Howdy folks, and welcome to another edition of “how to fix your asymmetries.” Today we’re going to talk about when those shoulder blades stick out A.K.A. scapular winging, winged scapula, scapular dyskinesia, and of, course the medical term, scapula alata (fancy). I personally suffered from this issue back when my posture was all “bleh” and I could hardly keep my chin from falling on the floor. It was so bad that I was able to hook my shoulder blades onto the backrest of my chair! Weird party trick, right?

Alright so let’s dive into it.

We’ll Define Scapular Winging
Why It Happen & What Muscles Are Involved (Biomechanics)
Why Scapular Winging Matters
How To "Fix" Your Scapular Winging
How To Test If You Have Scapular Winging
Exercises To Fix Scapular Winging

Prefer To Watch?

Here’s an in-depth video version of the blog! You can use it as well as this deep-dive for the full routine.

What Is Scapular Winging?

Scapula Alata (Winging Scapulae) - The medial border of the scapula protruding, like wings, due to the muscles of the scapula being too weak or paralyzed, resulting in a limited ability to effectivly stabilize the scapula. - Physiopedia

Basically, at rest and/or with shoulder movement, the inside portion of the shoulder blade (closest to your spine) pops off the ribcage as shown in the photo. This can happen when you move your shoulder OR while you’re just standing upright.

Pretty straightforward, right? Funny thing is, this is pretty much how you find out if you have scapular winging. Just look at the shoulder blade at rest or during movement and see if it does some wonky stuff, but we’ll dive into that soon enough.

What Causes Scapular Winging? What Muscles Are Involved?

So, there are different reasons as to why scapular winging occurs. One of the more rare reasons is due to the nerves affecting the serratus anterior muscle. The nerve that innervates this muscle is the long thoracic nerve, and sometimes it can be damaged or impinged, leading to malfunction. This makes the serratus anterior unable to do the job of keeping the scapula pulled flush against the ribcage, as well as supporting the shoulder through its normal movements (Park SB, et Al. 2020). Now, nerve impingement or muscular paralysis is rather rare. This typically occurs due to traumatic events such as car accidents, sports injuries, etc. This will also result in a lot of shoulder weakness and have some other weird symptoms that present alongside the scapula’s winged position.

Now the most common reason we’ll see scapular winging is due to postural deficits. Having a posture biased more forward onto the toes as well as 100 other reasons can cause a poor positional relationship between the scapula and ribcage. Positional relationship meaning that these structures just aren’t fitting together very nice - and it shows! It’s a combination of a ribcage that is compressed (tight muscles everywhere) and muscles like the serratus anterior, low trapezius, and others attempting to gain muscular leverage from a subpar foundation. Okay, I may have lost you there but let’s look at the photo below for an analogy.

Imagine pulling a shirt out of your dirty laundry. You really want to wear the shirt, but… it’s wrinkled and kinda gross… but damn it would look good with those jeans.

So, you shamefully put it on in hopes it won’t look “too bad,” but dear god it smells and it fits like a wrinkled, plastic grocery bag. It’s all wedge up under your armpits., you lift your arms up and a little bit of your belly shows, and you stand there hoping the problem will just fix itself. A minor adulthood existential crisis sets in about responsibility, chores, should you even go…? AND you quickly deflect and put on the clean but definitely not as good, second choice shirt.

I really hope at least one of you reading this has had this experience and I’m not some weird person that digs through his laundry.

ANYWAYS, that wrinkled shirt does not move very well while on, right? This is sorta similar to what happens when your ribcage is “compressed” from muscles like the intercostals, serratus, traps, pecs, and lats. All these muscles are just doing their best to get the job done i.e. moving around your shoulder blade effectively.

Now, you’re not going to go burn your wrinkled, slightly smelly shirt because it’s wrinkled right? Nah, you’re going to wash it, dry it, iron it, and treat it with the love it deserves. It’s not the shirt’s fault. The same goes for your ribcage. The intercostals, serratus, traps, pecs, and lats aren’t tight and squeezing the bones together in weird ways because your body hates you. It’s simply doing the best it can. So think of the right exercises as ironing these muscles out. Pick the right ones and it can help to reduce these tensions and scapular winging.

Now, imagine putting your favorite shirt on fresh out of the dryer. There aren’t any wrinkles, it’s kind of warm, and it moves freely over the body. This can be analogous to your ribcage “decompressed” (reduced tight muscles/increased space). The muscles aren’t too stretches out or overly tight (no wrinkles), you have full shoulder range of motion (shirt doesn’t show your belly), and your shoulder blade or blades moving freely without or reduced scapular winging.

