Here’s a video illustrating how impaired movement can cause someone pain. In this particular video it’s shoulder pain. Pay careful attention to the right scapula (shoulder blade). The impairment is progressive so be patient and watch the whole thing.
Also, It helps to look back and forth between the right and the left to see the asymmetry. Although in this case, it shouldn’t be hard to recognize the issue:
Now that you’ve likely been officially grossed out (sorry Holly :)), let’s talk about this.
If you’re not familiar with that’s going on with that right scapula, when Holly returns from straightening her arms is her right scap is winging rather than retracting.
That is, while normally the scapula retracts and sits nicely against the rib cage, her right one has decided after a little while it’s bored and isn’t going to sit at all.
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Why is this happening?
(Simple version- for those interested, specific muscles and anatomy information can be found at the end)
So when Holly first started she mentioned she had been in a car accident a while back. Ever since she’s had shoulder and neck pain. From listening to her talk she basically had accepted this and was resigned to living with it the rest of her life. Holly is 30. That’s a llllllong time to accept you’re going to be in pain.
The thing is, often times when someone has a traumatic injury happen to them (a car accident in this case), the reason for having chronic pain 6 months, a year, or years later, is not from the original traumatic injury. It’s from the compensations that come along with the original injury.
Using Holly as an example- while she was recovering she would often slouch her right arm down and let it be pulled forward to alleviate the stress on it.
Doing this over and over caused her muscles to get good at maintaining this position. When it comes to the body, you get what you train. And you are always, always training the body at something. You just may not realize it.
Holly essentially trained her right scapula to wing like that in the recovery from her original injury. What allowed her to be pain free in the acute stages of her injury recovery is what caused her to experience chronic pain in her shoulder. So it’s not the car accident is why she still has shoulder pain. It’s the fact the car accident made her more susceptible to acquire compensations that cause shoulder pain.
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How do we correct the issue and get rid of the pain?
Hopefully it’s apparent now chronic pain can have a solution. Solutions in Holly’s case consist of simply squeezing her shoulder blades together (gently) and pulling them down when she brings her arms to her body in the above exercise. Her shoulder pokes out and tips forward when she moves the arm back. We thus pull it back and down. Not a ton. Just enough to correct the fault. Rocket science, I know.
Other exercises that can help consist of
- wall slides,
- bench pressing with proper scapular positioning (also squeezed slightly together and pulled downward)
- and various forms of rowing exercises where you don’t let the arm(s) get pulled too far forward (remember this is what caused the scap to start winging in the first place, so we want to avoid all movement analogous to what caused the original issue).
Lastly, but most importantly, correcting her shoulder positioning during the other 23 hours of the day is CRUCIAL. Doing things like not letting her arm hang forward during activities such as using a computer mouse or driving with one arm will help a ton. And just good ole walking/sitting upright with good posture will help as well.
One other thought: Her fault is also an illustration how sometimes you simply need someone else to watch you move and help you figure out why you’re experiencing pain. Holly had no idea her shoulder blade was moving the way it was and therefore had no other reason to believe her shoulder pain was from anything but her car accident. Being aware of the cause of your pain is the first step towards getting rid of it.
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Become a client like Holly did
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Why is this happening?
(Anatomy version- I’ll try to make this quick and as easy to understand as I can)
For those interested in some of the nitty gritty- there are muscles that pull the shoulder and scapula forward and muscles that pull the shoulder and scapula backward and down. (Technically here, by down, we mean posterior tilt.)
When someone’s shoulder is winging like this there is an imbalance and a motor control issue between the muscles that pull forward and the muscles that pull backward. That is, the muscles that pull forward are typically stronger and used more readily than the muscles in the back of the shoulder.
Specifically, pec minor tends to wreak havoc on the shoulder due to the fact it connects to the shoulder blade and seems to always be in a shortened position. This is due to the fact that people are always sitting and walking with slouched shoulders.
So this is the primary muscle that causes issues with the shoulder and scap being pulled forward.
