Shoulder Impingement: Part 3 – The Shoulder Blade’s Role in Impingement

Understanding what is happening inside of the shoulder joint is a very important part of understanding impingement.  If you haven’t checked out part 1 and part 2 I’d recommend...

Understanding what is happening inside of the shoulder joint is a very important part of understanding impingement.  If you haven’t checked out part 1 and part 2 I’d recommend starting there before reading about the shoulder blade. To make matters a bit more complex, the musculature that surrounds and controls the shoulder blade (scapula) plays a large role in this condition as well.  I wanted to leave no stone unturned in fully understanding impingement so next we’ll discuss how the scapular musculature can affect impingement.

Patients with impingement have changes in shoulder blade kinematics that differs from healthy patients.  Basically this means that the shoulder blade is not moving normally as it should in normal patients.  In the world of shoulder pain and pathology, this is often referred to as scapular dyskinesia.

Why is this happening?  Part of the problem lies in what is happening to the musculature that attaches to the shoulder blade.  Similar to issues with the rotator cuff in impingement, we’re having these problems in scapular musculature.  These dysfunctions can present as:

  • Muscle timing issues (Muscles don’t fire as fast or reflexively as they are meant to)
  • Force couple imbalances
  • Weakness
  • Length issues (short and overpowering vs. long and weak)

The problems associated with the scapular musculature is thought to alter the orientation of the humeral head in its socket and decrease the subacromial space.  As discussed earlier, a decreased subacromial space can compress the rotator cuff tendons, bursa and the biceps tendon.  If we want healthy shoulders we’ve got to address this area.

Here’s what we typically see out of whack in this population:

  1. Dominance of the upper trapezius
  2. Weakness or delayed activation of the middle, lower trapezius and serratus anterior
  3. Scapular Winging and Anterior Tilt of the Scapula
  4. Poor Posture
  5. Scapular Dyskinesis

1. Patients with Impingement had on average greater recruitment of the upper trapezius and less recruitment of the lower trapezius when raising their arms overhead in the scapular plane.  This upper trapezius dominance can cause hiking or shrugging of the shoulder during overhead movement and decrease the ability of the scapula to rotate normally.

Taking a look at where the trapezius originates and inserts (attachment points to bone)  you can see that the upper trapezius will be responsible for elevating the scapula and rotating it upward as you elevate them arms overhead.  The lower trapezius will be responsible for keeping the shoulder blade stable and keeping it from excessively elevating.  The lower trapezius counterbalances the upper trapezius and allows the scapula to rotate normally.  Lastly, if the lower trapezius is not doing its job correctly then the upper trapezius will do more hiking/shrugging as opposed to rotating the scapula normally as you raise your arms overhead.

2. Those with impingement typically have either a weakness or delayed activation of the middle/lower trapezius as well as the serratus anterior.  These muscles play a large role in stabilizing the scapula flat against the ribcage with movement.

3.  Patients with impingement often present with scapular winging or anterior tilt of the scapula at rest and with movement.  Scapular winging and anterior tilt of the scapula are two terms for the same condition.  Scapular winging can either be caused by weakness in the mid/lower trapezius and serratus anterior or by tightness in the Pectoralis Minor.

As you can see if the pec minor is tight it will pull the shoulder blade forward, tilting the shoulder blade, protracting the shoulder (bringing the shoulder forward) and decreasing the subacromial space.  (bad news bears)

Here’s how it might look from behind.  Notice how prominent the inferior (bottom) and medial (inside) borders of the scapula become compared to the normal right side.  This individual is definitely getting some compression of the subacromial space.

4. Posture is also normally implicated in shoulder pain.  We know that a protracted shoulder can decrease the subacromial space, decreasing the amount of blood supply and nutrition the damaged tendons of the rotator cuff receive at rest.  Unfortunately the area where we usually acquire supraspinatus tendon tears is also an area of hypovascularity known as “the critical zone”.  Hypovascularity means that the area has poor blood supply.  If we want these damages tissues to heal and remain healthy then it makes sense to open the subacromial space and get more blood supply to the area at rest.  This is where the role of posture comes into play.  Posture will be a critical component to allowing our rotator cuff to heal and we’ll have to address this all throughout the day and when we sleep and not just at the gym.

One very common postural problem that is often associated with shoulder impingement is upper cross syndrome popularized by the late Dr. Janda.

Janda’s upper crossed syndrome demonstrates common postural problems in the upper body.  In his model, addressing protracted shoulders will not only take strengthening the lower trapezius, rhomboids and serratus anterior, but stretching tight pectorals.  Weak deep cervical flexors, tight/overactive traps and levator scapulae and poor thoracic spine extension range of motion are also probably culprits.  Even the position of your lower body impacts the upper body position as well.  (We may have a total body problem on our hands here but that is beyond the scope of this article.  It’s already long enough!)

5. Scapular dyskinesis is basically abnormal position of the scapula with movement.  Normally the scapula should slide flat on the ribcage and rotate normally as your bring your arms overhead.  This helps keep the shoulder centered in its socket and minimizes stress on the subacromial space.  In those with impingement the shoulder blade can be anteriorly tilted, elevated and may not upwardly rotate as much as it should.  This becomes evidence when you watch these patients raise their arms overhead or do pushups.

Notice how this woman’s shoulders are shrugged up while attempting a pushup against the wall.  Also notice her left shoulder blade looks as if it is lifting off the ribcage.  This is known as scapular winging and that’s the anterior scapular tilt we were discussing earlier that is associated with impingement.

Next we’ll talk a bit about the thoracic spine and rib cage and how it effects the shoulder in impingement.  I’m pumped!

