What, How, When, Where, & Why! Defines when it is problematic and when not to worry about it. With no load it’s the body’s natural way of compensating to achieve mobility and range of motion if the individual trying to achieve the end of their own range, and if that same person can stabilize under load the winging is not necessarily a disfunctional movement pattern. Decreasing winging is just an improvement in motor skills. If winging exist under load, there is the defining identity of a disfunction . I believe this is the best video I have viewed on this subject!
this is so amazing! The orthopedic doctor told me I had SICK scapula... although didn't even explain what that was and the physical therapy didn't do anything.
As you have someone internally rotate and reach behind their back there are two reasons EVERYONE will wing their scapula at end range. 1) The rhomboids become active to medially rotate the scap (they are antagonistic relative to the serratus anterior). The more active the rhomboids are, the less active the serratus anterior will be. 2) As you induce this motion you build tension on the external rotators (teres minor and infraspinatus) which pulls the scapula into a winging position. Unless someone’s scapula is unable to protract, retract, elevate, depress, medially or laterally rotate then the scapula is not an issue. Winging during that initial assessment is not an issue. Stability is important to improve performance and prevent injury, but for the most part mobility is the truest indicator of joint health.
For years I became obsessive about trying to make my scapula flush woth my ribcage and my posture. After being fed so much misinformation on the internet about tucking the shoulder blades, keeping the chest up all the time, keeping shoulders back, ect.. I changed my posture for the worse by over correcting. Now I have knots and extremely tight muscles all around the shoulders and upper back.. hood video, because you get it and you're not just feeding bad info to get views.
Thank you so much for taking the time to film these videos. I've been locked in thoracic extension for so long I've lost kyphosis and your Juggernaut article about it has help lots. I can finally address the cause of my shoulder pain. Again, thank you so much. I wish there was a Clinical Athlete practitioner in my country.
I've had an issue like this with my left shoulder. I tried the way to do pushups demonstrated in the video and also the dumbbell press while pushing into the wall and I could feel my left side working much better than it has in quite a while. Thanks for this video! I'll definitely continue to do this before push exercises.
As an experienced yoga teacher with a post grad, I have seen plenty of 'winging scapula' apparently caused simply by muscle weakness and poor posture. What is your advice to the people who don't typically wing without load, but under load their scaps are popping off the back. This tricep pushup position (in yoga we call it chaturanga where we lower down) often makes people wing when they don't have the muscular support there. I get them to lower with the knees on the floor to reduce the load on the upper body but would you recommend any specific cue or movement? I'd like to see this demonstrated on a model who isn't already athletic and strong. Most average, bordering on sedintary people couldn't manage what your model did. Could it also be too much pec minor strain on the way down and not enough upper back 'action' ?
Imo it needs to be treated outside of a class with exercises such as acapula push ups. It'd be basically impossible to cue them to not wing as they don't have the neurological connection to control or use the scapula correctly.
The video is very informative. I like what you're doing. Do not stop! Each video will teach me something new. and I'm just looking for this content. Thank you Dr. Henoch. :)
Quinn Henoch In ace we have been told that if the vertebral medial bordrr is visible I mean protruding outward then it is scapular protraction and if vertebral bordrr along with inferior angle it is refered as winging ... Any leads ??? Like is it exactly like this ?? Am I right or wrong
Sorry to be so off topic but does anyone know of a trick to log back into an Instagram account?? I stupidly forgot the password. I would appreciate any tricks you can give me!
be careful with this, I have scalpula winging and if you do too, loading it makes it worse. pretty much my entire upper body is asymmetrical because of working out with winging.
just load as much needed to activate the serratus anterior, this exercise is not for working out, it is for fixing scapular winging so you should not use a lot of load.
hmm dont know about this... loading in which sense ? every kind of loading ? been lifting for like two years now, had scapular winging my whole life, i think i noticed it at the age of 14, and i bench press 80 kg in my regular series without trouble, i am not feeling asymmetrical either.
Hey, man, great friggin video!! I actually did have some nerve damage and muscular damage from a nasty snowboard crash but after the nerves starting firing again I was led to focus more on pulls to retract the shoulder blades. We thought they were weaker muscles but after years of doing that I was still having issues, I finally figured out after my own research that more pressing was needed. I enjoy your comment about kyphosis being demonized because I fought so hard against it that I'm sure my lack of it led to other issues in the shoulder. It still has a bit of weakness but I can one arm press over 100 so it's getting stronger. Cool videos, I just found them!
Excellent vid doc, thanks for addressing this 'issue'. I've been concerned about this for years, doing all the banded rotator cuff exercises, etc., ad nauseam with no fix. Guess it's time to start doing push-ups again! Side note - Elaine is a great test athlete for these videos.
Great Ernesto, glad the info is worthwhile. Yeah, unless the issue is causing some type of obvious functional deficit, it may be an issue at all. Basic strength training with some unilateral loading sprinkled in should do the trick.
Quinn Henoch Thanks for responding doc. I have some slight muscular imbalance across my left-right shoulder girdle, but nothing that has ever really effected performance. Again, this was a really great video, you and the JTS team put out a ton of killer content.
Ernesto Manuel those banded rotator cuff will not fix scapular winging. but it still shows a muscular imbalance issue, it should be corrected. training the middle and lower traps will go a long way to correct for the imbalance that is at the issue here.
louis cyfer Pull-ups, push-ups, and heavy farmer carries have actually been the largest help for me in my recent training. Any specific movements you would recommend? I reversed my over/under grip on deadlift, that seems to be helping as well. I feel like the imbalance is always going to be there, despite years of unilateral training to specifically fix the issue. I know it's common in throwing athletes (I spend most of my youth playing baseball), so I've just accepted that it's probably not going anywhere. I powerlift, so a balanced aesthetic is no longer a priority for me.