Specific Biomechanics (if you’re into that)

I’m sure you’re just amazed by my “airing of dirty laundry” analogy. But let’s be honest, it doesn’t really give the concrete mechanics of what muscles to target from a biomechanical standpoint. But, I do hope my vulnerability and potentially weird behavior set the stage for how this all can work.

So typically a scapula may wing due to a shoulder, or both shoulders, being biased into internal rotation. Think of this as when the chest sinks in and shoulders roll forward (photo sw 1.2). Muscles like the pecs, obliques, subclavius, etc. grab the shoulder pulling it toward the sternum, and get stuck in a concentric (tight position).

This in turn pulls on the shoulder and scapulas in a forward direction causing the muscle on the back to become lengthened and taunt (think about pulling a rope tight). This long but tense musculature (rhomboids, traps, etc.) push the ribcage forward. While the posterior ribcage is being smooshed, the tight anterior muscles at the chest are pulling on the shoulder and lift the scapula away from the ribcage (photo sw1.3).

Why Does Scapular Winging matter?

Now that you know too much about my laundry habits, let’s jump into why scapular winging even matters. This is a great segue into the fact that scapular winging doesn’t really matter until it matters.

Now, unless you have thoracic nerve damage, you may not really have any problems with the scapular winging minus some asthetics. There are statistically more people walking around with scapular winging, having no idea that they have it (and without pain/loss of motion/decreased stability) than there are people that do know they have it or have “related” symptoms. I don’t have the actual statistics but I am 99% sure this is the case. Prove me wrong.

Sorry that was aggressive. But really, if you have proof, prove me wrong… Why does that still sound so aggressive?

Scapular winging can be an issue with some instability or pain but it is generally NOT the cause of these symptoms, but rather, just another symptom. Maybe that’s a hard pill to swallow but stick with me. Scapular winging is more an indicator of the scapula’s behavior on the above-mentioned compressed ribcage via muscles that can’t quite get leverage. That’s really it. Other than that, it may be again, aesthetically unappealing to some, but that’s a whole-nother’ blog topic.

Now, those tight/long muscles CAN limit your shoulder range of motion. The scapular winging you see happening is actually a “cheat code” compensation the body uses to get around the shoulder lacking internal rotation. The shoulder is already biased in that direction so you can’t really internally rotate anymore (can’t go to the living room if you’re already in the living room), so the body just pops the scapula off the back of the ribcage to allow for the movement occur when, for example, you lift your arm overhead.

Simple and effective.

Side note - scapular winging, in my opinion, is more a testament to the resilience and adaptability of the human body. If some people weren’t able to do this, they’d have horrible shoulder range of motion. The silver lining, am I right?

Anyways, in a perfect world, we would want to improve the body’s ability to internally rotate the shoulder without having to wing the scapula (or as much). Maybe you’re doing activities like bench pressing which requires a good amount of internal rotation to perform. Then we can go and hammer on exercises to improve that specific shoulder motion, though that doesn’t mean you CAN’T bench press when you present with scapular winging. Like I said above - it’s really only a problem if it becomes a problem.

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How To Test If You Have Scapular Winging

For real, how many of you actually read the above mumbo-jumbo I rant about above this section? I mean, this is really all that matters to you. That’s okay, I’ll use this time to plug my services ;)

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Okay, the real reason you’re here. Let’s test for and fix that scapular winging.

1) Visual Assessment

The first test is pretty straightforward with scapular winging. Typically if you have it, you’ll see it while just standing or sitting in a relaxed posture. You don’t have to move your arms or anything. Take a video of yourself, turn around and you’ll be able to pick it out real quick. If you have scapular winging with resting posture, then you’re probably pretty dang limited in your shoulder internal rotation and could use a little help (we’ll get there).

2) Appley Scratch Test (internal rotation focused)

This is a great test for those that may not have a resting scapular winging but instead have the scapula pop off the ribcage with movement. I personally only use the internal rotation portion of this test (yes, there is an external rotation portion you can do) as that motion is typically associated with scapular winging.

You’ll want to video yourself and start the test by reaching behind the back to the opposite side shoulder blade. When reviewing your video, you may see that the scapula pops away from the ribcage at certain points of the motion. Whenever it first starts to pop off, that’s where you stop the test.

I love this test for objectively improving scapular winging and shoulder internal rotation as you can continuously retest how far your arm can go up to your back before the scapula wings out. The further you’re able to go, the better your shoulder internal rotation and the less scapular winging.