Find Part 4 HERE

Want to learn more about how to assess yourself or your athletes and find the best exercises so that their shoulders move optimally?  Check out Dr. Dave Tilley and my product:

Monkey Method – Movement Essentials

The Ultimate Guide to Understanding and Fixing Technical Flaws in the Handstand, Muscle-up and Olympic Lifts

I recently wrote a few articles on how to address the shoulder blade in rehabilitation.  Check out the exercises videos in the below links:

Closed Chain Exercises

Open Chain Exercises

 

Is scapular dyskinesis a real word or did you just make it up?

Dan Pope

References:

  1. Behnke, R. S. (2006). Kinetic anatomy. (2 ed., pp. 35-56). Champaigne, IL: Human Kinetics.
  2. Bigliani LU, Morrison DS, April EW: The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228, 1986.
  3. Morrison DS, Bigliani LU: The clinical significance of variations in acromial morphology. Orthop Trans 11:234, 1987.
  4. Page, P., Frank, C. C., & Lardner, R. (2010). Assessment and treatment of muscle imbalances the janda approach. (pp. 195-207). Champaigne, IL: Human Kinetics.
  5. Sahrmann, S. A. (2002). Diagnosis and treatment of movement impairment syndromes. (1 ed., pp. 193-261). St. Louis, MO: Mosby.
  6. Smith, M., Sparkes, V., Busse, M., & Enright, S. (2009). Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: Is there imbalance and can taping change it? Physical Therapy in Sport, 10 (2), 45-50 DOI: 10.1016/j.ptsp.2008.12.002
  7. Wilk, K. E., Reinold, M. M., & Andrews, J. R. (2009). The Athlete’s Shoulder . (2 ed.). Philadelphia, PA: Churchhill Livingstone.
Categories
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114 Comments on this post.
  • Paul
    5 September 2012 at 10:26
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    Great articles Dan! Thank you very much.
    I’m looking forward to the pain prevention articles.

    • djpope
      5 September 2012 at 10:26
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      Thanks Paul! I’ll get to work.

      • Lance
        17 December 2013 at 10:26
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        djpope-
        I had rotator cuff surgery repair with torn laberum and ligament repair surgery. It has been five months and ever since the surgery I can not lay on my back due to my winging. My trapezoid also feels raised up and the muscles in my upper chest of that shoulder feel much pain and swelling when I use that shoulder. Is this impingment? It wasn’t like this before my surgery and the pain and discomfort are unbearable. Will I need another surgery to correct this? I feel like they didn’t put me back together correctly because these areas were the most painful immediately after surgery and still remain painful. I can move my shoulder but the more I use it the more pain and swelling seems to occur. Can you help me?

        • djpope
          19 December 2013 at 10:26
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          Hey Lance, did you ever go to therapy after surgery? What exercises bother you?

          • lance
            20 December 2013 at 10:26

            Yes…I am still in therapy. I went to my primary doctor and he seems to think I have swelling under my scapula and clavicle area since the surgery, that’s why I feel like my scapula is winging. He says the entire area is swollen …..what do you think it could be? Mt motion is great…some pain when I raise my arm above my head but I am more concerned with the swelling which hasn’t gone away since my surgery July 11th.

          • djpope
            22 December 2013 at 10:26

            How old are you? Are you doing any weightlifting? Can you consciously correct the winging? Does it just “feel” swollen or is there actually some swelling someone can feel and see?

          • lance
            23 December 2013 at 10:26

            I am 48 and I am lifting some weights at therapy…my primary doctor says there seems to be swelling under my scapula…..when I use my arm my upper chest muscles hurt and swell and ever since my surgery my trap seems raised up higher then it was and I feel pressure and pain under my scapula when laying down….these were the most painful areas after surgery….do you think something went wrong or do you think I might have something else going on? I think I need to request and MRI, I’m pretty concerned about it…it hurts more after therapy and it’s been 5 months since my surgery. I am wondering if something else is going on because no one seems to react as if this is a common reaction after surgery.

        • Val
          7 December 2016 at 10:26
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          Hi Lance,

          How is your scapula? I also had labrum repair surgery about 7 months ago and now have some scapular instability. I’m looking in every direction for help – PT, surgeon visits, recently had another MRI. I’m still hoping for some positive result but its so hard being patient and not getting depressed.

  • Brian Lelli
    8 January 2013 at 10:26
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    Thanks so much!!

    • djpope
      9 January 2013 at 10:26
      Leave a Reply

      Your welcome sir, how are your shoulders?

  • Chris
    25 January 2013 at 10:26
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    I have this winging. Wish I could fix it. I had a physical therapist tell me I had to work around my impingement. Is this winging fixable? I imagine you would need more information.

    Anyways, good articles. Thanks,

    • djpope
      27 January 2013 at 10:26
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      Hey Chris, winging is definitely fixable. I definitely would need some more info to help you though. When do you get winging? Do you have pain? What bothers your shoulder?

  • Chris
    29 January 2013 at 10:26
    Leave a Reply

    Hi Dan,

    I really notice it when I raise my arm straight out in front of me. I do get pain in the front of my shoulder in the soft area between the pec and shoulder. I feel like there is an impingement there and it won’t get released. My shoulder won’t sit properly like my right shoulder does. I’ve had Graston, ART, acupuncture and physio and nothing has fixed the problem over the years. It was a snowboarding injury from about 7 years ago where I caught my edge on a rail and landed on my head and shoulder. It wasn’t dislocated but did sit lower. Some doctors think I pulled my supraspinatus based on resistant movements. The physiotherapist I had said it was something I was just going to have to work around.

    I hope that helps. Thanks for the help.