Ernesto Manuel Hi ma right arm goes every morning when I wake up ? I have severe in my rt shoulder n right neck , that pain continue in my right breast it's too painful need help
Doc, good vid in general but I just wanna add my 2 cents about the topic. Mostly about the not-so-common nerve injury to the long thoracic nerve you mentioned. The presence of functional scapular winging is typically due to a simple imbalance of otherwise healthy muscles. But approximately 5% of cases are due to more significant pathology like nerve injury- particularly the long thoracic nerve. Differentiating the source of dysfunction is paramount in managing shoulder complaints. In case of the nerve injury, I felt it was important for you to address and educate about the nerve itself. So here's a bit of info for your listeners to digest: The long thoracic nerve originates from branches of the C5 and C6 nerve roots. These branches join beneath the middle scalene muscle and with some variability, either pierce the middle scalene or emerge between the middle and anterior scalene before uniting with a branch of the C7 (and sometimes C8) nerve root. The long thoracic nerve travels through the axilla to innervate the serratus anterior muscle- a shoulder protractor and scapular stabilizer. Injury to the long thoracic nerve denervates the serratus anterior muscle, resulting in scapular winging and shoulder instability. The long thoracic nerve may be injured from blunt trauma; however, the most common etiology seems to result from repetitive compression or traction. Over 1/3 of cases develop secondary to athletic activity, particularly during exercise or sports that require middle scalene activation. Activities that entail contralateral cervical rotation combined with ipsilateral arm elevation cause significant stretch to the long thoracic nerve. Long thoracic nerve palsy often follows strenuous upper extremity activity or heavy weight lifting. Symptoms typically include: Arm pain and rapid fatigue. Weakness or instability when pushing, pulling, and lifting, particularly with the arm above shoulder level Up to half of patients affected are unable to flex or abduct their shoulder beyond 90 degrees Because Long thoracic nerve palsy is relatively rare, diagnosis is often delayed for months or years. The prognosis for long thoracic neuropathy is quite variable with some authors reporting spontaneous recovery while other cases fail to respond to any treatment, including surgery. Initial management is typically conservative. Patients often show some degree of recovery within the first six to 12 months; however, complete recovery is not always achieved. Nerve flossing exercises may be employed; but clinicians should avoid aggressive or excessive stretch that could exacerbate the injury. Myofascial release and stretching should be directed at the scalene muscles. Patients should perform scapular stabilization exercises beginning in a supine position. Approximately 30% of patients fail conservative management. Surgical intervention may be considered when symptoms persist despite an extended trial of conservative care. Surgical intervention typically involves nerve release. Surgical outcomes tend to deteriorate in relation to chronicity. Patients who have suffered for greater than 10 years are typically candidates for scapular stabilization surgery vs. nerve release. As another healthcare provider, I felt it was important for you to address the possible underlying cause of the scapular winging as not everyone will be able to use their "reflex" to stabilize and engage the involved muscles properly when there is a true nerve injury in order for them to exercise and perform safely. Sorry for the long 2 cents~
Excellent information. I never got any improvement from my shoulder impingement pain and dysfunction until I worked on the scapula stabilisation (winging). Rotator cuff bandwork alone doesn't cut it. Scapula first then add in and include direct rotator cuff work. Great vid
Thank you for this. As a clinician ive heard so many times that you have to cure scapular winging but NONE OF THESE SO CALLED EXPERTS EVER TELL YOU HOW! Your way is very simple and straightforward
Thank you for sharing a mid/int. perspective! I've been trying to formulate a series of healing for my extra cervical ribs, and this video helped to guide me to what my body needs. con gratitudine!!!
It would good if you could also do a video where loading the scapula makes the winging worse, as it does with me. When I do a push up, the winging becomes more severe. The heavier the load the harder it is for me to keep the shoulder blade flush against my rib cage. Happens with push ups, bicep curls - pretty much anytime I load up. If the weight is very light then I can keep it flush, but I run out of strength to hold flush if the load is too much. Assume I need to strengthen the right muscles. Can you do a video to address this as well?
thank you , literally better after loading anatomical isometric tension simulating weight ( no wonder pain went away when applying moving shoulder blades isometric tensioning helped etc , now i have a anatomical sinonims for physiological approach to scapular winging injury cure ) , thankx again
Right on brother. A few critiques just to play devils advocate. The spinal accessory nerve can also produce winging, although lateral instead of medial. Long thoracic nerve compression can happen as seen in thoracic outlet, resulting in an Atraumatic winging. The long thoracic nerve is purely motor, non-sensory so it is plausible one may not know when or how their nerve was damaged. Also, many with clinically significant scapular winging show little to no signs of wallerian degeneration, so while I agree that complete denervation will produce obvious deficits, it is not safe to assume negative EMG rules out damage to the nerve (at some point). Just because someone’s nerve healed doesn’t mean they automatically get that function back! Cheers bro!
Thank you very much for the information. I have been struggling with a winging scapula for 1,5 year and my PT keeps telling me I have long thoracic nerve injury even tho I have no problems protracting and never had any trauma or pain. I have only been doing light horizontal rows and push up plus for 1 year because thats what he told me to do. I have not seen any progression yet tho. Going to try your loading strategy and hope it will help me!
