Understanding the causes of scapula winging is crucial to your shoulder health, both from a prevention and treatment perspective.
Causes of Scapula Winging
Scapula winging can be caused due to a long thoracic nerve injury, which typically is a result of blunt trauma to the neck and or shoulder area. A virus could also affect the long thoracic nerve causing scapula winging. I recommend having your doctor or an orthopedic specialist rule out nerve damage from blunt trauma or a virus which may be causing scapula winging before exploring corrective exercises.
If the factors in the above paragraph have been ruled out, the main cause of weakness in serratus anterior is when the rhomboid and levator scapulae muscles are shortened. This problem exists in those who often have poor posture when performing computer work; particularly those who carry stress in their neck. Often people subconsciously contract their shoulders in an upward fashion when stressed out. Additionally, poor form during weight training and improper exercise selection can contribute to anterior serratus weakening.
When the rhomboids and levator scapulae are too tight, it causes a lengthening of the serratus anterior. In most cases, when the origin and insertion of a muscle gets pulled further apart, it has a weakening effect. If the serratus anterior is weak, conditioning it is important because it keeps the scapula (shoulder blade) flush up against the thoracic cavity, preventing scapular winging. During pressing movements such as pushups, a strong anterior serratus keeps the scapula in check. If the scapula wings during a pressing movement, it is important to temporarily stop most pressing movements and implement serratus anterior exercises and other muscles that correct the problem.
Before selecting exercises to specifically strengthen serratus anterior, assess whether or not the serratus is in fact weak. Without hiring a professional to determine a protocol for a winged scapula, one can easily make the mistake of going online to find numerous articles reporting “strengthing the anterior serratus will help or solve a winged scapula.” In some cases a recipe approach like can worsen the problem.
For example if the scapula is in a protracted position at rest (static posture), and the pec minor is tight, anterior serratus conditioning is not the first line of defense in correcting a winged scapula. In this case, restoring strength of the rhomboids, lower, middle and possibly upper traps are priority. Also, stretching of the levator scapula alongside some soft tissue work may be necessary.
Knowing the difference between a tipped and winged scapula is crucial to correcting scapula problems.
A forward tipping of the scapula is often misdiagnosed as scapula winging. Scapula tipping is caused by a shortening of the pec minor muscle. Tipping of the scapula happens when the inferior angle (bottom corner) juts out. See Image below bottom corner of shoulder left:
In scapula winging, the lateral border and inferior angle will displace itself from the thoracic cavity (see image below)
It is possible to have both tipping and winging of the scapula, which means there are an increased number of dysfunctions in the shoulder girdle to correct.
After getting your scapula checked out by a specialist and he or she determines you need strengthening of serratus anterior, please contact us and one of our trainers can help you correct the weakness or dysfunction in that muscle. The second best option is to check out the below serratus anterior strengthening video exercise series (Please note there are five progressions):
Physical Therapy of The Shoulder, Robert A. Donatelli