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Pain Free Athlete
22 November 2016
Posture and Technique

What are winged shoulder blades?
The image to the right shows a young boy with winged shoulder blades (scapulae). Notice the pen marks on the inner edge of the scapulae where these bones are sticking out from his back. There is a gap between his rib cage below and his shoulder blades above. Ideally, the shoulder blades would sit snugly on the rib cage with no space, as shown in the image below.


Do you have winged shoulder blades?
Take a look by asking a friend or family member to visually examine, or take a photo of, your back. Prominent shoulder blades pulling away from your back, as pictured to the right, indicates winged scapulae. Another way to measure is to ask your friend or family member if s/he can easily fit his/her fingers up under your scapula, thereby revealing extra space between your shoulder blade and rib cage. Also, while examining, you may notice your right and left sides are not equal. This is not uncommon, but this misalignment can cause some issues.

 

What’s the problem with winged shoulder blades?
Whenever the body is out of position, there is weakness. Alignment is strength! Winged scapulae denote weakness and lack of proper function in the upper body. These muscle imbalances often lead to compensations, where other muscles and joints do the work of the weak structures. This often causes pain from overuse. There may also be chronic increased muscle tension, such as in the top of the shoulders and into the neck or in the mid-back. Sound familiar? Additionally, shoulder range of motion is frequently reduced, and the risk of injury, including damage to the rotator cuff, increases.

 

How did the shoulder blades become winged?
There could be several reasons. However, I am going to answer this question based on a common postural adaptation that often happens as a consequence of faulty breathing mechanics. Take a look at Figure A below. This image shows the scapula, rib cage and diaphragm, which is depicted as the top of the red curved line within and in front of the skeleton, in good position. Like the image directly above, there is no space between the shoulder blade and the rib cage. In contrast, Figure B depicts a poor postural position. The lower part of the rib cage has moved up and forward, away from the spine and shoulder blades, and the diaphragm is flattened out. As the rib cage rotates in this way, space is opened up between the scapulae and the rib cage, thus creating the appearance of winged shoulder blades.
But how does this relate to breathing?

 

Figure A Figure B
Figure used with permission from the Postural Restoration Institute© © 2016, www.posturalrestoration.com.

Let’s turn our attention to the squiggly red line in the figures. As I mentioned, the top of this red line represents the diaphragm, which should be the primary muscle of breathing. When we are breathing with good mechanics, the diaphragm returns to the domed (or hooked) position as shown in Figure A. When we are breathing poorly, and not exhaling completely, excess air becomes trapped in our system and the diaphragm doesn’t return to its fully relaxed (domed or hooked) position as shown in Figure B. This extended-forward position of the diaphragm pulls the rib cage forward and away from the scapulae. This, then, causes the winged shoulder blades.

 

 

Three Keys to Fixing Winged Shoulder Blades
To correct winged scapulae, the rib cage must be rotated back to a neutral position. The lower part of the rib cage needs to move down toward the pelvis, back toward the spine, and in toward your center. To attain this repositioning, the following three factors will need to be retrained through strengthening and integration exercises:

  1. Breathing Mechanics
  2. Abdominal Muscles
  3. Serratus Anterior Muscle

 

1. Breathing Mechanics
Specifically, you will need to focus on a complete exhale and expelling all of your air out. This allows the diaphragm to relax back into its domed position, rotating the rib cage down, back and in, thus eliminating winged scapula. The muscles that are needed to support this rearward rotation of the lower rib cage are the abdominals on the front of the body and the serratus anterior in the back.

If you’d like more information on breathing and posture, please check out these blogs:
My Low Back Hurts Because I Can’t Breathe!
Improve Core Stability and Posture with Diaphragm Training
The Secret Role of Your Abs

 

2. Abdominal Muscles
The abdominal muscles --external and internal obliques and transversus abdominis-- are exhalation muscles. They assist in compressing the trunk and lungs to squeeze the air out of the body. As you can see in the images above, all of these muscles have connections to the rib cage. When these muscle activate and shorten through forced exhalation, the rib cage is pulled into a more neutral position.

 

 Exernal Obliques  Internal Obliques  Transverse Abdominis
Source: Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., Romani, W. A. (2005). Muscles Testing and Function with Posture and Pain Fifth Edition. Baltimore, MD: Lippincott Williams & Wilkins.

 

3. The Serratus Anterior

  The serratus anterior lies between the rib cage and the scapulae, as shown to the left. Just as the abdominal muscles pull the lower rib cage down, back and in on the front of the body, the serratus anterior rotates the top of the rib cage up and into the shoulder blades. The serratus anterior must be strong to maintain the connection between the rib cage and scapulae without gaps or winging.
Source: Kendall et al. (2005).  

 

 

Exercises to Fix Winged Shoulder Blades
The following exercises are adapted from the Postural Restoration Institute© course, PRI Integration for Fitness and Movement. I recommend doing them in the order presented. If you find these exercises too advanced, please start with the exercises on my blog, 3 Exercises for Better Upper Body Posture.

Note: For all of the exercises presented, you will inhale through your nose and exhale out your mouth.