Fixing my posture and decrompressing my spine in combination with strengthening my abs and glutes fixed my winging scapula. It wasnt a nerve injury at all so fuck that PT
Omfg! Thank you for this video.. I have this winging terribly.. causing Costochondritis and more.. Will diligently work on fixing this the best I can.. Cheers!
Both me and my younger brother can flex our scapula to wing out voluntarily. It only goes out if I want it to. I never thought it was something weird until today.
This video had so much great information in it, thank you for taking the time to make! Also your model was strong and adorable in the best way, subscribed! 🤣💪🏻
I had trigeminal neuralgia, the nerves all way through my to arms go numb all the time, it only gotten better loading the shoulders and doing Olympic lifting, I'll often feel my bicep pop in when mouth my mouth after a broken jaw, but I can move just incredibly weird sensations that do not hinder movement or range of motion? It's incredible you truely do train you nervous system
I was born with a winged scapular. It affects my shoulder mobility and the way that my muscles on back, shoulders and slightly on the chest have developed. I can still do most workouts but the range of motion and stability is a problem. If you truly have the issue it most likely will never be cured but you can improve it.
My shoulder blades have winged my whole life. I can hook my thumbs under my scapulars and have been able to do so for 40 years. I didn't have a traumatic event, to both shoulder blades, when I was 8.
I have this on both shoulders. I thought I've been doing push-ups correctly for the past two years until I took a video of me doing push-ups and saw my shoulder blades sticking out 3 inches, even when I'm just laying down on my elbows my shoulder blades go up a good 2 inches.
I have excessive winging on my right shoulder. It's only an issue when I'm doing uni lateral push ups like archer push ups. I've noticed it greatly effects my range on my cross punch. But like hes saying once I warm up the serratus the protraction is great. Thx for info doc!
Love the channel. Definitely had the winging at a lighter weight. At 145 lbs my shoulder blades would always flap around. Jumped to 170 lbs and now I gotta struggle to get them to wing. Thinking it's due to strengthening scapula retraction.
Hi Rocier, no there's no 'good' or 'bad' here necessarily; which is the point of the video. That test was more-so to create a visual for the viewers. Many athletes will not have the amount of range of motion, and that is ok.
Hi Dr. Quinn! Really like your ideal! The Improper position of scapular caused my neck pain for years. How can I know if I injured the long thoracic nerve? Thanks!
i have that problem...and id love to see you working with someone that have that has winging sqapula.and thank you that video is amezing and very halpful:)
Not if you cannot naturally load properly anymore because your winged scapula got so bad. Then you’re just making it worse. Your video really helped me, but it was the beginning part in which you described the issue that helped. At 21 I became addicted to the gym and now matter how much research and videos I watched the best I could do is portray movement through their coaching on the screen. After the beginning of your video I fully believe I gave myself a winged scapula. I’m 28 now and can’t get any enjoyment out of the gym anymore it got so bad. It effects my job (which is the trades), my happiness, my family, my vision, my balance, my breathing and eating. literally every single aspect of my life. I want my daughter to be able to run and jump for a hug without dad saying it hurts.. I know it’s not and injury I can feel the tightness somehow somewhere..
I'm not sure about this.The specific movements place the winged scapula back in position but it seems to be just a bandaid approach because there is no mention how to actually correct the physical problem of winging...or should I assume that doing exercises with the scapula in the proper position automatically heals the muscle or nerve issues at the source of the problem so there won't be any more winging?
I herniated my C5/C6 disk and injured my LTN which caused winging in my right arm and I have noticeable decreased strength and size loss, as well as mobility in my arm. Will be starting PT soon once I recover from my Artificial Disk Replacement. Hopefully I can come back from it relatively soon.
It's kind of like saying if you have shit posture but no pain currently, dont worry about it. Now sometimes what isnt broke doesnt need fixing but sustained forces outside ideal movement patterns over years is a sure fire way to lead to a much bigger problem than the one you had early on. Perfect example is RTC tears caused by years of poor biomechanics. There are other factors potentially but feel it holds true none the less.
Quinn just a question.I injured myself about 2 months ago doing dips using a coffee table.I think I over did the exercise because later that day I had very bad pain in my shoulder area which went on for a couple of weeks.When the pain subsided I noticed I could not lift my arm much above 90 degrees along with very pronounced winging.Can I assume this is Thoracic nerve damage?My Physio is not a hundred percent sure so I have been scouring the internet for answers.You seem very knowledgeable :-)
If you have really injured your thoracic nerve of bell, you will know it, your winging scapula may not correct properly for years (if at all) i know from personal experience. You can have a test on the nerve but from my experience its a bit hit & miss unless there are new tests i do not have any knowledge of. This was still a very informative video and should hopefully help a lot of people.
I injured my shoulder doing behind the neck press many years ago. I've seen a shoulder specialist, and had an MRI, but all the chest showed was there was some instability. Presently I've been doing scapula exercises but I still have pain whenever I perform shoulder exercises, even with very light weights.
While doing exercise I was lifting up dumbles suddenly left blade pooped in the x Ray report left scapula found a bit rushed up and it's been 4 years still I have pain I am wrech why I did exercise but now I fixing it taking some therapy
i think i have probably just about the worst scapula winging that anyone could possibly ever see. i can't do much in the way of upper body exercises anymore but i have found that when i do O/H press with an empty barbell that seems to fire up my upper back muscles like nothing else... i thought about that as soon as you mentioned load being a fix for scapula wing.
Great stuff Dr. Quinn, do you think that part of the reason this happens is affected person doesn't own the ground which then affects the hips, ribs, and scapula?
Hypermobile individual here. My scapulae still wing like crazy when I'm bearing weight/loaded. No history of traumatic injury. Any other input? I feel like a lot of mainstream advice isn't always applicable/transferable to the hypermobile crowd...
