352 | Scapular Winging? What can you do!

[00:00:00] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom, and we are Doctors of

[00:00:10] Physical Therapy bringing you the body tips and physical therapy pearls of wisdom to help

[00:00:14] you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover

[00:00:24] what Optimal means within your own body. Let's dive in! Dr. Dom Fraboni So before we jump into the PT

[00:00:30] Pearl, I have to tell you that Vivo Barefoot has upped our discount code for this month only. So

[00:00:35] for all of April, you can get 25% off using code TOB25. We have never had a discount code

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[00:00:52] love about Vivo's is they have shoes for every single occasion. Some of our favorites for movement

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[00:01:22] notes. You can make sure you get that 25% discount using code TOB25 and I promise you,

[00:01:29] you will feel the difference in your feet. All right, next up we have scapular winging or

[00:01:35] winging of our shoulder blade. I think this is something that happens to a fair amount of

[00:01:39] people and it's a little bit scary the first time it happens. It can look a little odd,

[00:01:42] which might make people go, Oh my gosh, what's going on to your shoulder? But is it really a bad

[00:01:48] thing? I know. I think this is such an important topic because there is a lot of fear in weird

[00:01:54] movements, which for me was always, you know, my party trick. I'd be like, Oh, look at how I could

[00:01:59] just like kind of push my shoulder blade off my spine and people will be like, Oh my God.

[00:02:04] And I could also like just so rotate my shoulder blades forward that when I was really

[00:02:10] strong too in gymnastics, I would like look like the Hulk. Those were like my special shoulder

[00:02:14] blade tricks. Go beast mode with your shoulders. It wasn't muscles. It wasn't upper traps. It was

[00:02:19] literally my shoulder blades like roll into the top. I made the muscles look big though.

[00:02:24] It did serve this purpose, right? So what the heck is scapular winging? What causes it?

[00:02:30] Why does that happen? Yeah, so when we're talking about scapular winging, we're thinking

[00:02:35] that the lower edge of that shoulder blade that is closest to the spine is kind of popping off of

[00:02:42] the rib cage. And that's where you can kind of see like some space underneath that shoulder blade.

[00:02:47] And what happens if that back portion is then popping off, that means the shoulder blades kind

[00:02:51] of rotating forward and up just a little bit. So it almost think of rounded shoulders, but

[00:02:58] a little bit more just in the shoulder blade rather than the shoulders itself on the front.

[00:03:03] And that's why you kind of get that winging and a lot of people see it through movement or exercise.

[00:03:10] Yeah, like if I do this certain movement, then I notice my shoulder blade pops out this certain

[00:03:15] way. And the shoulder blade or the scapula is kind of in an interesting spot because it's

[00:03:19] just kind of floating there. It's not like directly attached to another joint. It more

[00:03:23] so just slides along that rib cage and stuff. And it has like a bajillion things connecting

[00:03:29] into it. Like we got the upper trap and the biceps and we got our rotator cuff muscles.

[00:03:35] All of the rotator cuff muscles. So if we think of all those stabilizers or anything that kind of

[00:03:40] inches underneath that shoulder blade that we got the stabilizing, the serratus anterior everyone

[00:03:46] likes to talk about. Serratus anterior, our rhomboids, all those things that tuck our shoulders

[00:03:49] back. Our traps. The lats even in some people will connect through the bottom edge of the

[00:03:54] bottom angle of that shoulder blade. So so many things pulling and tugging on the shoulder blade

[00:04:00] and so many things like our pecs, like our upper traps, like our lats that we know can be kind of

[00:04:05] those trouble muscles. And if one of those is angry or has a lot of tension in it,

[00:04:10] it may throw off all of our shoulder blade motions just because we have one angry muscle,

[00:04:14] let alone if a few of those are not firing together right?

[00:04:18] And that's where a lot of people like to say, well, if it's super tight pecs or

[00:04:22] super tight lats, I just need to rub them out. I need a massage amount.

[00:04:25] I need to stretch the back and then strengthen the retractors.

[00:04:28] Yeah, which it's like, well, why is my brain connecting to my peck muscle or why is my brain

[00:04:36] connecting to my lat to say you are my stabilizer? You are the muscle that's going to control

[00:04:42] my movement here. And so it's almost like, is it an angry muscle or is it an overpowering

[00:04:50] muscle or one that has learned a little bit differently than we would have expected throughout

[00:04:54] life. And now every time we go to push or raise our arm or reach behind our back,

[00:04:58] our peck is like 100%. Yeah, I do this. Go. And that's a very excited muscle.