Testing Summary

I use both of these tests to see the severity of the scapular winging. If you have scapular winging at rest, then it’s more severe whereas if you can reach your arm behind your back and touch the opposite shoulder blade without it winging, you’re good to go.

Follow along with the testing in the video below.

How To Fix Scapular Winging

So in order to “fix” scapular winging, we need to essentially relax all those muscles previously stated and decompress the posterior ribcage. I keep putting “fix” in quotations because you really never “fix” scapular winging. It’s a part of being human and can play a key role in our movement as it can yield great ranges of motion for people. That said, we can totally manage the scapular winging that occurs by improving shoulder internal rotation so that it’s not a movement strategy that’s potentially overutilized. Got it? cool.

So areas such as the pump handle (anterior ribcage or chest) and posterior mediastinum (posterior ribcage) are the targets. But, how do we expand/relax/stretch/decompress these areas? It’s pretty hard to stretch around there, massages can only get you so far.

So we’re going to utilize our breathing to open up these areas. We can use the breath and the pressure it creates in the thorax to pop open ribcage and get those shoulder blades gliding smoothly. Think, your lungs sit nice and snug in the top of the ribcage. If we get this amazing organ to expand, we can stretch the front and back part of the ribcage from the inside out. That said, we can still use some self-massage / myofascial release to reduce some muscle tone around these areas.

Serratus Anterior Scapular Winging Fix.png

Now that we loosen some things up and pressurize the system (sounds fancy), it’s time to load it up. This wouldn’t be a scapular winging article without talking about strengthening the ole’ serratus anterior muscle. This is the primary muscle the pulls the ribcage back the scapula and the scapula to the ribcage. Many people have a hard time feeling this muscle work so they think it’s weak, and it may be. But I believe that the muscle can’t get enough leverage due to the poor postural positioning of the ribcage, hence why we do the breathing stuff to move the ribs into the correct position and set the serratus muscle up for success.

Scapular Winging Exercises

And now, the moment you’ve all been waiting for! The Exercises to fix that mangled chicken wing. Too vulgar? My bad. But really! Here are some step-by-step moves that can all be done at home and for all strength levels. We’ll start with some self-massage, move to reposition the ribcage and scapula, and lastly, strengthen it to make it all stick. Huzzah!

1) Scapular Winging Self Massage Techniques (SMR)

You’re going to want to use a tennis ball, lacrosse ball, or a baseball (if you’re really crazy like that) to dig into these areas. No, we’re not breaking down any muscle fibers or fascia with this technique. We’re simply spending 30 seconds to 2 minutes max at each muscle group (pecs, subclavius, lats, serratus, traps, and rhomboids) in order to get some blood flow and decrease muscle tone. This tames the body a bit so that the breathing and repositioning exercises stick a bit more. The full routine breakdown is in the video below.

2) Scapular Winging Breathing & Repositioning Exercises

We’re going to use three exercises to expand and reposition the ribcage. The common theme between the exercises is that we need to fully exhale to feel abs, and then maintain that tension while we inhale in order to expand into the ribcage. Think of it like inflating a hot air balloon with the ribcage being the balloon, and your abs/ diaphragm as the fiery torch thing that pumps the hot air up… I think that’s how hot air balloons work... Let me know if that analogy clicks. Anyways, watch this video for an in-depth walk-through of each exercise.

a) Banded Posterior Expansion 3x5 breaths

b) Bear Position Breathing 3x5 breaths

c) Door Supported Squat Hold 3x5 breaths

3) Scapular Winging Strengthening Exercises

This is where the rubber meets the road. We’re going to use the new internal rotation we have available at the shoulder and the repositioning of the ribcage to get these muscles working. We’re targeting the serratus anterior, pecs, and midback muscle all with these exercises to improve your strength and maintain your scapular position.

a) Seated Serratus Wall Slides 3x10-20 reps

b) Rough Country Bear Crawls 3x30-60 second bouts

C) Off-set Push-up/Incline Push-up with Reach 3x10-15 reps

Scapular Winging Summary

Well first, thank you a ton for making it this far in the post. It means a lot that you get something from this post. In summary, scapular winging isn’t a bad thing. It happens and it’s not going to wreck your shoulder stability. The best way to improve it is to improve your ribcage’s positioning against gravity and shoulder internal rotation. Really focus on the repositioning & breathing exercises followed by the strength routine and I guarantee you’ll see improvements. Hit this routine 2-3 times per week and reap the benefits!

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Scapular Winging - How To Fix Your Asymmetries