Great video. Thank you for posting. However, while standing or kneeling, weights above the shoulder (in a military press form)....aren't you in a shoulder impingement setup?
Probably weak rotator cuff tendons(stretched or worst torn) and weak rotator cuff muscles. Weak back muscles. Muscle imbalance maybe doing too much weight on bench press. Decrease the weight on your Bench and do shoulder, rotator cuff and back exercises with light weight and strict proper form. Incorporate light band exercises for your rotator cuff and shoulder. Be more patient.
My pectoral minor is fuuuuuucked up from this. Stopped lifting over a year now after ten years of regular lifting. Just now getting the nerve back to start strength training at square one. I can still feel strain in the right pectoral minor.
Quinn- Really have enjoyed watching your videos. Recent MRI shows a bursitis in the AC joint (Former Shot/Disc Thrower). All Using many of the typical cuff mvmts (Y T I's). The Bells up work (stability emphasis) will soon be added. Strict horizontal presses remain painful, but overhead movements actually alleviate the pain. I feel my positioning under load when pushing vertical is much more stable. Why would the horizontal press cause such an issue with the AC?
too much pushing not enough pulling. my sports masseuse tells me everytime, train rhombois rhomboids rhomboids the diamon muscle between shoulder blades. neglecting that causes all my shoulder issues. too much chest training.
thank you for this. I have scapular winging in both shoulders, along with bilateral labrum tears and partial rotator cuff tear. What do you recommend for correcting this problem safely with such injuries? Had an orthopedic surgeon tell me I have "loose joints" so the tears are not getting fixed. I got some 1 lb walking weights to start out with because my shoulder snapped really loudly while lifting a 2 lb kitten after a series of trigger point injections (that did not help). I will look for your recommended doctor list and browse your channel. much appreciated info. with gratitude.
I have noticed how the shoulder blade glides smoothly across the ribcage when I use Gymnastic rings or do the pushups on my knuckles as your athlete did. When I do the push-up on me hands close to the chest and try to keep my elbow close to the ribcage, the medial border sticks out and flaps over before I get to the retracted bottom position. Do you know why that is? Thank you so much for this great informative video!’
Probably why I have bi-lateral rotator cuff tears :( My shoulder blades have always winged out - its been a difficult challenge to strengthen that scalpular region (allowing me to retract it) .
Scapula Winging is a problem.When you sit straight your scapula is surely going to hurt...I have experienced this,winging might not be an 'injury',but if you sit straight for like 30-45 mins your shoulders are going to hurt if you have winging
Dear Dr Quin, I do experience pain due to my winged scapula. I am not injured. Do your exercise help with those needing more therapeutic regiment for pain relief? Thank you.
This man is brilliant. Very cool stuff for the aspiring physical therapists out there, like me!
Happy to hear it's helpful, good luck in your journey!
What, How, When, Where, & Why! Defines when it is problematic and when not to worry about it. With no load it’s the body’s natural way of compensating to achieve mobility and range of motion if the individual trying to achieve the end of their own range, and if that same person can stabilize under load the winging is not necessarily a disfunctional movement pattern. Decreasing winging is just an improvement in motor skills. If winging exist under load, there is the defining identity of a disfunction . I believe this is the best video I have viewed on this subject!
this is so amazing! The orthopedic doctor told me I had SICK scapula... although didn't even explain what that was and the physical therapy didn't do anything.
@michael browne thinking bad of other people is bad for your well being man
As you have someone internally rotate and reach behind their back there are two reasons EVERYONE will wing their scapula at end range. 1) The rhomboids become active to medially rotate the scap (they are antagonistic relative to the serratus anterior). The more active the rhomboids are, the less active the serratus anterior will be. 2) As you induce this motion you build tension on the external rotators (teres minor and infraspinatus) which pulls the scapula into a winging position. Unless someone’s scapula is unable to protract, retract, elevate, depress, medially or laterally rotate then the scapula is not an issue. Winging during that initial assessment is not an issue. Stability is important to improve performance and prevent injury, but for the most part mobility is the truest indicator of joint health.
For years I became obsessive about trying to make my scapula flush woth my ribcage and my posture. After being fed so much misinformation on the internet about tucking the shoulder blades, keeping the chest up all the time, keeping shoulders back, ect.. I changed my posture for the worse by over correcting. Now I have knots and extremely tight muscles all around the shoulders and upper back.. hood video, because you get it and you're not just feeding bad info to get views.
Thank you for this. After researching this condition for years, this was by far the most informative and actually effective.
👍
Thank you so much for taking the time to film these videos. I've been locked in thoracic extension for so long I've lost kyphosis and your Juggernaut article about it has help lots. I can finally address the cause of my shoulder pain. Again, thank you so much. I wish there was a Clinical Athlete practitioner in my country.
Did u fix ur scapula winging??
Thanks for this, I was told I have this "issue" with my scapula and was skeptical. This video is an eye-opener. THANKS
I've had an issue like this with my left shoulder. I tried the way to do pushups demonstrated in the video and also the dumbbell press while pushing into the wall and I could feel my left side working much better than it has in quite a while. Thanks for this video! I'll definitely continue to do this before push exercises.