[00:05:05] Totally. And then the next question is if our shoulder blade is doing some of these funky

[00:05:09] things, do we have pain? Does that mean that we're going to be injured?

[00:05:14] And so as we've continued to study this throughout the years, like early on in physical

[00:05:18] therapy, that was the thing that you look for. If someone has shoulder pain,

[00:05:22] they probably have some what we call shoulder dyskinesia or just kind of funky weird shoulder

[00:05:28] blade movement through their shoulder range of motion. And we're coupling those two. But

[00:05:34] as we've continued to study, we cannot correlate scapular dyskinesia or again, like as you're

[00:05:42] raising your arm one shoulder blade kind of takes a little time to get up there or

[00:05:47] doesn't quite move right or maybe elevates or does crazy things as we're moving,

[00:05:52] different than the other side. But what we're seeing is that we can't correlate it. Some

[00:05:58] studies can be like, oh yeah, more athletes got injured and then where others were like,

[00:06:05] that didn't correlate at all. Yeah, it's really hard to draw a direct like,

[00:06:09] hey, because your shoulder blade was doing this interesting motion, that's the reason

[00:06:14] that you have pain or that's the reason that you have a rotator cuff tear. Well, no,

[00:06:18] because we might see that same motion in people who don't have an injury or go their whole life

[00:06:22] without having a severe injury or shoulder pain. So again, if we're seeing a major shoulder

[00:06:29] dyskinesia, which we said this winging scapula is kind of underneath this larger umbrella of

[00:06:35] shoulder dyskinesias, which dyskinesia literally means like wrong or incorrect movement.

[00:06:40] That's all that word means. So if we are seeing that in somebody, then it's more like, hey,

[00:06:46] are you aware that you do this? Are you aware your shoulder is moving in this way?

[00:06:50] Because say that person wants to start a big Olympic lifting program or doing resistance

[00:06:55] training, we might want to see how we can get them more aware of how that shoulder blade and

[00:07:00] arm is moving before we start loading it up and doing a bunch of resistance training through

[00:07:04] those movements. Right. And I think one of the other studies that really popped out to me too

[00:07:09] was there was a study that looked at two groups of people who had shoulder pain or subacromial

[00:07:16] shoulder pain, which really just means pain in that shoulder region. And usually with overhead

[00:07:23] lifting, it could think of bursitis, rotator cuff, impingement, any of those kinds of things.

[00:07:30] AC joint, anything. Yeah. So think of all of those things. And what they did is they separated

[00:07:35] these people into two groups, one who did just kind of rotator cuff strengthening,

[00:07:41] which still attaches onto the shoulder blade. But the shoulder blade is more in a stable position.

[00:07:47] It's not moving. The shoulder blade is not doing the motion.

[00:07:50] And then another group that did rotator cuff exercises plus additional like six to eight

[00:07:58] scapular stabilizing exercises. And they did exercises that really just focused on

[00:08:05] really drawing the shoulder blades back and down and together. And so if we think of like when

[00:08:11] people are usually telling us go into good posture, it's usually bring the shoulder blades

[00:08:15] back and then draw them back into your pockets like that into your back pockets. It's what

[00:08:20] was kind of like the language that they used in physical therapy school.

[00:08:23] And so those were really like the scapular stabilizer muscles or exercises that they focused on.

[00:08:29] And what they found was that there was no difference between the two groups after eight weeks. So they

[00:08:35] did these exercises three times a week for eight weeks. And at the end of the day, both groups

[00:08:40] reported the same level of, well, you know, how their pain changed. But they also looked

[00:08:47] at muscle strength. They looked at shoulder range of motion. And in both groups, they had

[00:08:52] the same improvements. And so really at the end of the day, they said, well, this didn't mean anything.

[00:08:59] And so adding you can add shoulder stabilizing muscle or exercises into your exercise program,

[00:09:04] if you want to, it might not mean that there's going to be any significant change.

[00:09:08] I think more what that is pointing out too is that, okay, all we knew about those people

[00:09:14] is that we're all having shoulder pain. And we've already talked about how

[00:09:17] hundreds of different things can be caught like contributing to that shoulder pain, right? So

[00:09:23] if we blanket assign the same thing to everybody, it's not really going to be addressing specifically

[00:09:30] what they might need. So I would kind of expect similar change in all them, because some of

[00:09:35] them it might not be helping at all their specific imbalances or their specific patterns.

[00:09:40] Secondly, if we're again just focusing on Oh, they have shoulder pain, let's look at the

[00:09:44] shoulder. Let's look at the shoulder blade, even let's throw in the shoulder blade, right?