In the back of the shoulder, serratus anterior, the middle and lower trapezius are not working properly (motor control). They may be weak too. The serratus anterior is especially supposed to be pulling the shoulder blade nice and close to the rib cage due to the fact it inserts into the medial portion of the scapula. That’s what’s so grossly sticking out in Holly’s video.
Look at the orientation of the muscle fibers of these muscles. It’s easy to see how they pull on the scapula:
Now the reason this causes pain is because when the scapula wings, it’s putting a greater amount of pressure to the front and top of the shoulder (because it is not being pulled down like it should be).
Basically the top and front of the shoulder joint are being lightly punched, over, and over, and over again. Now there is pretty much always going to be a little pressure being put on the shoulder, but it shouldn’t always be in one direction.
It’s like the tires on your car. If you never rotate them the front tires will wear away a lot faster than if they got a break every 5,000 miles by being put in the back.
Just like how you try to extend the lifespan of the tires of your car, making sure the shoulder moves properly (doesn’t wing in this case) helps improve the lifespan of your shoulder.
UPDATE: Here is Holly a few weeks later:
Notice the improvement in keeping the scap nice and tight against the rib cage. There are definitely still some reps where Holly has to really concentrate, but it is much better.
Marilyn Williams
July 7, 2011
Wow- great information Brian! You did a great job communicating the issue and its complexities. Thank you for investing in our health; we are all living better lives because of it!
reddyb
July 8, 2011
Thanks for the kind words Marilyn. Hope those legs feel alright over the weekend :).
Felipe
December 14, 2011
Hello! I’m from Chile and I have this same problem here, so I need help. I’m 18 years old and I was swimming normally, but suddenly I felt some pinching in my right shoulder, but I ignored, so I continue swimming, so after a while I was starting to feel less movility every day that was passing by.
So the question is: What type of medician should I see? A physiotherapist, traumatologist?
The thing here is that right now I’m seeing a traumatologist, but he only send me to a kinesiologist that is not helping too much.
So I found this video in youtube and I think that if someone could correct it, why shouldn’t I?
Help Please!
PD: sorry for the bad english, I just learned this by myself
reddyb
December 14, 2011
Hey Felipe (all the way from Chile!),
A physiotherapist would definitely be better than a traumatologist. Having somebody watch your shoulder move during various movements, and help you correct those movements, could really help.
Some things to work on are your posture: Make sure your shoulders aren’t rounded and you are standing up straight.
Next, try doing this exercise. The first two videos are the WRONG form and the last video is the right form. This will help improve your shoulder mobility:
Wrong ones: http://www.youtube.com/watch?v=r1zul4Uylfg and http://www.youtube.com/watch?v=a5IcQX3P_Y0
Better form here: http://www.youtube.com/watch?v=IrOlWaeeRtU
Go with that first and then let me know how that goes.
Jose castillo
November 4, 2012
Hello !! This is a very interesting video ( both of them ) i had recently had an accident on my road bike where i had hit my right elbow and have push it back i did not notice anything out of the normal for the first couple days just pain from the fall but i noticed that my scapula was higher on the right side and actually sticking out an d my shoulder and bicep were in constant pain and also felt very weak i have searched and went to see a chiropractor but did not help much until just now i saw this video everything you have written make perfect sense i will start trying some diferent excersises to work on my serratus posterior . Thx for posting such and informative videos now i have hope to now that this condition could be reverse with the right exercises . Thx . Also from chile !!! Really hope this helps i havent been able to swim for 3 weeks now. !! Any other advice would be great !!!
reddyb
November 4, 2012
What’s up Jose,
I’m glad this seemed to clarify things for you. Let me know how things go; best of luck!
Rawa Jalal (@HeroNissan)
August 22, 2013
what is the exercise that you are doing in the videos? Does not look like a traditional row where the rope is parallel to direction you are facing, the rope is perpendicular.
reddyb
August 22, 2013
Called a Pallof Press. More on the exercise here: http://b-reddy.org/2012/11/13/another-better-pallof-press-variation/
Note: I don’t use that exercise for someone with scapular winging. It was merely an opportunity to video the winging and show the improvement.