As an experienced yoga teacher with a post grad, I have seen plenty of 'winging scapula' apparently caused simply by muscle weakness and poor posture. What is your advice to the people who don't typically wing without load, but under load their scaps are popping off the back. This tricep pushup position (in yoga we call it chaturanga where we lower down) often makes people wing when they don't have the muscular support there. I get them to lower with the knees on the floor to reduce the load on the upper body but would you recommend any specific cue or movement? I'd like to see this demonstrated on a model who isn't already athletic and strong. Most average, bordering on sedintary people couldn't manage what your model did. Could it also be too much pec minor strain on the way down and not enough upper back 'action' ?
same with me, my scapula doesnt wing at rest, but when i get into the push up position by left scapula wings noticibly.
Exercises that target the upper back and scapula region should fix it
Imo it needs to be treated outside of a class with exercises such as acapula push ups. It'd be basically impossible to cue them to not wing as they don't have the neurological connection to control or use the scapula correctly.
Should a winging scapula patient consult neurologist or just physical therapy is enough?
The video is very informative. I like what you're doing. Do not stop! Each video will teach me something new. and I'm just looking for this content. Thank you Dr. Henoch. :)
Glad it's helpful!
Quinn Henoch agreed! i love your videos. thanks
Quinn Henoch In ace we have been told that if the vertebral medial bordrr is visible I mean protruding outward then it is scapular protraction and if vertebral bordrr along with inferior angle it is refered as winging ... Any leads ??? Like is it exactly like this ?? Am I right or wrong
Awesome video. Thanks a lot for sharing. Will incorporate unstable loads to my training routines. ;)
Sorry to be so off topic but does anyone know of a trick to log back into an Instagram account??
I stupidly forgot the password. I would appreciate any tricks you can give me!
@Jorge Kane Instablaster ;)
i was taught the rubber band to engage the scap muscles but your method is adding more load; i like the progression thanks
be careful with this, I have scalpula winging and if you do too, loading it makes it worse. pretty much my entire upper body is asymmetrical because of working out with winging.
just load as much needed to activate the serratus anterior, this exercise is not for working out, it is for fixing scapular winging so you should not use a lot of load.
hmm dont know about this... loading in which sense ? every kind of loading ? been lifting for like two years now, had scapular winging my whole life, i think i noticed it at the age of 14, and i bench press 80 kg in my regular series without trouble, i am not feeling asymmetrical either.
I've always thought that the scapular thing is genetic, i happen to be very flexible and also have this like double joints in my thumbs
Itachi0567 fo me quite a lot on my left is bigger than my right but I’m stronger on my right hand side
edit bazelli Define “activate.”
Hey, man, great friggin video!! I actually did have some nerve damage and muscular damage from a nasty snowboard crash but after the nerves starting firing again I was led to focus more on pulls to retract the shoulder blades. We thought they were weaker muscles but after years of doing that I was still having issues, I finally figured out after my own research that more pressing was needed.
I enjoy your comment about kyphosis being demonized because I fought so hard against it that I'm sure my lack of it led to other issues in the shoulder. It still has a bit of weakness but I can one arm press over 100 so it's getting stronger.
Cool videos, I just found them!
Did u fix ur scapula winging??
I really loved this Dr. Quinn, he seems to really know what he is doing. I did a few of these exercises tonight & they were ROUGH...
Excellent vid doc, thanks for addressing this 'issue'. I've been concerned about this for years, doing all the banded rotator cuff exercises, etc., ad nauseam with no fix. Guess it's time to start doing push-ups again!
Side note - Elaine is a great test athlete for these videos.
Great Ernesto, glad the info is worthwhile. Yeah, unless the issue is causing some type of obvious functional deficit, it may be an issue at all. Basic strength training with some unilateral loading sprinkled in should do the trick.
Quinn Henoch Thanks for responding doc. I have some slight muscular imbalance across my left-right shoulder girdle, but nothing that has ever really effected performance. Again, this was a really great video, you and the JTS team put out a ton of killer content.
Ernesto Manuel those banded rotator cuff will not fix scapular winging. but it still shows a muscular imbalance issue, it should be corrected. training the middle and lower traps will go a long way to correct for the imbalance that is at the issue here.
louis cyfer Pull-ups, push-ups, and heavy farmer carries have actually been the largest help for me in my recent training. Any specific movements you would recommend? I reversed my over/under grip on deadlift, that seems to be helping as well.
I feel like the imbalance is always going to be there, despite years of unilateral training to specifically fix the issue. I know it's common in throwing athletes (I spend most of my youth playing baseball), so I've just accepted that it's probably not going anywhere. I powerlift, so a balanced aesthetic is no longer a priority for me.
Ernesto Manuel
Hi ma right arm goes every morning when I wake up ?
I have severe in my rt shoulder n right neck , that pain continue in my right breast it's too painful
need help
Doc, good vid in general but I just wanna add my 2 cents about the topic. Mostly about the not-so-common nerve injury to the long thoracic nerve you mentioned. The presence of functional scapular winging is typically due to a simple imbalance of otherwise healthy muscles. But approximately 5% of cases are due to more significant pathology like nerve injury- particularly the long thoracic nerve. Differentiating the source of dysfunction is paramount in managing shoulder complaints.
In case of the nerve injury, I felt it was important for you to address and educate about the nerve itself. So here's a bit of info for your listeners to digest: The long thoracic nerve originates from branches of the C5 and C6 nerve roots. These branches join beneath the middle scalene muscle and with some variability, either pierce the middle scalene or emerge between the middle and anterior scalene before uniting with a branch of the C7 (and sometimes C8) nerve root. The long thoracic nerve travels through the axilla to innervate the serratus anterior muscle- a shoulder protractor and scapular stabilizer. Injury to the long thoracic nerve denervates the serratus anterior muscle, resulting in scapular winging and shoulder instability.
