What to do About Winged Scapula & Outwardly-Pointing Shoulder BladesOct 05, 2020
If you would rather see me talk about this than read, see below.
Winged Scapula are those shoulder blades that look like you could hook your fingers underneath them.
The term ‘winged scapula’ (also scapula alata) is used when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula. As a result, the medial border of the scapula protrudes, like wings.
In this guide, I will cover:
- How winged scapula develop
- Consequences of winged scapula
- What can be done to correct this issue
TL;DR: Winged scapula are often a result of the shoulder blade not being able to glide freely on the ribcage due to compression within it (poor breathing mechanics). This causes the scapula to deviate outward in an attempt to find more movement. To fix this, we need to make sure the scapula can first glide on the ribcage first, then address the musculature that can help re-orient it on the ribcage.
How Winged Scapula Develop
Generally speaking, the primary goal of the scapula is to glide freely on the ribcage. It needs to do so to allow for movement to occur at the humerus and arm.
The scapula and humerus have a delicate interplay of motion known as Scapulo-Humeral Rhythm.
This is probably the most important thing your scapula is responsible for, so it needs to freely glide on the posterior (back) ribcage in order for that to happen.
In addition, the scapula is a concave (rounded inward) structure that is meant to sit on a convex (rounded outward) posterior ribcage. That is a reason why there is a slight outward curvature in the normal human spine.
Scapulo-Humeral Rhythm is primarily concerned with shoulder flexion, or moving the arm overhead. As the arm progressively moves upward, there should be a ratio of scapular upward rotation for every degree of humeral flexion.
The muscles responsible for this are primarily the Serratus Anterior and Low/Upper Traps. Scapular winging is usually associated with weakness or dysfunctional activation in one or multiple of these muscles.
The scapula also goes into varying degrees of internal/external rotation as well as anteiror tipping depending on the level of shoulder flexion.
If the scapula is lacking any of the aforementioned qualities, it will likely find the best possible orientation where it can glide on the ribcage effectively. This is often a “winged” state.
In addition, if an individual has a lateral pelvic tilt and/or trunk rotation to one side causing a forward shoulder, the shoulder that is more forward and lower is likely to have a more winged scapula than the other side.
Consequences of Scapular Winging
A primary consequence would be a lack of range of motion within the shoulder, primarily in the actions of:
- Internal Rotation – 70+ degrees is ideal
- Adduction – 30+ degrees is ideal
- Extension – 60+ degrees is ideal
If these movements are missing, you’ll be missing a lot of movement capabilities within your shoulder.
This winged scapula orientation also often results in a forward translation of the humerus (forward shoulder) within the Glenohumeral joint which often causes impingement and subsequent discomfort.
On the front side of the body, this causes the pecs and other muscles to become tight and compresses the front side of the ribcage on that side, preventing it from expanding and that can limit breathing mechanics.
This can also affect the elbow. If the humerus is in this internally-rotated position, the forearm could also be biased towards too much pronation.
Very similarly to how femoral internal rotation and tibial external rotation causes a knee valgus, the forearm can try to find supination it is lacking up turning “out” (relative to the humerus) and cause an “elbow valgus”, which can heavily stress the elbow.
What Can Be Done For Scapular Winging
The first and foremost priority that is most often overlooked is the ribcage.
If the ribcage isn’t positioned well, neither will the scapula. Then the humerus won’t be either and it feeds down the chain.
So we should start with the ribcage and position that first to allow room for the scapula to “roam” on the ribcage, then address scapular position. This is the step most people miss and why many don’t get lasting results (in my opinion & experience).
We should start with addressing the front side of the ribcage to allow for expansion to occur there. When we inhale, the shoulders should translate backward and the scapula should posteriorly & downwardly rotate.
This activity will help gravity act “downward” on us to allow for expansion to occur in the front ribcage while also releasing the lat, a muscle that is often contributing to pulling the shoulder and scapula forward.
You’ll know you can get expansion in your ribcage anteriorly when you have passed the Humeral Internal Rotation, Adduction, and Extension measurements above.
After we can get expansion in the ribcage, we can then put the scapula in a better place. Two muscles that are very important for this are the low traps and long head of the triceps. Notice where the longer head of the triceps attaches. If it contracts, it will pull the scapula back.
Those are the two main steps that should be respected in that order. Those are just two exercises that can help in this situation, but is by no means a comprehensive approach.
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