[00:09:49] Yeah. Those areas are so connected to how the back moves, how the neck might be positioned,

[00:09:54] what our rib cage is doing on top of our pelvis and how those are in relation to each other.

[00:10:00] And it's like, okay, we can do these in a controlled stationary environment, rotator cuff

[00:10:05] and scapular stabilization. But as soon as we stand up and try doing that scapular exercise,

[00:10:10] what's our rib cage and our pelvis doing? And how have we coordinated those to move better together?

[00:10:16] Exactly. Now I'm going to the store and I'm lifting things or I have my kid or have my,

[00:10:20] you know, like how are these all relating to functional movement, which is what we're

[00:10:23] trying to get people back to anyways. And when we only focus on the shoulder blade,

[00:10:28] it's like the same thing of just focusing on the pain area, which is really hard for me

[00:10:32] because I don't like to say, Oh, this is your pain. This is what to do for this area.

[00:10:39] And we've talked about the reason why before another podcast, but especially when it comes to

[00:10:44] the shoulder blade, like Dom said, the rib cage is a huge component. If your rib cage isn't even

[00:10:49] expanding, so moving movement into the rib cage based on your diaphragmatic breathing,

[00:10:55] your shoulder blades don't have a good place to glide over in the first place.

[00:10:59] So other muscles are going to have to work and compensate to help.

[00:11:02] So that's one right there. Yeah. How are we breathing? Shocker, we bring that up all the

[00:11:07] time. How is that upper back moving? And then like we do in the optimal body membership, when we

[00:11:14] take these muscle activations, we're not just focusing on the shoulder blade, but we take it

[00:11:18] all the way down to what your feet doing. And we say from your feet to your pelvis to your

[00:11:24] rib cage to your shoulder blade. Now we're going to have a better idea of how that's going to

[00:11:30] functionally, you know, go into standing, how it's functionally going to go into loading

[00:11:35] and into other movements because that's really where it becomes beneficial.

[00:11:39] It's so funny because we talk about this all the time and then

[00:11:43] eventually somebody will be like going through the optimal body and they'll have that like

[00:11:46] aha moment where they say like, I was more focused on doing like the hits and the mobility

[00:11:51] and stuff. And then I was starting to have this little issue. So I went back to doing the core,

[00:11:56] you know, core one, two, three, four. And man, I noticed how just doing that breathing,

[00:12:00] I got my back to feel different than it ever has before or whatever. And they start to

[00:12:04] make those connections between doing the muscle activation in the core and they're like,

[00:12:08] I noticed myself doing that when I was doing the hit or even when I was out singing. This person

[00:12:14] was like a part of a part of a choir or something in there just like I've sang my whole life and

[00:12:19] I've never felt myself, you know, control my breath and my voice support through my pelvic

[00:12:24] floor like I did after doing, you know, your breath work in the optimal body. And so people

[00:12:29] really start to realize it once they do it. But again, that's where we come back around to

[00:12:33] can you breathe on your back? We do this really cool exercise. What was it? Episode 11?

[00:12:38] Episode 11.

[00:12:39] When we do breath where Jen wraps this band around my ribs and can you tell them a little bit what

[00:12:43] the premise of wrapping like an exercise band around the ribs is?

[00:12:47] Yeah, I mean, it's really just feedback for the mind. Everything is like,

[00:12:50] can we get this mind body connection in terms of what is supposed to be moving as,

[00:12:55] especially in this case, breathing. You talk about expanding through the ribs.

[00:12:58] Yeah, we want that rib cage to expand so that the diaphragm has room to like

[00:13:03] actually lift and contract the way that we breathe. And so when we're getting this feedback,

[00:13:09] we're actually then if my rib cage is going to expand, I'm going to get different changes in

[00:13:13] my thoracic spine, which I just did this also in the almost 30 virtual camp. I had 10 minutes

[00:13:21] to try to get these people to feel something different because someone else's session ran

[00:13:25] over and so I'm like, okay, here we go. And all I did was like, let's test our range

[00:13:30] of motion through the thoracic spine, just kind of sit and rotate. Now we're just going to breathe.

[00:13:35] Where are you breathing from getting this rib cage to move? And then I had them retest

[00:13:39] and the comments into that section were like, oh my gosh, my range of motion is so much better.