  • Chris
    29 January 2013 at 10:26
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    Oh, here’s another thing; If I have my elbow bent at 90, and then push laterally against resistance, like a door jam, it hurts in the front in the area I mentioned. If I have my shoulder seated properly (down and back) I don’t have the pain as much.

    • djpope
      30 January 2013 at 10:26
      Leave a Reply

      Cool little tidbit. From what you’re saying it does sound like a rotator cuff issue. usually pain in the front of the shoulder is a sign of impingement, biceps or supraspinatus involvement(Part of the rotator cuff). Setting the shoulder back/down posteriorly tilts the scapula and clears some room for those tissues, probably alleviating some of the pain. If you’ve got a true rotator cuff partial tear or tendonosis it could take as long as 12 weeks of rehab to get the area to heal. Have you been doing rotator cuff exercises multiple times per week, scapular stability exercises etc?

  • Shoulder Impingement: Part 5 – How Posture and Breathing Effects Shoulder Impingement | FITNESS PAIN FREE
    7 April 2013 at 10:26
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  • Tim
    2 May 2013 at 10:26
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    Dan,

    First off, thank you for writing these articles. They have helped a lot with understanding what could be going on with my shoulder. I’d like to get your opinion on my shoulder pain and my plan to fix it. I’ll try to give as much background info as I can.

    I’m a competitive middle-weight strongman and have been dealing with some shoulder pain for a while now. I get pain while performing any type of overhead press or bench press. The pain is mainly in the posterior region of my left shoulder. I’ve noticed that my posterior delt is extremely tight and I have a good amount of scapular winging when I raise/lower my arm overhead. I’m fairly confident that the winging is the cause behind my shoulder pain. I also sit at a desk all day, which probably just complicates things further. Obviously, I should probably see a specialist, but I’d like to try to fix the problem on my own first.

    Here is what I’ve been doing so far for roughly 2 weeks now:
    -taken out all exercises that cause pain
    -soft tissue work on tight rear delt
    -ice shoulder after training
    -lots of stretching of pecs and lats
    -thoracic extensions on PVC pipe
    -add more rows to strengthen lower traps
    -rotator cuff work (external/internal rotations, front lateral shoulder raises)
    -bamboo bar bench for stability work

    So far things feel like they are improving slightly. I think I should add in some exercises to strengthen my serratus anterior because I feel that could be weak as well.

    Anyways, I’d like to get your opinion on all this if you don’t mind. It’s frustrating to be a strongman and not be able to press 🙁

    Thanks.

    • djpope
      3 May 2013 at 10:26
      Leave a Reply

      Tim! Great to hear from ya! I’ve been competing in strongman since 2008, awesome to hear from a fellow strongman. It looks like you’re on the right track. Do you feel like you’ve been making progress over the past 2 weeks? This is something similar to what I’ve been experiencing myself. I’ve been doing quite a bit of scapular stability work, some rotator cuff work and a lot of dumbbell work overhead to try and get my left side up to snuff compared to the right. If you’ve got some winging then some pec stretching and anterior serratus strengthening would help a lot. I’m a big fan of crawling variations for serratus health as long as you can perform it pain free. Get back to me and maybe we can troubleshoot some more.

  • Tim
    6 May 2013 at 10:26
    Leave a Reply

    Hey Dan, thanks for the reply! Yes, I feel as though I’ve made some slight progress in reducing my shoulder pain. I’ve noticed that I see immediate improvements when I do soft tissue work on my rear delt, but it seems to tighten back up fairly quickly. I also think the scapular stability work I’ve been doing with the bamboo bar is helping quite a bit too. I haven’t tried any pressing or benching in the past couple weeks, but I can perform push-ups pain free.

    Unfortunately, I haven’t seen much visual improvement to my winging, but I suspect this could take a while. Quick question: Would stretching the lats also stretch the serratus anterior? I’ve been doing a lot of lat stretching in addition to pec stretching since tight lats internally rotate the shoulders. But if the serratus gets stretched too, I think that would be counter productive to my winging issue.

    Thanks for the help, Dan. I appreciate it.

    • djpope
      8 May 2013 at 10:26
      Leave a Reply

      Hey Tim, glad you’re making progress! Stretching the lats won’t overstretch the serratus I wouldn’t worry about that. As far as the serratus is concerned, having it fire properly with enough force at the right time is going to be the most important thing. Have you been stretching your pecs and working your lower traps?

  • Tim
    8 May 2013 at 10:26
    Leave a Reply

    Yup, sure have. I’ve been stretching my pecs while a work after sitting for a while and I also stretch them before doing any shoulder rehab stuff. I’ve also been doing added rowing every training session. Movements like chest-supported rows w/ dumbbells, lat pulldowns with a hold at the bottom, and all types of scapular retractions (banded, chest supported, etc.) are what I’ve found to stress the lower traps.

    I’ll continue doing all this and let you know how things look/feel in a couple weeks. I was able to do some dumbbell benching yesterday w/ minimal discomfort, so I believe things continue to improve.

    • djpope
      8 May 2013 at 10:26
      Leave a Reply

      I agree, keep us updated.

  • devarshi
    21 June 2013 at 10:26
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    hi ,

    excellent article . it cleared all my doubts .

  • Tyson
    4 July 2013 at 10:26
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    Hey dan i have scapular winging and its cause my serratus and low\mid trap are weak my upper trapezius is over compensating which causes me
    Neck pain especially when i do over head workouts.My shoulder cracks when i rotate it and can be annoying and my whole left arm bicep tricep shoulder lat is smaller can you give me a program that can fix this its so annoying having this condition Heeeeelllp!

    • djpope
      6 July 2013 at 10:26
      Leave a Reply

      Hey Tyson, what exercises bother you? is it just neck pain? How do you know your scapula wing? have you seen a doc or PT yet? Get back to me and we’ll figure it out.

