How to fix a Winged Scapula

winged scapula

Image from ePainAssist.

What is a Winged Scapula?

A Winged Scapula is when the medial (inner) border of the shoulder blade protrudes off the rib cage.

 (… Ideally – it should sit completely flat!)

Winging of the scapula can be observed in:

  • Natural resting posture (static) and/or
  • Certain shoulder movements (dynamic).

It is often one of the causes of shoulder impingement and shoulder blade pain.

 

What are the causes?

1. Pec minor tightness/over-activity:

Have a look at your posture. Are your shoulders rounding forward?

If they are… I can guaranty that your pec minor muscle will be tight (along with the upper trapezius, levator scapula and biceps). And this is a problem!

Why?…

Not only will it pull the shoulder blade off the rib cage, it will also place the shoulder blade into an ineffective position.

This will lead to…


2. 
Serratus anterior weakness/inhibition:

The Serratus anterior is the primary muscle that keeps the scapula flat on the rib cage.

If you do not have control of this muscle, it may result in a winged scapula.

 

 

3. Long thoracic nerve palsy:

The Long thoracic nerve supplies the Serratus anterior muscle.

Therefore – any damage to this nerve will result in the inability keep the scapula flat onto the rib cage.

(However… from what I have come across in the clinic, Long thoracic nerve damage is actually very rare!)

 

Quick tests – “Do I have it?”


Image courtesy of Stuart Miles at FreeDigitalPhotos.net

a) Static test

Take a photograph of your back.

Can you see the inner border of the shoulder blade pop out?

b) Dynamic test:

Take a video of yourself performing a push up onto the wall.

Observe for any winging of the scapula during movement.

How to fix a Winged Scapula


Note: All exercises are to designed to be performed pain-free. If you are unsure of anything, please feel free to contact me on the facebook page.


 1. Release the pec minor

The pec minor is actually quite a difficult muscle to stretch properly.

Solution?… Release it!

Instructions:

  • Place massage ball directly underneath of your pec minor.
    • To locate your pec minor, you can see it here.
  • Apply pressure into the ball using your body weight.
  • To increase the release, move your arm around.
  • Hold for 1  minute.
  • Repeat 3 times.

 

2. Stretches

These tight muscles pull the shoulder blade into a position where the Serratus Anterior muscle is unable to function properly.

(For a more great stretches, check out the post on How to fix Rounded shoulders.)

a) Upper trapezius

Instructions:

  • Hold onto a stationary object at hip level.
    • (You can also use a stretch or resistance band if you have one.)
  • Lean away from that hand to lock the shoulder blade down.
  • Tilt your head in the opposite direction.
    • To increase stretch: Pull the side of your head further using your other hand.
  • Aim to feel a stretch between your shoulder and neck.
  • Hold for at least 30 seconds.
  • Repeat 3 times.

b) Levator scapula

Instructions:

  • Hold onto a stationary object at hip level.
    • (You can also use a stretch or resistance band if you have one.)
  • Lean away from that hand to lock the shoulder blade down.
  • Tilt your head towards the opposite arm pit.
    • To increase stretch: Pull the side of your head further using your other hand.
  • Aim to feel a stretch between your neck and shoulder blade.
  • Hold for at least 30 seconds.
  • Repeat 3 times.

c) Pec minor

Instructions:

  • Place your hand on a door frame. (see above)
  • Keep your shoulder blades locked downwards.
  • Lunge forwards.
  • Aim to feel a stretch in the chest area.
    • Make sure that you do not arch your lower back as you push into the wall.
  • Hold for 30 seconds.
  • Repeat 3 times.

d) Front shoulder stretch

Instructions:

  • With both hands on a bench behind you, let your body sink down as low as possible. (see above)
  • Keep your shoulder blades squeezed together.
  • Keep your elbows in. Don’t let them flare out.
  • You should feel a stretch at the front of your shoulders.
  • Hold for 30 seconds.
  • Repeat 3 times.

 

 

3. Wake up your Serratus Anterior!

The Serratus Anterior is the most important muscle in fixing your winged scapula! It keeps your shoulder blade flat on your rib cage!

** Hey you! – Read this! **

In all of the following exercise, it is VITAL that you know how to activate and feel the serratus anterior muscle working.

Activating the Serratus anterior:

Instructions:

  • Assume the wall plank position.
  • Activate the Serratus anterior. (… Remember this!! I’m going to keep repeating it below.)
    • Tilt the shoulder blades BACKWARDS.
    • Pull your shoulder blades DOWN and AROUND the ribs.
  • Push your forearms into the wall.
  • Aim to feel the contraction in the lower and side region of the scapula.
    • (… This is where the Serratus anterior muscle is!)
  • Hold for 30 seconds.
  • Repeat 5 times.
  • Progress this contraction with your arms in different positions to get a good feel of the exercise. (see above)

Once you understand exactly how to ENGAGE the serratus anterior, let’s get started with the exercises!

Note: The below exercises are arranged in order of difficulty. Aim to progress to the next level only when you are ready.