[00:13:46] And like all these crazy things are so much fun to watch. But that's why it's like,

[00:13:51] we can get so much more movement change when we actually just start to come back to that

[00:13:58] foundational piece, which is what we do in the membership. And the thing that I love with

[00:14:02] the band around the ribs is it's that feedback that isn't going to go away, right? So if we change

[00:14:07] positions and here's what I want you to do, if you can think of, oh, here's a shoulder

[00:14:11] stabilization exercise I do, whatever it is, if it's a little serratus press, even if you're

[00:14:16] lifting your even if you're just lifting your arm over your head, whatever it is,

[00:14:19] tie that band around your ribs, take a few breaths just laying on your back

[00:14:23] and then try to do that shoulder stabilization exercise and see what the ribs do. See what you

[00:14:28] notice your ribs or your pelvis doing in relation to each other, then to really mess yourself up,

[00:14:34] stand up and try doing the same thing. And you'll notice so quickly how you detach from what

[00:14:41] your core is doing based on what you're doing with your arms or your shoulders.

[00:14:45] Yeah. And so getting yourself comfortable in uncomfortable positions or changing positions,

[00:14:50] like it's something that we talk about a lot. So now let's go through just ranges of motion of what

[00:14:54] you should be able to own and have control of in your shoulder blade. Yeah, there's three primary

[00:15:00] planes of motion for the shoulder blade. Like I said, it's kind of just floating there on our ribcage.

[00:15:04] So the first one that I think everybody does a little too much of is shoulder shrugs or

[00:15:09] elevation where our shoulders are up near our ears and then shoulder depression where we kind

[00:15:15] of push them down towards our back pocket elevation and depression. Yeah. And then another one is

[00:15:21] protraction and retraction. A lot of people have heard of that. So that means protraction is when

[00:15:25] that shoulder, those shoulder blades are going to move away from the spine and they're going to go

[00:15:29] forward. And then retraction is bringing the shoulder blades back toward the spine. Now the

[00:15:34] goal is to be able to do this without using your arms. The first thing I like to do is have

[00:15:38] people just have the arms out at the side and keep the elbow straight. And now can I move just

[00:15:44] for my shoulder blades forward and back? And then can I do it with my arms out straight? Then can I do

[00:15:49] it with my arms straight overhead? And what a lot of people want to do is row, right? I want to bend

[00:15:54] my elbows with the movement kind of thing. Or even if you're in like a plank position and people

[00:16:00] want to bend the elbows to kind of get that shoulder blade, don't feel bad if that happens.

[00:16:04] Like especially if you're new to this motion. So common. I got almost every client that I've

[00:16:10] introduced this movement to that's the first thing that happens. But really being able to control those

[00:16:15] ranges without the arms, without lifting up or pulling down like just pure movement forward,

[00:16:22] back, up, down. If we can't isolate that protraction by itself, that in itself is telling me that we

[00:16:30] have evidence that our motor patterning is a little bit muddy and that our brain isn't exactly

[00:16:36] understanding what we're telling us ourselves when we're saying, hey, just punch that little

[00:16:41] protraction forward. It's too connected into our elbow movement. It might be too connected into our

[00:16:47] thoracic spine movement. So again, just laying there and working on it with your arms,

[00:16:52] sitting there and working on it with your arms by your side can really help us start to type

[00:16:56] in that program to be like, oh, now we know how to isolate that movement on its own. Exactly.

[00:17:01] And then the third one is going to be upward rotation and downward rotation, which is a little

[00:17:05] bit more of like a composite movement, which is in that scapular or that rib cage kind of plane where

[00:17:13] upward rotation is really helpful for getting our arm fully overhead into that full flexion

[00:17:18] where that shoulder blade and that lower kind of angle that shoulder blade is going to roll out

[00:17:23] to the side. Yeah. And then being able to control that down. And that's where a lot of

[00:17:27] people can find that scapular dyskinesia is when they lift the arm up if you take a video

[00:17:33] and you try to slowly lower your arm down, you might see like some either all of a sudden the

[00:17:38] shoulder blade just comes crashing down or it's like bouncing back down because it's like, whoa,

[00:17:46] I don't know how to control this range. And it's almost kind of a cool thing. How cool to

[00:17:52] see your movement. And so, I mean, this is why I love videotaping. And I remember even when

[00:17:57] I was teaching Pilates and one of the first things that I would just start hosting videos

[00:18:02] like the Sun Instagram of me teaching Pilates on the reformer and stuff. And I remember one of

[00:18:06] the first times I was just doing like banded retraction and I was like super lean and ripped

[00:18:12] back then too. And the first time I saw my shoulder blades from the back, I was like, whoa,

[00:18:17] that's what people are seeing. It looked crazy. My muscles were popping. Things

[00:18:22] were happening. One shoulder blade might have been doing something different. It was cool to

[00:18:27] see though. I think it's so cool to just start to gain this awareness and not be afraid of movement.