The long thoracic nerve may be injured from blunt trauma; however, the most common etiology seems to result from repetitive compression or traction. Over 1/3 of cases develop secondary to athletic activity, particularly during exercise or sports that require middle scalene activation. Activities that entail contralateral cervical rotation combined with ipsilateral arm elevation cause significant stretch to the long thoracic nerve.
Long thoracic nerve palsy often follows strenuous upper extremity activity or heavy weight lifting. Symptoms typically include:
Arm pain and rapid fatigue.
Weakness or instability when pushing, pulling, and lifting, particularly with the arm above shoulder level
Up to half of patients affected are unable to flex or abduct their shoulder beyond 90 degrees
Because Long thoracic nerve palsy is relatively rare, diagnosis is often delayed for months or years. The prognosis for long thoracic neuropathy is quite variable with some authors reporting spontaneous recovery while other cases fail to respond to any treatment, including surgery. Initial management is typically conservative. Patients often show some degree of recovery within the first six to 12 months; however, complete recovery is not always achieved. Nerve flossing exercises may be employed; but clinicians should avoid aggressive or excessive stretch that could exacerbate the injury. Myofascial release and stretching should be directed at the scalene muscles. Patients should perform scapular stabilization exercises beginning in a supine position.
Approximately 30% of patients fail conservative management. Surgical intervention may be considered when symptoms persist despite an extended trial of conservative care. Surgical intervention typically involves nerve release. Surgical outcomes tend to deteriorate in relation to chronicity. Patients who have suffered for greater than 10 years are typically candidates for scapular stabilization surgery vs. nerve release.
As another healthcare provider, I felt it was important for you to address the possible underlying cause of the scapular winging as not everyone will be able to use their "reflex" to stabilize and engage the involved muscles properly when there is a true nerve injury in order for them to exercise and perform safely. Sorry for the long 2 cents~
Excellent information. I never got any improvement from my shoulder impingement pain and dysfunction until I worked on the scapula stabilisation (winging). Rotator cuff bandwork alone doesn't cut it. Scapula first then add in and include direct rotator cuff work. Great vid
Hello, could you elaborate on how you first target the scapula
Thank you for this. As a clinician ive heard so many times that you have to cure scapular winging but NONE OF THESE SO CALLED EXPERTS EVER TELL YOU HOW! Your way is very simple and straightforward
Did u fix ur scapula winging??
Thank you for sharing a mid/int. perspective! I've been trying to formulate a series of healing for my extra cervical ribs, and this video helped to guide me to what my body needs. con gratitudine!!!
VERY GOOD PRINCIPLES, Dr. Quinn...I will definitely incorporate your methods in my clinic. Thank you, sir!
Thanks again, Quinn! Helping me fix myself one video at a time
It would good if you could also do a video where loading the scapula makes the winging worse, as it does with me. When I do a push up, the winging becomes more severe. The heavier the load the harder it is for me to keep the shoulder blade flush against my rib cage. Happens with push ups, bicep curls - pretty much anytime I load up. If the weight is very light then I can keep it flush, but I run out of strength to hold flush if the load is too much. Assume I need to strengthen the right muscles. Can you do a video to address this as well?
Did u fix it? If so how?
thank you , literally better after loading anatomical isometric tension simulating weight ( no wonder pain went away when applying moving shoulder blades isometric tensioning helped etc , now i have a anatomical sinonims for physiological approach to scapular winging injury cure ) , thankx again
The body....what a beautiful thing, its crazy what it does and what it can do.
This video speaks to me Dr. Quinn! I'm from Wisconsin and I am just waiting for some clinical athlete practitioners to pop up D:
Awesome video this series is brilliant, one on SI joint dysfunction would be very interesting indeed!
@juggernaut training systems? YA HEAR? Let's rock it!
Great video and clear explanation. You just confirmed many of my own thoughts and observations of this 'condition'.
Right on brother. A few critiques just to play devils advocate. The spinal accessory nerve can also produce winging, although lateral instead of medial. Long thoracic nerve compression can happen as seen in thoracic outlet, resulting in an Atraumatic winging. The long thoracic nerve is purely motor, non-sensory so it is plausible one may not know when or how their nerve was damaged. Also, many with clinically significant scapular winging show little to no signs of wallerian degeneration, so while I agree that complete denervation will produce obvious deficits, it is not safe to assume negative EMG rules out damage to the nerve (at some point). Just because someone’s nerve healed doesn’t mean they automatically get that function back! Cheers bro!
Best channel ever. Dr Quinn is the freakin man.
Excellent video, intelligent discussion of the "problem". Thanks.
IMHO: THIS IS AN EXCELLENT VIDEO!!!! THANK YOU!!!
Thank you very much for the information. I have been struggling with a winging scapula for 1,5 year and my PT keeps telling me I have long thoracic nerve injury even tho I have no problems protracting and never had any trauma or pain. I have only been doing light horizontal rows and push up plus for 1 year because thats what he told me to do. I have not seen any progression yet tho. Going to try your loading strategy and hope it will help me!
How are you doing now? Thanks.
Yes please tell us tour progress
Update?
Fixing my posture and decrompressing my spine in combination with strengthening my abs and glutes fixed my winging scapula. It wasnt a nerve injury at all so fuck that PT
@@TomvDriel niiice that's great
Omfg! Thank you for this video.. I have this winging terribly.. causing Costochondritis and more.. Will diligently work on fixing this the best I can.. Cheers!
Both me and my younger brother can flex our scapula to wing out voluntarily. It only goes out if I want it to. I never thought it was something weird until today.
Thank you for this, very helpful.