Level 1: Isolate the Serratus anterior. 

a) Rock back

 

Instructions:

  • Assume the plank position with your knees on the floor.
  • Activate the Serratus Anterior.
  • Push your forearms into the floor.
  • Rock backwards and forwards.
  • Repeat 30 times.

b) Push up plus (wall)

Instructions:

  • Assume the push up position on the wall with your arms straightened.
  • Activate the Serratus anterior.
  • Push your arms into the wall.
  • Whilst keeping your arms completely straight, proceed to protract your shoulder blades.
    • Think of your shoulder blades gliding down and around.
  • Do not round your back.
  • Hold this end position for 5 seconds.
  • Slowly bring your shoulder blades back to the starting neutral position
  • Repeat 30 times.

c) Push up plus (plank position)

Instructions:

  • Assume the plank position on the wall. (see above)
  • Activate the Serratus anterior.
  • Push your forearms into the wall.
  • Whilst keeping your forearms on the wall, proceed to protract your shoulder blades.
    • Think of your shoulder blades gliding down and around.
  • Hold this end position for 5 seconds.
  • Bring shoulder blades back to the starting neutral position
  • Repeat 30 times.

 

Level 2: Serratus anterior isolation (+ Resistance)

d) Push up plus (with resistance band)

Instructions:

  • Hold onto a resistance band as shown above.
    • (Make sure you choose a resistance you can handle.)
  • Assume the above position on the wall with your arms straightened.
  • Activate the Serratus anterior.
  • Whilst keeping your arms completely straight, proceed to protract your shoulder blades.
  • Hold this end position for 5 seconds.
  • Bring shoulder blades back to the starting neutral position
  • Repeat 30 times.

e) Protraction in lying

Instructions:

  • Lie on your back with your knees bent.
  • Whilst holding onto a weight, lock your arms straight in front of you.
    • Use a weight that you are able to control properly.
  • Activate the Serratus anterior.
  • Push the weight up towards the sky whilst keeping the arm straight.
  • Hold for 5 seconds.
  • Return to starting position.
  • Repeat 30 times.

Level 3: Serratus anterior activation (+ Shoulder movement)

f) Push up

Instructions:

  • Assume a push up position on the wall.
  • Activate the Serratus anterior THROUGHOUT movement.
  • Perform a push up.
  • Repeat 30 times.

g) Wall slides (with resistance band)

Instructions:

  • Hold onto a resistance band. (see above)
  • Assume the wall plank position.
  • Activate the Serratus anterior THROUGHOUT movement.
  • Slide your forearms up/down the wall.
    • Maintain pressure on the wall through the forearms
  • Repeat 15 times.

h) 1 arm pivot

Instructions:

  • Assume the wall plank position. (see above)
  • Activate the Serratus anterior muscle.
  • Push the forearm (on the side of the winged scapula) into the wall.
  • Whilst keep that arm fixated on the wall, rotate your body away.
  • Return to starting position.
  • Repeat 15 times.

i) Arm raises (with resistance band)

Instructions:

  • Hold onto a resistance band. (as shown above)
  • Activate the Serratus anterior THROUGHOUT movement.
    • Try to push your hands as far away from the body whilst keeping your shoulder blades back, down and around throughout movement.
  • Raise and lower your arms from your side.
  • Repeat 15 times.

 

 

Level 4: Weight bear (Both arms)

j) Plank

Instructions:

  • Assume the plank position on the floor. (see above)
  • Activate the Serratus anterior muscle.
  • Push the forearms into the floor.
  • Hold this position for 30 seconds.
    • (If you can not hold this with good technique, try to do the exercise with your knees on the floor)
  • Do NOT let your shoulder blades cave in.

k) Push up

Instructions:

  • Assume the push up position on the floor. (see above)
  • Activate the Serratus anterior muscle THROUGHOUT movement.
  • Perform a push up.
  • Do NOT let your shoulder blades cave in.
  • Repeat 10 times.

 

Level 5: Weight bear (Single arm)

m) Straight arm plank (with pivot)

Instructions:

  • Assume the straight arm plank position. (see above)
  • Activate the Serratus anterior muscle THROUGHOUT exercise.
  • Lean your weight into the hand that is on the side of the winged scapula.
  • Whilst keep that arm fixated on the floor, slowly rotate your body away.
  • Return to starting position.
  • Repeat 10 times.

 

l) Plank (with reach)

Instructions:

  • Assume the plank position. (see above)
  • Activate the Serratus anterior muscle THROUGHOUT exercise.
  • Lean your weight onto the forearm that is on the side of the winged scapula.
  • Whilst keep that arm fixated on the floor, slowly reach forward.
  • Return to starting position.
  • Repeat 10 times.

 


Remember…

Now that you know how to engage your Serratus Anterior muscle, it is important that you practice activating it throughout the day.

Keep your shoulder blades tilted backwardsdown and around.

 

Any questions?… Leave me a comment down below!

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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6 thoughts on “How to fix a Winged Scapula

  1. Mark,

    THIS IS EXACTLY WHAT I WAS LOOKING FOR!

    Thank you so much for posting it.

    I am so excited to start these exercises.

    I’ll keep you up to date!

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