  • Tyson
    18 July 2013 at 10:26
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    When i do overhead exercises my kneck takes all of the weight and my upper trap over compensates and my scapula wings out ..it seems like the stuff that suppsossed to strengthen the serratus and lower trap aint working i just want it fixed . I have impingement to it dracks so loud when i rotate it i know a physio would take care of it in a fee months but i just dont have the money as yet please help!

  • Tyson
    18 July 2013 at 10:26
    Leave a Reply

    Ive done my homework and its scapula winging due to muscle weakness and stability ..it seems like the stuff that suppsossed to strengthen the serratus and lower trap aint working i just want it fixed . I have impingement to it cracks so loud when i rotate it i know a physio would take care of it in a few months but i just dont have the money as yet please help!

    • djpope
      18 July 2013 at 10:26
      Leave a Reply

      Do you have any pain with exercise? Do overhead presses hurt? What exercises have you tried? How frequent and how long? Have you tried dropping the weight some to see if that cleans up the winging? Is there winging or just weird timing issues with the shoulder blade. little tough to tell what’s going on with your description. A video would be helpful if you can upload one to youtube.

  • Tyson
    1 August 2013 at 10:26
    Leave a Reply

    All i know is i have a shoulder impingement and my lower trap and serratus is weak so my upper trap over compensates gives me neck pain i dont think my posture isnt to good.

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    1 August 2013 at 10:26
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  • Bohdan
    22 August 2013 at 10:26
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    Hey man, I’ve got shoulder impingement in both of my shoulders due to scapula winging and a bad workout routine I used to do in which I never included any exercises for my posterior delt. Do you think if I email you some pics of my back/side views of my shoulders you’d be able to give me some pointers from there? I’ve been doing reverse flyes but I of course manage to pull something in my upper back and it’s become painful doing them. Bottom line is that my shoulders have been a pain in my ass for like 3 months now, I would seriously appreciate any help you’ve got for me, thanks.

    • djpope
      23 August 2013 at 10:26
      Leave a Reply

      Ya sure Bohdan send them over. It might be best to go see a qualified professional who could take a closer look though. Pretty tough to evaluate someone with pain online.

  • gaza
    25 August 2013 at 10:26
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    Hi Dan I’ve been told I have to strengthen my serratus but it seems restricted when protracting. It feels tight near my teres muscle. And upper trap hiking u. Could you help

    • djpope
      26 August 2013 at 10:26
      Leave a Reply

      Sure, who told you your serratus needs work? What bothers you? You feel like you can’t fully protract your shoulder on one side?

  • Paul
    29 September 2013 at 10:26
    Leave a Reply

    Great Article,

    After an injury practicing martial arts over 4 weeks ago I experienced extreme pain and tightness in my shoulder and neck area for almost 2 weeks afterwards. The inital pain has been reduced by massage and gry needling and PT.

    I have experienced winging scapula on my right shoulder and had an MRI to state “acromion impinges on the superior surface of the supraspinatus. Degenerative change at the AC joint. The muscles and tendons of he rotator cuff are intact with no evidence of significant tear or strain. No muscle or tendon retraction.

    As it is at the minute my scapula wings alot and the shoulder is very weak although about 70% of movement above head height. Trap on the injured side is staying flat along side when the arm is elevated in front of my body. Really tight area around teres major and upper pec area is tight. Slight neck pain and tightness but this had reduced due to dry needling and deep tissue massage.

    As it is it feels as if I will never get fit again as the injury is still so restricting so any help is welcome. Can I please have your advice on Rehab exercises to get the shoulder back top full strength and how do I know it is not a damaged long thoratic nerve?
    Thanks again for your help and an amazing article.

    • djpope
      4 October 2013 at 10:26
      Leave a Reply

      Paul thanks for sharing!

      Depending on where you are with your strength and level of rehab its tough to tell the best exercises. I like training the serratus anterior by getting on hands and knee. At this point press away from the floor to get your scapulae flat to the rib cage. After you’ve mastered that I do shoulder touches in that position and progress to modified pushups and eventually crawling exercises. A heavy dose of T-spine mobility coupled with scap stability (all types of rowing) mix in some rotator cuff work and eventually progress back to the exercises you want to (with good technique) get back to, find a good program to follow and that’s my rehab process in a nutshell. When do you get shoulder pain right now?

  • Daniel Brady
    16 October 2013 at 10:26
    Leave a Reply

    I get scapula winging, but it’s most pronounced when I do the Apley Scratch Test (ie reach up my back). That is also the movement that causes pain in my shoulder, around the front of the humeral joint. I also get pain at the bottom of the bench press…

    When I reach up my back, it feels like my shoulder moves forward instead of rotating like the other shoulder. I read that this is because of lack of internal rotation and I should do the sleeper stretch, but the sleeper stretch seems to give me a pinching pain at the front of the shoulder, so I worry that it does more harm than good.

    I have had this for a couple of months, I think, but the bench press pain is newer. Since there is new pain, maybe I need to go back to the RICE again.

    I am in a foreign country, so even if I find a shoulders expert, I’ll still have a hard time conveying my symptoms.

    Any help would be appreciated.

    • djpope
      16 October 2013 at 10:26
      Leave a Reply

      Hey Dan, that could definitely be from a lack of internal rotation. best bet would be to go see a professional. Sounds like it needs some time off to rest and regain full pain free ROM before you start training again. Pain free scapular stability and rotator cuff exercises are never a bad idea to start with either.

      P.S. Nice name

      • Daniel Brady
        16 October 2013 at 10:26
        Leave a Reply

        Thanks. Maybe I was too focused on treatment exercises, and forgot about rest. I guess the scapula still needs exercises so it stops winging, but the new pain may suggest that I need a break from bench press.