[00:18:32] So just to kind of talk through a couple examples and decent ways, I think, to access some of these,

[00:18:37] especially the difficult ones. I want to talk about scapular depression. I think a lot of people

[00:18:42] struggle to find what true depression of our shoulder blades is. And one of my favorite ways

[00:18:46] to do this is like at your standard kitchen chair, if you're sitting at the kitchen chair,

[00:18:51] the nice thing is your pelvis was already kind of tucked. So we're kind of keeping our core

[00:18:55] in more of like this flexed position and not allowing our back to extend. And if you just put

[00:19:01] your hands on the edge of the chair and scoot your bum forward off the edge and then just kind of press

[00:19:07] your hands straight down into that chair, like you're trying to push your shoulder blades down,

[00:19:11] again, that's going to help you get that scapular depression without being able to arch your

[00:19:16] back so much, which is what a lot of people do. Again, when we say shoulders down and back,

[00:19:20] a lot of people will arch through their back as well. Yeah, that is such an important cue because

[00:19:26] that is, I mean, I just can remember all the time of people doing that. And that just goes

[00:19:32] into like we don't have awareness, right? If my back has to arch and my rib cage flares in order

[00:19:37] to pull my shoulder blades back down, do I really have control of just what my shoulder blades

[00:19:40] are doing over the trunk, which is again, what we do in the membership all the time?

[00:19:45] And then after that, I'd have to say something that I struggle with the most

[00:19:49] is kind of what we were talking about with that, that press motion, like just that scapular press,

[00:19:54] which my favorite place to probably start this is either like you said, sitting and just arms at

[00:19:59] the side going forward and back or just in like a quadruped or on your hands and your knees,

[00:20:04] elbow straight and just exploring how much can I get those shoulder blades to come back and

[00:20:08] together and how much can I push those around the rib cage towards the ground and push through

[00:20:15] those hands. And again, if it's something you haven't done, you might feel some pretty intense

[00:20:18] stretches when you get to the end ranges of those motions. Yeah. And sometimes people need like I've

[00:20:23] had clients that need to start that like elevating the hands onto a table or against the wall. Yeah,

[00:20:28] or against the wall. And the moment you do that because you really get to see is my sternum

[00:20:32] kind of moving and rounding as I'm pushing like does my rib cage move? Or can I keep that

[00:20:39] stable and again only move from that pier shoulder blade movement. So it's just it's fun to

[00:20:44] explore. And one of the stories and one of the things that always has kept with me since physical

[00:20:49] therapy school was we watched a video of a physician who is kind of giving a lecture. And so there was

[00:20:57] like a big group of people in front of him. And he had this kid up who had shoulder pain,

[00:21:01] but the physician didn't know which shoulder he had painted. And the physician was just

[00:21:06] kind of going through like, Oh, this is what I would look at. And he's like, oh, let's

[00:21:10] look at his shoulder range of motion. And the kid would lift his arms in different planes.

[00:21:14] And what the physician noticed was that there was one shoulder blade that was kind of a little funky,

[00:21:19] you know, like whether it didn't track very nicely or it kind of bounced and it did some

[00:21:23] weird stuff. And so he was like, well, because this shoulder blade doesn't move well, like the

[00:21:28] other one, this is probably the shoulder that you have pain in, right? And the kids like, Oh,

[00:21:32] no, actually, it's the other one. And as embarrassing as that might be as you're

[00:21:37] giving a big lecture, it just goes to show we cannot determine that funky movement means pain

[00:21:45] or means injury. Right? And all like the overall message is just continue to explore the body,

[00:21:52] continue to explore your awareness of what you have within your body so that you can gain control,

[00:21:58] you can gain strength and that you can gain better awareness of your body in general.

[00:22:02] Thanks for tuning into another episode. Of course, these episodes would not be possible unless we got

[00:22:09] the word out. So please continue to leave a rating and review if you haven't yet and share

[00:22:15] these episodes. Scapular winging is something that is so commonly talked about and really

[00:22:20] misunderstood. So spread the word. And if you want help on how you can really maximize

[00:22:25] understanding your control awareness and strengthening around your shoulder blades overall,

[00:22:31] that's where I really recommend the shoulder plan on GenHealth. You can try a week free,

[00:22:36] see how it is, and then progress through not just one phase, but two phases to really help

[00:22:41] to gain that control awareness and confidence within your body. So no matter what winging you might

[00:22:47] have, you know that you have the strength to do what you need for your shoulder health.

[00:22:50] So that we're going to link that up below, but it's just gen.health backslash free trial.

[00:22:54] Try out the shoulder plan or any of our other 10 other plans and start improving and getting

[00:23:00] awareness into your body.