Understanding Winged Scapula and the Benefits of Myofascial Release Therapy
If we look at winged scapula as a shoulder blade that protrudes from the back it’s a fairly common presentation.
Although scapular winging due to nerve damage is rare, the most severe and easier to diagnose form of scapular winging, winged scapula due to imbalance in the muscular and myofascial system is much more common and less evident but it can also cause problems and it has a better prognosis. So why not talk about it?
Winged scapula consists of the shoulder blade protruding outward from the back (rather than sitting flat agains the ribcage) making it appear as though it is “winged.” While people with this presentation don’t always experience pain, it is common for those with winged scapulas to experience musculoskeletal pain, as well as shoulder instability that leads to a variety of injuries and clinical conditions, especially related with the shoulder joint and the scapulothoracic joint.
Winged scapula can be present in different degrees of severity with different prognosis and it can be both sided or just present on one side, the whole shoulder blade protruding or just the medial side (side closer to the spine).
What muscles are involved in scapular winging
The main muscles involved in scapular winging are the serratus anterior, trapezius, rhomboids, subscapularis, levator scapulae, and pectoralis minor. Although ultimately all rotator cuff muscles are somewhat involved or suffering as a consequence of a winged scapula.
One important function of these muscles is to stabilise the shoulder blade in place against the rib cage, in all planes of movement. Like every muscle in our body, they must work in balance. This balance can be broken by both shortness/tightness and weakness of these muscles and fascia, pulling the shoulder blade out and or failing to stabilise it agains the rib cage.
When this happens the shoulder joint looses stability and the strength characteristic of a balanced structure, becoming more vulnerable and exposed to injury and pain, limiting sports performance and shortening the lifespan of the sport we enjoy.
What’s our approach to addressing scapular winging
As soft tissue therapists our focus is on addressing the imbalances within the soft tissue that contribute to the presentation.
In this case we focus on releasing the muscles and fascia that are shortened/restricted and strengthening the muscles and myofascial chains that are weak and or not firing up to provide enough support and stability.
By releasing the soft tissue around the joint we also account for nerve irritation by soft tissue pressure due to tightness.
Important mention here is the fact that winged scapula, like any other presentation or condition, rarely presents isolated from imbalances in other parts of the body. The body functions as a connected unity where changes anywhere along it will affect the whole system in a domino-like effect. This means that an imbalance in, for example the shoulder, might be a result of an imbalance somewhere else and therefore the whole body needs to be addressed holistically in order to get the most effective results treatment wise. This is both during a soft tissue release session and during a strengthening session.
For this reason our approach during a soft tissue release session has always into consideration the myofascial tissue and the way this tissue organises itself through our body.
For this reason too our approach to rehabilitation is also incorporating the myofascial system and the way it organises itself through our body in chains, incorporating functional exercises that build up strength in chains in the weakened structures, where the whole body works in balance during that specific motion.
What is the best exercise for scapular winging
One of the best exercises for scapular winging, NOT THE ONLY ONE, but one that usually gets great results is SERRATUS PUSHUPS.
When done correctly, this exercise increases shoulder stability targets and strengthens the serratus anterior muscle, which is usually weak in people presenting with winged scapula.
This exercise increases the connection between the spiral myofascial line and the lateral line so much needed for good thoracic and scapular stability.
Of course this is not the only exercise needed and a your rehab therapist will guide you through a program of exercises specific for your individual presentation.
Conclusion
Winged scapula is by no means an easy fix presentation but it is possible to drastically increase shoulder stability and improve shoulder positioning with the right combination of soft tissue release and strengthening, reducing the risk of injury and pain associated with it.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for over 8 years, successfully treating a wide range of conditions.