the scapula should be snug against the posterior ribs with no obvious edges visible as in the photo below.

How to Assess If You Have Scapular Winging

  1. Take a photo of your upper back while standing with arms at your side. Do you see the shoulder blades pop out?
  2. Take a video of you performing a wall push up while shirtless, or wearing a sports bra. Observe for winging of the scapula during movement.  

The photo above left has obvious scapular winging of the right shoulder while the photo on the right shows a fairly flat back with good scapular control during the wall push up test.

Can I Fix It?

To fix the scapular winging involves some Self Myofascial Release  (SMR) techniques, as well as stretching and strengthening exercises that will help to restore balance. First let’s try to figure out the primary culprit(s) for your scapular winging.

Tight Pectoralis Minor Muscle (Pecs)

The pec minor muscle attaches from your ribs to your shoulder blade. Tights pecs (from actual shortening) can occur from front rounding of the shoulders when we sit for prolonged periods or are hunched over a computer. This chronic tightening can tilt your shoulder blade forward, causing the winged look from the back.

Remedies for Tight Pecs

  1. Perform SMR by placing a lacrosse ball or soft ball directly under the pec muscle and rolling out tightness.
  • You can do this while lying on the ground or
  • Standing against a wall or corner of a weightlifting rig and leaning into the ball.
  • Apply pressure into the ball, move your arm around slowly.
  • If you find a painful spot, hold the ball on that area for one minute to release that trigger point.
  • Repeat 2-3 times every day.

2. Doorway Stretch

  • Standing in a doorway, extend both arms against the door trim keeping elbows at a 90 degree. Lean the body through the door slightly to get a good stretch of the Pec Major.
  • Now raise arms a little higher, around 2” with more of a “Y” configuration and do the same stretch. This will stretch the pec minor.
  • This can also be done in a corner of a room.
  • Hold for 1 minute and repeat 2X at each height.

Unengaged Serratus Anterior (S.A.) Muscle

The S.A. muscle holds your shoulder blades against your rib cage. If this muscle is weak, or not engaged appropriately, it will be ineffective, and lead to scapular winging.

Activate (Engage) the Serratus Anterior

  1. Assume a wall plank position with one arm on the wall but place the other arm on your serratus anterior muscles on the opposite side. You should feel the bumps where the S.A. connects to the ribs. Internally pull your shoulder blades down then try to draw your shoulders around the ribs. You will feel the S.A. muscle move when you have properly engaged it. It is difficult for many people to activate this muscle, so take time trying to move the various muscles until you feel it engage.  Once activated:
  • Hold the contraction for 30 seconds.
  • Repeat 5 times.
  • Practice activating the SA during push ups.
  1. Wall Push Exercise – perform a wall push with arms fully extended.
  • Activate the serratus anterior.
  • Push your arms into the wall keeping arms locked.
  • Protract your shoulders (slide then down and around).
  • Do Not round your back.
  • Hold this end position for 5 seconds.
  • Slowly bring your shoulders back to a starting position.
  • Repeat 10 times. Gradually progress to 30 reps.

     

     

    Do NOT round your shoulders

    3. Wall Push in Plank Position:

    • Same as above only have your forearms bent against the wall instead of extended out straight.4. Lying Dumb Bell Protraction:
      • Lie on back with knees bent.
      • Hold a DB straight over your shoulder (easily maintainable weight).
      • Activate the S.A.
      • Push the weight toward the sky while keeping the arm straight.
      • Hold for 5 seconds.
      • Return to starting position.
      • Repeat 10 times. Gradually progress to 30 reps.
Supine DB SA Push

Weak Rhomboids

Strong rhomboids hold the shoulders together, rotate the scapula down and provide stability for the shoulders. They also play a big part in posture. So when the rhomboids are weak, the shoulders tend to round forward, the back hunches over and we can develop pain between our shoulder blades and into our neck.  To strengthen our rhomboids:

  1. Prone Lateral Raises
    • Lie flat on your stomach. Hold a light dumbbell (DB) in each hand or no DB if performing for the first time
    • Place forehead on the floor or mat and keep toes down.
    • Raise the light DB’s with arms fully extended, thumbs up.
    • Once you have reached shoulder height, squeeze your shoulder blades together and hold for 1 sec. The goal is to isolate you back. You will only lift the DB’s a few inches.
    • Inhale, then slowly lower the DB to the starting position.
    • Repeat 8 X, gradually working toward 15 reps.

2. Front Raise Thumbs Up

  • Same as above but arms are straight out in front of you next to your ears.
  • Thumbs should be facing up, with no weights initially.
  • Keeping torso glued to the floor or bench you are lying on, slowly raise arms. Squeeze the muscles between your shoulder blades as you lift as high as you can without breaking form.
  • Hold for 1 second.
  • Repeat 10 times, gradually working to 15 reps.

3. Banded Pull Aparts

  • Using resistance tubing, keep arms at a 90 degree angle, elbows bent at chest level.
  • Extend the arms out laterally, fully extending the tubing until the arms are at full extension.
  • Squeeze the shoulder blades together.
  • Hold for 1 second.
  • Release the tubing slowly and start again.
  • Repeat 10 times, gradually working up to 20 reps.

We have covered a lot of important material regarding shoulder stability.  Now is a good time to perform these exercises if you have any sign of scapular winging or other shoulder weakness.  The strength you develop performing these exercises can prevent a more severe injury down the road.  Remember mobility, stability, strength and intensity, this is the roadmap to moving better and feeling better.

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