  • Get Your Trapezius In Tune! | Yoga Tune Up
    6 December 2013 at 10:26
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    […] Pope from Fitness Pain Free gives a great description of how the upper and lower trapezius work together and how imbalance in […]

  • jeb Dopp
    18 February 2014 at 10:26
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    Thank you. That was excellent.

    • djpope
      22 February 2014 at 10:26
      Leave a Reply

      You’re welcome

  • Aaron Williams
    23 March 2014 at 10:26
    Leave a Reply

    Just stumbled across this article and reading some of the comments,

    I’ve been having non-stop pain now for the past 6 months from slight winging in my left shoulder which has ultimately stopped me from proceeding with any lifting in the gym. I’ve been to see several PT’s along with a specialist of late who also said I have impingement along with the winging. I haven’t done any sort of exercise in 3 months however the winging pain still persists all the time. Describing the pain is like a tooth ache – constant dull aching pain right underneath my shoulder blade, along with my shoulder feeling extremely week compared to my right shoulder.

    The specialist suggested a cortisone shot to help with the impingement (First one) 3 weeks ago which hasn’t seemed to help all that much (I’ve been having tendonitis problems for the past year or so). Up to now I am 3 weeks into my injection and I am scheduled for some sort of physical therapy. However I am a little sceptical because every physio I have seen I haven’t seen any improvements from the exercises they have given me. I am aware of having to strengthen the serratus anterior along with strengthening the rotator cuff muscles however I am all a bit confused as to where to start of exactly. Performing the majority of external – internal exercises are all painful after several reps.

    I am a student who spends a lot of my time behind my desk and my posture isn’t perfect (some rounding of the shoulders). Any advice would be much appreciated!

    • djpope
      6 April 2014 at 10:26
      Leave a Reply

      Hey Aaron, have you been doing scap stability and rotator cuff work religiously? For how long? Has it been getting better? Can you do anything that is pain free? What did you PT say about the lack of progress?

      • Aaron Williams
        6 April 2014 at 10:26
        Leave a Reply

        Thanks for the reply, 5th week after my injection and my shoulder still feels the same probably 20% less painful but still same symptoms.

        When I saw my 3rd physio around Christmas time I was advised to do a series of exercises to strengthen the rotator cuff and my posture, these included external isometric holds (arm against side and bent at 90 degrees) and to continue with work on my foam roller – rolling on the front and back of the shoulder would often help with the pain for around 5 – 10 minutes (I often used the foam roller before upper body lifting). The physio also gave me some ultrasound treatment to the front of my shoulder but nothing I felt directly to treat the winging. I did these things every day for 4 weeks and saw absolutely no improvement, which is why I wonder why try and strengthen and exercise something that is already inflamed? I couldn’t progress with the same physio as Christmas break was over so I had to go back to uni and therefore found another who suggested the injection. I’m scheduled my first PT session this Thursday but again I’m sceptical about what they will say. The only exercise that isn’t painful is probably the isometric hold, everything else I just get aching pain after a few seconds.

        • djpope
          20 April 2014 at 10:26
          Leave a Reply

          Hey Aaron,

          It’s never a bad idea to get a 2nd opinion PT wise. These issues often take several months to get back to competitive levels without pain. If you’ve got a tendinopathy or partial tear then chances are you’ll have some pain with rehab exercises. It isn’t always possible to do all exercises pain free but should be a goal to find the exercises you can load with least pain. I also feel that you’ll need to be progressed beyond normal rehab exercises to make the jump back to crossfit. Did you physio check full full range of motion at the shoulders? Was any particular test positive? Did they do any scapular testing?

          • Aaron Williams
            22 April 2014 at 10:26

            Yes they did and yes the painful arc test was positive but my rom was fine. I went to see the referred PT and was given 3 band exercises (only one for my scapula winging) along with now being put on the waiting list for an ultrasound scan.

          • djpope
            26 May 2014 at 10:26

            Good start, let me know how it goes.

  • Mohinder
    17 April 2014 at 10:26
    Leave a Reply

    Very nice article sir and it was very helpful
    Sir was suffering from this scapula dyskinesia 2years back and. Now it was normal my shoulder was working properly and therefor I started doing gym in March
    And. While doing gym for 20 days there is a swelling in trapezius according to me in that same shoulder left side . Am going for massage every day but it is not making it good . Sir what should I do how will I get rid from it , and from when can I do gym. Please help me out sir
    Can you gave me your number please mail me
    And thanks for this article sir very helpful it was . Have a good day sir

    • djpope
      20 April 2014 at 10:26
      Leave a Reply

      Hey Mohinder. What did you do initially for your dyskinesis. What exercises bother you? have you seen a dr.?

  • sam parker
    29 April 2014 at 10:26
    Leave a Reply

    Alright i was wondering if you could help me with my shoulder problem it seems to be getting worse there’s all sorts of crunching and pain all around my front shoulder. And the scapular on one side is sticking out more than it should. I have trouble getting up in the morning because of this it courses me to have back pain. When in standing and bring my shoulder back they crunch and it hurts all down my inner traps and seems like my shoulder has become attached from something

  • Maciek
    18 June 2014 at 10:26
    Leave a Reply

    I read your articles for some time now and just wanted to say thank you for your work and shearing. You make this world to be with less pain and this is great. My best regards.
    Maciek

    • djpope
      10 August 2014 at 10:26
      Leave a Reply

      Thanks Maciek!

