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.

How do I work with someone with scoliosis?

From Melanie Byford-Young

Hi Jeff,
Great questions about your client.

Scoliosis and scapula

My name is Brigitte and I’m a certified STOTT PILATES instructor and massage therapist in Montreal. I have watched you over many hours while editing the rehab DVD series that you did (I edit from English to French). I find you very knowledgeable, inspiring and motivating and if I could, would love to just spend a few months with you to learn even more (something that right now is not possible but who knows what the future holds!). I’m writing to you because I’d like to have your opinion on someone I’m working with. I realize that you cannot make any diagnosis or give me the absolute answer regarding this client, however perhaps you could shed some light.

I’ve been working with a woman for over a year now, she has spondilolithesis (so she’s obviously quite kyphotic in thoracic and hyperextended in cervical), fused lumbar, with a slight scoliosis, winging right scapula. She has a lot less stability in right shoulder and scapula. I have been focusing on spinal extension and scapular stabilization. I also work her in seated, kneeling and standing positions to encourage recruitment of the spinal and pelvic stabilizers in a neutral position. My one issue that I have is this terribly winging right scapula. I make her do lots of rotator cuff work, I also do lots of protractions against resistance to work her serratus anterior. I work on the cadillac, doing mid, lower and upper trap work, often unilaterally. The upper fibers of her rhomboids and mid traps seem to be firing well. However her mid to lower area of her scapula is always winging at a certain degree, usually when her elbows are bent (ex: when they’re bent and at elbow height, or while side-lying and doing ext. rotations with ball – although this has improved greatly). I make her do certain things and think, wow, her scapula is flush and moving smoothly. Then I make her do something else and it totally pops right off. I’ve been trying to help by placing her against a wall, with elbows bent at 90 degrees, in line with her shoulders. I then get her to do external rotations, bringing her forearms to the wall. She has a much smaller range with her right side and sometimes cringes while attempting this (she has improved but still not to full range).

Is there anything else I could do, it’s just boggling my mind and I really want to help this woman. I know I already have but I’m stumped. I started to think that she has quite a few active trigger points which may be preventing her from getting that full range. Either way, anything insight you could give would be much appreciated. I hope to one day attend one of your workshops, perhaps when you’re a little closer to Montreal!

Thanks so much and have a great day!

Sincerely,
Brigitte

From Brigitte to Pacific NW Pilates