This video had so much great information in it, thank you for taking the time to make! Also your model was strong and adorable in the best way, subscribed! 🤣💪🏻
amazing, been doing some of this tuff with athletes, also learned some new stuff ill incorporate with others as well. Thanks, keep these coming!
using the wall to "load" is great
I had trigeminal neuralgia, the nerves all way through my to arms go numb all the time, it only gotten better loading the shoulders and doing Olympic lifting, I'll often feel my bicep pop in when mouth my mouth after a broken jaw, but I can move just incredibly weird sensations that do not hinder movement or range of motion? It's incredible you truely do train you nervous system
I was born with a winged scapular. It affects my shoulder mobility and the way that my muscles on back, shoulders and slightly on the chest have developed. I can still do most workouts but the range of motion and stability is a problem. If you truly have the issue it most likely will never be cured but you can improve it.
Yeah, I can "load" my scapula, but that doesn't help me the rest of the 24 hours in the day.
My shoulder blades have winged my whole life. I can hook my thumbs under my scapulars and have been able to do so for 40 years. I didn't have a traumatic event, to both shoulder blades, when I was 8.
I have this on both shoulders. I thought I've been doing push-ups correctly for the past two years until I took a video of me doing push-ups and saw my shoulder blades sticking out 3 inches, even when I'm just laying down on my elbows my shoulder blades go up a good 2 inches.
She has flawless pushup form. Love it.
I have excessive winging on my right shoulder. It's only an issue when I'm doing uni lateral push ups like archer push ups. I've noticed it greatly effects my range on my cross punch. But like hes saying once I warm up the serratus the protraction is great. Thx for info doc!
Love the channel. Definitely had the winging at a lighter weight. At 145 lbs my shoulder blades would always flap around. Jumped to 170 lbs and now I gotta struggle to get them to wing. Thinking it's due to strengthening scapula retraction.
Great to know thanks. I'm 150 and my goal weight is 170.
wtf. Am i supposed to be able to hold my hands behind my back like that?! impossibru!
Hi Rocier, no there's no 'good' or 'bad' here necessarily; which is the point of the video. That test was more-so to create a visual for the viewers. Many athletes will not have the amount of range of motion, and that is ok.
Im not mobile at all and can overlap my palms completely
Hi Dr. Quinn! Really like your ideal! The Improper position of scapular caused my neck pain for years. How can I know if I injured the long thoracic nerve? Thanks!
Nerve/EMG test for the long thoracic nerve.
no doubt about the bell up exercises adding a much more difficulty stability element to it!
Thank You, Very Helpful.
extremely informative and very easy to understand.
13:00 activating muscles can cure your winging
Define “activate.”
Great content. I've been watching your vids, learning much along the way. Thank you!
Excellent instruction. Very helpful.
Its called pseudo-winging of the scapula, if there is no injury or dysfunction to the long thoracic nerve.
i have that problem...and id love to see you working with someone that have that has winging sqapula.and thank you that video is amezing and very halpful:)
Not if you cannot naturally load properly anymore because your winged scapula got so bad. Then you’re just making it worse. Your video really helped me, but it was the beginning part in which you described the issue that helped. At 21 I became addicted to the gym and now matter how much research and videos I watched the best I could do is portray movement through their coaching on the screen. After the beginning of your video I fully believe I gave myself a winged scapula. I’m 28 now and can’t get any enjoyment out of the gym anymore it got so bad. It effects my job (which is the trades), my happiness, my family, my vision, my balance, my breathing and eating. literally every single aspect of my life. I want my daughter to be able to run and jump for a hug without dad saying it hurts.. I know it’s not and injury I can feel the tightness somehow somewhere..
So glad I discovered your videos!
great info Thank you Dr. Quinn Henoch
I'm not sure about this.The specific movements place the winged scapula back in position but it seems to be just a bandaid approach because there is no mention how to actually correct the physical problem of winging...or should I assume that doing exercises with the scapula in the proper position automatically heals the muscle or nerve issues at the source of the problem so there won't be any more winging?
Awesome. Best explanation I have heard. Thank you.
I herniated my C5/C6 disk and injured my LTN which caused winging in my right arm and I have noticeable decreased strength and size loss, as well as mobility in my arm. Will be starting PT soon once I recover from my Artificial Disk Replacement. Hopefully I can come back from it relatively soon.
It's kind of like saying if you have shit posture but no pain currently, dont worry about it. Now sometimes what isnt broke doesnt need fixing but sustained forces outside ideal movement patterns over years is a sure fire way to lead to a much bigger problem than the one you had early on. Perfect example is RTC tears caused by years of poor biomechanics. There are other factors potentially but feel it holds true none the less.
Quinn just a question.I injured myself about 2 months ago doing dips using a coffee table.I think I over did the exercise because later that day I had very bad pain in my shoulder area which went on for a couple of weeks.When the pain subsided I noticed I could not lift my arm much above 90 degrees along with very pronounced winging.Can I assume this is Thoracic nerve damage?My Physio is not a hundred percent sure so I have been scouring the internet for answers.You seem very knowledgeable :-)
He'd need to analyze you in person. Anything else is just guesswork.
"A light kettle, 18 pounds"
Damn I'm weak xD
12:41 Best moment 😄
If you have really injured your thoracic nerve of bell, you will know it, your winging scapula may not correct properly for years (if at all) i know from personal experience. You can have a test on the nerve but from my experience its a bit hit & miss unless there are new tests i do not have any knowledge of.
This was still a very informative video and should hopefully help a lot of people.
I injured my shoulder doing behind the neck press many years ago. I've seen a shoulder specialist, and had an MRI, but all the chest showed was there was some instability. Presently I've been doing scapula exercises but I still have pain whenever I perform shoulder exercises, even with very light weights.