      • Crystal
        26 June 2015 at 10:26
        Leave a Reply

        Hi I read your article and it seems as if this might be one part of some issues I may be having! I started noticing a dull aching pain in my upper back by my trapezius muscle and under my shoulder Ive noticed recently that my shoulder blad on that side comes out farther than my left side it constantly causes me annoying pain i canfeel it in my chest it make my chest feel tight and short of breathe my knedk muscles are tight and this side droos lower than my left side when I breathe in I feel alot of the breathe I take on my right side I have seen doctors for.over 3 years telling me my muscles are tight and it.migjt be myofacial pain/musculoskeletal issues I just need to know if you can infact feel this when you have infringement with it in your chest as well as the feeling of shortness in your breathe my kneck muscle stay tight and I can feel discomfort on my entire right side I also can feel where the issue radiates.its I beleive the trigger point! This sice alos has less muscle than the left side I have very bad posture after a three story fall.that fractured my L1 it was a hairline compression fracture I was in a back brace that caused me.to hunch and then after having 4

        • djpope
          28 September 2015 at 10:26
          Leave a Reply

          Have you been through a trial of physical therapy?

  • DylanG
    16 July 2014 at 10:26
    Leave a Reply

    These articles have been very helpful, thank you!
    I think I’ve had Scapula Winging for around four/five years but never really noticed up until now that it was not normal! I think it started when I use to spend almost all my day leaning over on a computer as a teenager I’d have this warm deep pain directly under my shoulder blade like an ache. Another sympton was that when I tense my traps the one on the side of the winging scapula raises considerably higher than the other. Also, it creates a stretching feeling in my back muscles, a tight pain and the scapula protrudes outwards. It was only until around 1/2 years ago though that I think I have developed shoulder impingement in the same shoulder of my winging scapula. I can sort of stick and unstuck my shoulder joint (which grinds and clicks) inside its joint which is very un comfy and makes it tough to stand with a correct posture without aching. Also, I have awoken around two to three times in the past 3 years where I could not move my shoulder at all without a horrific pain in my rotator cuff. All these things seem linked and I’ve recently gotten into boybuilding. Any time of pressing movements causes impingement and my winging shoulder is much weaker that the normal shoulder. Also, when I tense my lats my left lat (the side with the winging scapula) does not show as much as my right lat. It has been a hindrance in my body building so I started to perform the serratus punch technique with two dumbbells that I was told would help strengthen my serratus thus cure the winging. However, as soon as I finished the technique I feel really tight in my shoulder blade and traps and some times my whole left arm goes numb and tingly (the underneath of the arm following all the way to the little finger). Some times I still have the burning and tingling sensation in my shoulder blade too. It would be very helpful and very much appreciated if I could be enlightened on my problem here as I’m becoming depressed about the situation. Thank you very much for taking your time to read this and hopefully reply!

    • djpope
      10 August 2014 at 10:26
      Leave a Reply

      Hey Dylan, sounds like you’ve got a complex issue here. Definitely go to your doc or a therapist to get it checked out.

    • Alex
      17 September 2014 at 10:26
      Leave a Reply

      Hey Dylan

      Your condition seems similar to mine. I also have a disproportionate lat and a winged scapula.

      I read through your post and my best advice is to not focus on individual parts of your body.

      Before you do anything, fix your posture. Weightlifting + bad posture is a recipe for trouble. Look up the Gokhale method on YouTube and if it interests buy the authors book. Ever since I changed my posture the tingling and numbness you described was significantly alleviated.

      I know about the frustration and depression you are experiencing. I remember feeling very alone and desperate at the onset of my injury and still have down days to this day. Just know you are not alone and the pain is an indication of a greater problem. Take it as an opportunity to better yourself and not as a cataclysmic event that has happened to you.

      If you don’t, that downward spiral is ugly and leads you places you don’t want to go.

      Take it easy and I seriously hope you make a full recovery.

      Sincerely,
      Alex

  • Scott
    6 September 2014 at 10:26
    Leave a Reply

    I notice my scapula winging when I raise my arm out in front of me. I went to a physio and he said rows would help. I feel like my rhomboid is tight so would rows not make the scapula worse? I also feel like my chest gets tight occasionaly. Im a martial artist so I do alot of punching, its not overly painful but it feels very unstable. How do I figure out if its weakness or a nerve issue?

    • djpope
      7 September 2014 at 10:26
      Leave a Reply

      Are you still working with the physio? Some things I would check would be how much upward rotation your shoulder has between sides, what your mobility is. Is it a painful winging that can be changed with adjusting shoulder blade position? Very challenging to tell online. I don’t think the rowing would be bad but I’ve never seen you in person so I can’t know.

  • Scott
    12 September 2014 at 10:26
    Leave a Reply

    The physio never told me to come back just said do rows. it wings when i extend my arms forward in a press ups type posistion when my arms are straight. I dont see how it would be caused by weak back muscles because i regulary did pull ups and chin ups. Whats the best way to fiure out if it due to nerve damage?

  • dennis
    16 September 2014 at 10:26
    Leave a Reply

    Solid information in a professional, readable approach….

  • Alex
    17 September 2014 at 10:26
    Leave a Reply

    Awesome article Dan!

    This answers so many questions that I have never gotten answered. Your article has enormously helped me narrow down the nature of my injury.

    About three years ago I was moving out of my apartment and carrying furniture and in between doing pull ups. Very stupid. Probably did 100 in total while moving out heavy furniture upstairs. Anyways that night I experienced an incredibly sharp pain along my mid spine. I shrugged it off but was worried by the intensity of the pain.

    Ever since then I have had weakness and tingling in my left arm with prominent scapular winging. For a year I thought it was my rotator cuff but it is fine.

    After reading your article and becoming more body aware I am starting to suspect the role of the rib cage and spine in the scapular winging and the nerve impingement.

