Scoliosis & Winging Scapula

This question was emailed to us from Mila in NYC:

I have long s-shaped thoracolumbar scoliosis. I looked at a post on your website and realized you spoke to someone about a client that had a shoulder blade that tips foward. My left shoulder blade, which has been described as a “winged scapula” is tipped foward to the point where it looks like I am slouching. I have a thoracic scoliosis with convexity to the right.

I often feel “tired” on the left side of my upper body. Do you know of any exercises to help with this or with aesthetic apperance of the scapula? I failed to mention that I am 21 years old.  Also, I know you are not a doctor but I was just wondering if you know whether my condition can worsen with time. I happen to be left-handed. Could that have contributed to scoliosis as well? Also, can an abnormality in the shoulder blade (such as winging or rotation) cause scoliosis?

Jean’s response:

Winging scapulas are not an uncommon occurrence when you have a thoracic scoliosis. If it is feeling tipped forward as well as winged then it would help to strengthen the mid and lower segments of the trapezius muscle as well as serratus anterior. STOTT PILATES has a variety of exercises that can help target those muscles. However, based on the curvature of your spine that scapula may not ever be able to lie perfectly flat on your ribcage. We should be able to decrease the amount of winging and help it to stablize in a more neutral position.
As far as feeling “tired” or less connected to your left side, it might help to focus on breathing into that side more. Most of us have a somewhat assymetrical breathing pattern and a scoliosis increases the odds of that happening. Lying over the spine corrector or an arc barrel or large pillow on your right side will help to open up the ribcage on your left side. Imagine the ribs opening and closing like an accordian to increase the oxygenation to that side. Breathing can create some amazing changes in the body just by bringing awareness and increased blood flow to that area.
I have included some photographs of  winging and tipped scapula as well as a good  exercise to strengthen the scapula stabilzing muscles below.

Melanie’s response:

Thank you for writing to us. Indeed there is alot that you can do to help relieve the fatigue you feel in your spine. Whether or not you can change the appearance of your scapula depends on whether there is a myofascial component causing the winging, or if the scapula position is determined solely by your scoliosis.

There is some great research by Paul Hodges that talks about the differences in muscle type and function on either side of the curve. As Jean wrote, combining breathe and movement is one of the very most effective ways to change scoliosis and optimize function.

A couple of exercises that you could start with:
Arm scissors and arms overhead: focus on the motion of the left scapula and clavicle. The clavicle must rotate posteriorly to achieve full elevation and to bring the scapula in contact with the rib cage. Keep your posterior rib cage down as you slowly create the proper mechanics at the SC joint and clavicle. You can use your inhale to try to elongate the pectoralis minor which is frequently is a cause of winging.

Mermaid- Do this to both sides but have a different focus for each side: side bending to the right with the left arm in elevation: focus your inhale into the pectoralis minor region and try to get elongation through the lateral muscles of your trunk and scapula. Really focus on reaching up and over as you side bend right. On the side, after side bending to the left, really focus on your return to vertical. Developing the the multifidus and erector spinae should help with the fatigue.

Spinal rotation with scapula isolation: focus on spiraling through the rotation. Usually we will allow the pelvis to move instead of maintaining the initial stacked position due to the scoliosis.

Spine stretch forward with hands on a stability ball- exhale as you roll forward focusing on keeping your scapulae centered and with no gripping; inhale in your flexed position focusing on not gripping around your scapular and neck muscles; then exhale as you re-stack your spine. After having done a couple of repetitions, add an additional challenge to your spine; after stacking up your spine perfectly, maintain your spine and lift both arms off the ball without shifting or rotating.

Start with those and let us know how it goes. Naturally every exercise can be adapted for your scoliosis and scapular issue.

A good example of winging and anteriorly tipped  scapulae.

Shrugging the shoulders up and then sliding them part way down is a good way to find a more neutral alignment.

Once you have your shoulder blades as neutral as possible, (i.e. flat against the ribcage) then try some wall push-ups, trying to maintain the scapula in this stable position while you are bending and straightening the elbows. You should not let the shoulder blades move while you do the push-up.

Keep the body in one straight line as you do the push-ups. The heels can come off the floor as needed.