Rawa Jalal (@HeroNissan)
August 23, 2013
I had a back injury (erector spinae group on the right side mid-back) when I was 18 lifting a fridge, and during the acute stages. It was less painful when sitting if I sat crooked, having my right side down, so that my left side would be higher and taking most of the work. From that position my right scapula also felt more comfortable being protracted. Even after the injury I guess I kept this crooked position, that led to shoulder injuries such as supraspinatus tendonitis and bicipital tendonitis. Now when I sit with my weight properly distributed and with my shoulders retracted in the normal position, after 1-2 minutes, I can feel my serratus anterior burning, like I am doing a marathon. Also when looking in the mirror, my external oblique on my left side is much bigger than my right side.
I have been to a physiotherapist, and she told me I had winging on the right side, and the exercises she wanted me to do was wall push ups with my shoulders protracted, and I never felt my serratus anterior working. I told her this, and she told me to “think about your scapula hugging your ribcage”. That might be the stupidest thing I have ever heard, it’s not like you think about your Quadriceps contract, then your Gastrocnemius, then your Hamstrings when you walk. You just think about walking, and you automatically contract the correct muscles. After I read your article and maintained good posture and avoided contracting my pec minor, I felt my serratus anterior working in pretty much every activity I did.
Anyways, your article has helped so much, thank you for taking the time to write it up.
reddyb
August 24, 2013
As you said, don’t worry so much about how much you feel an exercise working. Worry more about having the proper form. The muscles will take care of themselves. Good for you for figuring this out. I wish this understanding was more prevalent.
If curious, this is a more comprehensive look at scapular winging: http://b-reddy.org/2013/07/25/musings-on-scapular-winging-anatomy-muscular-and-nerve-causes-and-exercise-considerations/
I go over why things like wall push ups are inadequate for training the serratus anterior.
Thanks for the comment; great to hear you got something out of this.
Brian
Jarad Spence
September 10, 2014
Great article and great information!
My situation is a wpwinged scap on my right side along with what I suspect is thoracic outlet (really right scalenes) – I’m currently doing a lot of stretches to release and lengthen my scalenes as well as exercises to strengthen my serratus (scap pushups, rows, face pulls, lat pull downs)
I’m not sure how well this is working, and was wondering if you had any further information?
Also regarding working out, the scap issue has created a serious development issue in the pec of the same side. Trying to hold scapula position during a press Is near impossible.
Any ideas how to continue to work chest (albeit a lot less than most people) and any ideas of further ways to deal with the scapula winging?
Kind Regards
jarad
reddyb
September 11, 2014
Hey Jarad,
You might find this worthwhile: http://b-reddy.org/2013/07/25/musings-on-scapular-winging-anatomy-muscular-and-nerve-causes-and-exercise-considerations/
Brian Noyes
November 1, 2014
hello. I am 20 years old. a year and a half ago I dislocated my shoulder at the skatepark with a stretched out arm. I never went to get help for it as it didn’t bother me at all other then when I hung from it I could feel my shoulder was not all right. about 4 months ago I fell again this time directly to my back dislocating my shoulder again and which I believe was the cause for my winging scapula. I read everywhere that winging scapula can cause your shoulder to droop but in my case it seems that everything is pushed up (collarbone, arm, pec). When ever I tighten my arm I only have one 1thin muscle sticking up and is very weak with no muscles at all compared to my other arm. My deltoid muscles are about completely gone . I have been going to physical therapy for about 6 weeks but has only helped gain a little strength back. Now that I look at videos it seems like almost my other blade is winging to. I have pain mostly in my rotator cuff area and no pain in my scapulas which I believe is very weird. could this be a nerve problem? It has been pretty depressing few months as I am very active but have been doing nothing but physical therapy, at home stretching and sitting down… PLease help!
I also have a very small hard bump on the end of my shoulder near the joint and rotator cuff
reddyb
November 4, 2014
Hey Brian,
I’d have to take a closer look at you to see whether or not I could help you, as your shoulder has gone through some pretty traumatic stuff. You’re welcome to take a look at this: http://b-reddy.org/2013/06/20/the-remote-client-process/