Ive got scapular winging and I wish I had mobility..putting on a T-shirt and washing my hair is painful. Pt for 4 months hasn't changed much😪
How are you doing now? same issue?
While doing exercise I was lifting up dumbles suddenly left blade pooped in the x Ray report left scapula found a bit rushed up and it's been 4 years still I have pain I am wrech why I did exercise but now I fixing it taking some therapy
I fixed it finaly
@@HQLifeChanging bro little help
4:45 My hands can't even reach each other when I do this with my left arm above, but with my right arm above I can do this no problem
same
same.. need help
Do it in your warm-up routine, your both hands grabing a towel, spend more time on your bad side, pulling up and/or down
+extraphenomenal Omg same , do you guys play a lot of video games and use mouse with your right arm like me?
I do, but I don't have this issue :p
This is really Helpful. Thank you sir!
i think i have probably just about the worst scapula winging that anyone could possibly ever see. i can't do much in the way of upper body exercises anymore but i have found that when i do O/H press with an empty barbell that seems to fire up my upper back muscles like nothing else...
i thought about that as soon as you mentioned load being a fix for scapula wing.
Great video! What if the winging keeps me from being able to press overhead single arm loaded or unloaded?
What if i do have this "damaged" thoracic nerve that prevents me from retracting my left scapula?
See a doctor man
@@lampej_9251 every hospital is busy with corona i have the same problem
Watch the AthleanX video on this. DO NOT load.
@OVERCOME72
ruclips.net/video/VCPp1DUypo0/видео.html
Great stuff Dr. Quinn, do you think that part of the reason this happens is affected person doesn't own the ground which then affects the hips, ribs, and scapula?
Hypermobile individual here. My scapulae still wing like crazy when I'm bearing weight/loaded. No history of traumatic injury. Any other input? I feel like a lot of mainstream advice isn't always applicable/transferable to the hypermobile crowd...
work on eccentric works for serratus anterior
same
same
Strenghten your serratus anterior. I do bench press with bands for serratus anterior.
Great explanation, very educational, thanks!
Great video. Thank you for posting. However, while standing or kneeling, weights above the shoulder (in a military press form)....aren't you in a shoulder impingement setup?
These are great videos! Thank you!!
Best explanation. Thank you.
What if you have scapular winging and pain the that same shoulder when bench pressing (but only one shoulder, not both).
What does that mean?
Probably weak rotator cuff tendons(stretched or worst torn) and weak rotator cuff muscles. Weak back muscles. Muscle imbalance maybe doing too much weight on bench press. Decrease the weight on your Bench and do shoulder, rotator cuff and back exercises with light weight and strict proper form. Incorporate light band exercises for your rotator cuff and shoulder. Be more patient.
Could be a rib out of place.
My pectoral minor is fuuuuuucked up from this. Stopped lifting over a year now after ten years of regular lifting. Just now getting the nerve back to start strength training at square one. I can still feel strain in the right pectoral minor.
Very good facts, myth busting and coaching!
Chick's hair on point!
I have advanced scapular winging, hope these tips could help me.
Did it?
Quinn- Really have enjoyed watching your videos. Recent MRI shows a bursitis in the AC joint (Former Shot/Disc Thrower). All Using many of the typical cuff mvmts (Y T I's). The Bells up work (stability emphasis) will soon be added. Strict horizontal presses remain painful, but overhead movements actually alleviate the pain. I feel my positioning under load when pushing vertical is much more stable. Why would the horizontal press cause such an issue with the AC?
too much pushing not enough pulling. my sports masseuse tells me everytime, train rhombois rhomboids rhomboids the diamon muscle between shoulder blades. neglecting that causes all my shoulder issues. too much chest training.
thank you for this. I have scapular winging in both shoulders, along with bilateral labrum tears and partial rotator cuff tear. What do you recommend for correcting this problem safely with such injuries? Had an orthopedic surgeon tell me I have "loose joints" so the tears are not getting fixed. I got some 1 lb walking weights to start out with because my shoulder snapped really loudly while lifting a 2 lb kitten after a series of trigger point injections (that did not help). I will look for your recommended doctor list and browse your channel. much appreciated info. with gratitude.
this is exactly what i needed thanks dr
Thank you!! Amazing info
I have noticed how the shoulder blade glides smoothly across the ribcage when I use Gymnastic rings or do the pushups on my knuckles as your athlete did. When I do the push-up on me hands close to the chest and try to keep my elbow close to the ribcage, the medial border sticks out and flaps over before I get to the retracted bottom position. Do you know why that is? Thank you so much for this great informative video!’
Excellent video. Can you also make a video on snapping scapular syndrome?
Probably why I have bi-lateral rotator cuff tears :( My shoulder blades have always winged out - its been a difficult challenge to strengthen that scalpular region (allowing me to retract it) .
Scapula Winging is a problem.When you sit straight your scapula is surely going to hurt...I have experienced this,winging might not be an 'injury',but if you sit straight for like 30-45 mins your shoulders are going to hurt if you have winging
doing gods work with these informative videos keem em coming brother!
Great video. So great that doctors of physical therapy are providing this content instead of some Joe blow pretending to know
That intro was like a flashback to the early 2000's infomercial on the ab dominizer
Should I perform these exercises if poping and throbbing sound comes from my shoulder blade..
i have this same issue
Dear Dr Quin, I do experience pain due to my winged scapula. I am not injured. Do your exercise help with those needing more therapeutic regiment for pain relief? Thank you.