    You seem extremely knowledgeable and your literature has been so informative and helpful in diagnosing my injury. I have a positive attitude but after 3 years of debilitating injury I am quite exasperated. This post is a breath of fresh air.

    Please answer me back. This might be a good opportunity for the both of us.

    I hope to hear from you soon.

    Sincerely,
    Alex

    • djpope
      7 December 2014 at 10:26
      Leave a Reply

      Glad to hear it Alex! How is the back feeling?

  • Dan
    5 October 2014 at 10:26
    Leave a Reply

    Hey. I saw this, I’ve been having an issue for about 3 years now. It never got quite “full on” bad, but it’s always been bothering me.

    The first thing I noticed was that when I push my shoulder forward and elbow back on the left side, making the collarbone stand out, I see this tight strand of muscle from above the collar bone, flaring down, one part to the front delt, one to the chest. The one to the front delt is the tightest.

    When I squeeze on this tight strand it’s like it’s metal string or something, so damn stubborn. I’ve tried massaging myself at the front shoulder, and up along the neck, I’ve found a few muscle knots but I don’t know the “core” of the issue, where “mother knot” to dissolve to make this go away.

    What I also notice is scapula is “winging” or whatever it’s called. If I hold my hands straight out, then lean forward, against a wall for example, my left scapula will protrude out. The lower portion. Like in upper pushup position, it’ll really stand out, and when I lean against the wall it feels as if it “slides” back along the rib, to the point where it is poking at my spine.

    I’ve only recently started doing stuff to alleviate it. What I’m doing now is: Stretching entire trapezius, + soft tissue work. Stretching chest and delts, and front of neck. For “prehab” exercises I do face pulls, and kneeling rope pulls, other than that my routine is pretty standard. One day where I work my back, and one day where I work my chest. I’ve cut out barbell bench press and replaced it with cables/dumbbells.

    But yeah, it just seems like the scapula just is loose, whereas the right one is more tight. I’m not sure exactly which muscles may be tight/weak causing this to happen. Like, if I do pushups, or decline pushups, even in the lower position, my left scapula feels as if it’s “sliding up”, messing up my shoulder retraction. It’s all weird, I’m trying to unravel it, hopefully face pulls and kneeling rope pulls will do its thing.

    Oh and also: My entire left arm feels like it’s “closer” to the body than the right, and movement feels a bit more awkward than with the right. Right arm feels smooth and natural and no problem at all, left isn’t.

    If you’re still reading this, any help would be massively appreciated. The tight part just feels so rigid, like stubborn as a mountain, as if it can’t be changed. I’m squashing it so hard in every possible way but it’s not even close to being “normal”.

    • djpope
      7 December 2014 at 10:26
      Leave a Reply

      If you have any pain going on in your shoulder that’s definitely something that will cause the shoulder blade to do some funky things. Go talk to a doc/therapist to get a thorough eval.

  • james
    8 October 2014 at 10:26
    Leave a Reply

    hi after reading your article I think it may be similar to what im experiencing, basically about 12 weeks ago I was training shoulders and in my left arm I could lift literally half of my right (im left handed) which was unusual because I experienced no pain, then I kept trying to train but it got worse, so I rested it for about 10 weeks Im back training but my middle delt on my left shoulder has wasted away and also theres a massive difference on my bench press like my left arm feels unstable and also lateral raises or front raises its also very weak, over head press isn’t too bad, but I have noticed when I raise my arms in front of my my left scapular sticks out a lot more and when I do up right rows my left arm moves differently like the elbow doesn’t come up it stays low, i was doing lateral raises with no weight to see how my muscles activate and my right delt tenses up and my left does not, just wondered if you would have any idea sorry for the rant, also im 19 and have weight trained roughly 2 years 🙂

    • djpope
      7 December 2014 at 10:26
      Leave a Reply

      Hey James, go see a doc/therapist. Tey’ll be able to help you best.

  • james
    8 October 2014 at 10:26
    Leave a Reply

    oo i missed off that when i stopped training i did start to feel pain when i was leaning on my left side and also after training my left shoulder feels as if it hurts more and every movement it sounds as if its popping/cracking

  • Brendan
    6 November 2014 at 10:26
    Leave a Reply

    Excellent article. I have suffered from winging of right shoulder for years, I can control it but have to really focus the mind to do so. When standing with arms at shoulder height and elbows bent at 90 and hands pointing up, when I rotate them forward and get past shoulder height, right trap kicks in and pulls whole shoulder joint upwards towards my ear. I suspect the weakness is in lower trap or lat but no matter how much strengthening I put into these areas it appears to be a constant battle with the upper trap. Anything else specific I could attempt.

    • djpope
      7 December 2014 at 10:26
      Leave a Reply

      Hey Brendan. I’d check your shoulder rotation flexibility. This could also lead to compensation.

  • Adam
    3 December 2014 at 10:26
    Leave a Reply

    I have scapula winging whenever I do push-ups or chest press at the gym. I’m pretty sure it’s also causing an uneven distribution of muscle gain in my pectoral muscles. My left pectoral is noticeably smaller than my right and doesn’t have near as much muscle mass. I’ve been consistently integrating chest workouts in my workout routine for the past 2 years and haven’t been able to regain any lost muscle mass in my left pec. Is there a way for me to fix this on my own or do you think I’ll need to have surgery done?

    • djpope
      7 December 2014 at 10:26
      Leave a Reply

      Doesn’t sound like a surgical condition to me. Have you checked how much elbow flare you have left to right when pressing? I have a similar condition with my pec.