 

 

Knees to Chest

Starting Position
Begin in a plank position on a box, chair or bench, which is at your knee height or lower when standing. Place your elbows directly below your shoulders and extend, but do not lock, your legs straight behind you. Round your back by engaging your abdominals to pull the front of the pelvis up and ribs down. Think about rotating your rib cage up into your shoulder blades and pushing your back to the ceiling. In addition to feeling the work in your abdominal muscles, you should also feel the serratus anterior muscle tension right under your shoulder blades. Maintain this upper body posture throughout the exercise.

 

Movement and Breathing
With both feet extended and your feet on the ground, inhale into your back and push down into your elbows and forearms. Engage your trunk and round your back (as described above). As you exhale, bring your knee into your chest. Return the leg back to the extended position. Inhale and check your upper body position before you exhale, and repeat the movement with the other leg. You will alternate bringing the knee towards the same side arm, opposite arm and center. Repeat 5-10 times on each leg. Then rest and perform additional sets, if desired.

 

 

 

Side Plank with Bent Elbow

Note: Since you will be balanced on the sides of your feet during this exercise, I recommend using shoes for support and comfort.

Starting Position Begin lying on your side with your top leg in front of your bottom leg. Position yourself so that your torso and upper body is centered between your legs and aligned from your pelvis to head. Your hips will be on the ground and your bottom arm will be extended directly below your shoulder.

 

Movement and Breathing
Bring your top arm up, bending at your elbow with your fingers at the level of your ear. Pull both shoulder blades down and together, feeling the muscles between the spine and scapulae become tense. Keep your head looking straight ahead, which can be harder than it sounds! This was the only picture taken where I wasn’t looking down.

Next, lift your hips off the floor, and push into the floor with your extended arm to engage your serratus anterior, feeling the tension between the rib cage and scapulae. You will notice that I have pulled my left hip back behind my right. This increases the activation of your abdominal muscles, taking the strain off your back. As you pull your hip back, also bring your pelvis under using your abs to prevent back extension (arching). Breathe deeply into your back and sides while keeping your pelvis tucked and abs engaged. Hold this position for 30 seconds to one minute. Repeat on the opposite side.

 

 

Forward Punch

Starting Position
This exercise can be done with a piece of tubing anchored behind you, or on a cable machine at the gym. Whichever method you choose, keep the resistance light to start. In the image to the right, I have secured the tubing in the door frame by knotting the end of the tube.

Stand facing away from the door or cable machine with your bottom supported, lower back flat and abdominals engaged. Think of reaching your upper back towards the door or machine as your abdominals engage to hold your rib cage position in the front. Place your feet parallel to each other. Notice the weight in your heels. Keep your weight back in your heels with light toe contact and awareness of your arches throughout the exercise. Slip your hand through the loop of the tube or handle of the machine.

 

Movement and Breathing
From this starting position, bend your knees into a small squat. You will notice that my right knee is bent more and is slightly ahead of my left. This is assisting me to shift and center on my left leg. This should happen naturally when you reach forward. As you exhale, reach the arm forward that is holding the resistance. Be careful to reach the arm down, below shoulder height. You want to engage your serratus anterior, under the scapulae, and not your deltoids on the top of the shoulder by your neck. You may need to adjust your arm position lower to feel the correct muscle. I also find that keeping a slight bend in my elbow helps. As you reach forward on one side, you will notice your weight shifting to the opposite side. This increases the abdominal contraction and heel pressure on that side. In the photo, as I am reaching with my right arm, the contraction of my left abdominals increases along with the pressure in my left heel. Hold this position for 30 seconds to 1 minute. On each exhale reach farther forward, being aware of maintaining correct form in your torso --lower back flat, abs engaged, rib cage pushing towards the door --and pressure in your feet-- heavy heels, light pressure on the toes and awareness of your arches.

 

 

Summary

Winged shoulder blades can be caused by poor breathing patterns that alter posture. Primarily, exhalation is not complete, leaving residual air in the system that leaves the diaphragm extended. Since the diaphragm is located within the rib cage, its failure to relax and redome affects the position of the rib cage. The lower rib cage is pulled up and forward in front and rotates beneath and away from the scapulae. This change in rib cage orientation creates space, or winging, between the rib cage and shoulder blades. To fix winged scapulae breathing mechanics, abdominal muscles and the serratus anterior muscle must be retrained and strengthened to reposition the rib cage and reconnect it with the shoulder blades.

Winged scapulae can be fixed! The exercises above will help reposition your upper body when done consistently, three or more times a week. As with any strengthening exercises, you should notice improvements quickly in your ability to perform the exercises as your body becomes more efficient in the movements. Further strength gains will take six weeks or more. In addition to gaining greater shoulder mobility and strength while reducing your risk of injury, you may also experience less tension and stiffness in your upper body as a result of overworked muscles finally being able to relax as the body begins functioning as designed again. And, your breathing will improve, which is likely to give you more energy and better sleep. It may also enhance the action of many of your body systems. Fix your winged scapulae and many other benefits will follow! Get started today--and feel free to contact me if you have questions.

 

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