  • Sean Deane
    10 February 2015 at 10:26
    Leave a Reply

    I am having the EXACT same problem Dan with my tendons and muscles sticking/popping out of my neck when I frown or just tense my collarbone muscles. It looks like a tree trunk sprouting on the left side of my neck. Dan you are 100% correct, and it’s not just this that I’m having trouble. I am basically having what every single person in ‘the thread’ is talking about with the Anterior Winged Scapular Dyskinesia. It’s on the left side for me personally, and my back has been like this for EXACTLY THREE YEARS NOW!!!! I’m really not trying to scare anyone on purpose, but I am so freckin’ depressed about it a lot of the time now. It’s so unusually odd/peculiar to explain as well. If I do my best to explain to a professional/specialist I say something along the lines of, “I never FEEL I can accurately convey this message properly to these doctors AND MANY of the doctors I have been too say there is really NOTHING TOO SERIOUS going on with my back/scapula/trapezius/ shoulder/neck area going up into the base of my skull. To best EXPLAIN from my perspective, once the sharp/dulling tingle of throbbing pain creeps up my neck traveling into my ACTUAL HEAD; that’s where it is as painful as can be for me. I went to “PT” two different times for a few months both times in the last three years. I did Yoga/Acupuncture /Thai Chi and no luck. I went to a Chiropractor for a few months and got many Back Adjustments, along with long sessions of great massage therapy, and it feels like there is the biggest bulging knot known to man JUST LIKE YOU SAID DAN!!!!!! SERIOUSLY!!!!!! I am getting so fed up with this now. I still do some “PT” exercises and sleep with a tootsie roll behind my neck at times. I’ve literally tried everything I can possibly think of there is to do possible including Jacuzzi’s/Sauna’s. This is so crazy that I had to take a leave of absence from ‘LIFE ITSELF’ because WHATEVER I have also makes me Fatigued, Depressed, Nauseous at times, etc. It can ‘START HAPPENING’ as easily as when I JUST start to ‘turn’ my neck back and forth, as it turns to the right, I can feel my stiffened tendons/veins wanting to crunch there way out from pure chaos/misery. Thinking in my own justifiable mind, “JUST MAYBE, MAYBE TONIGHT!!!…..THERE’S ALWAYS THAT ONE CHANCE, THE SOUND THAT ASTONISHINGLY OPENS UP THE GLAMOUR THAT THE VIBRANT AND EXQUISITE WORLD HAS TO
    OFFER WILL OPEN THE DOOR TO FREEDOM ONCE MORE !”
    Until then (for whomever knows that answer) imagine ONLY a sharp dull pain piercing you from ALL SIDES FROM THE ONES YOU THOUGHT LOVED YOU. NO ONE CARES ANYMORE you guys, I offically burnt through ALL OF MY BRIDGES!!!.I somehow still felt there could be, (felt like there needed to be) cracks that let me loose. Just like the time before, ” was there ever a time before in the past I ponder now in present time!” Out another few hours of my time, MORE LIKE MONTHS NOW!!!! I’ve spent Days, Weeks, Months, YEARS (no exaggeration), on this problem ” Searching” in whatever is causing this to happen to my sophisticated Scapular activity and upper neck correlation, which was now acting upon being a tight rope of strings that one could now strum to play notes on my “Neck Guitar.” The feeling of a bug that creeps and slithers under your skin, traveling with a sense of ease from the base of my neck/skull when I’m laying down on the bed (every other night), makes his way up and down my head, not to miss a millimeter of runway space. I know people are going to think I’m crazy freak, but I swear on everything in my life to this point that I just want help! I have truly given up so long ago it’s so cruel!!! Everything you guys explained in your ‘threads’ above, I have the “EXACT” same problem as most, but I just added a few more details and life on life as I know it!!! I have gone too “many” specialists here in Chicago/Florida/California, and they think I’m seriously playing mind games with them after I get done telling them what I just got done telling all of you guys. I go into ‘Northwestern’ with my ‘partner’ who is 66 years old. I’ve been living with him for over one year now. He knows I would not be doing this ‘ALL’ for attention and to pay bills for fun. I can’t explain it any better than someone stealing almost ‘ALL’ the life/energy/breathe out of me. Maybe I have a serious case, but I think from what I’ve read from most of these ‘posts’, I’m freckin’ talking about real LIFE “SHIT” and I would rather have a choice in the future that’s not laced with family “ties” and “dyes.” I’m not giving up!!!’ Not now, I’ve come to far and have lived to much ‘REAL’ ‘LIFE’ in the shirt I’m wearing as I’m typing. Life is too great and life had been mundane since this B.S. SCAPULAR problem for the last three years. I don’t want drugs. I want my life back that I know is there in my near to death future (somewhere). I can’t get an actual breath at any given moment! My anxiety is unlike ever before for no specific reasoning. Life sucks at times and now I’m
    learning to accept that no matter what’s waiting in the sack or not.. I have too crack/pop my chest out to get a better breath otherwise it feels like someone is squeezing me at all times. I’ve been given ALL OF the ‘PT’ exercises, plus more! I still do them! I just don’t know what to do?!?!? I feel like I’m back in 4th grade. It’s so impossible to describe this feeling that seriously feels like I’m slowly almost dying, and then maybe your getting better one week, then it’s like, oh wait, no nevertheless I feel terrible again. I don’t feel like hanging out with anyone or doing anything, but watching a movie here at my place. Once again, this is by FAR the WORST thing I’ve EVER felt physically in my entire life hands down. Anyways, the reason I don’t like bringing that up at ALL anymore is because doctors think I’m just doing it for attention!!!! I tell them after every thing I just told you!!!! Well, it should go back into place by itself it’s no biggie! I’m sure you ALL know after me trying to explain something so awkwardly peculiar that is still paying a HEAVY TOLL to this very day and second with me feeling my scapula/ tightened neck/ and back all at once while I’ve been typing this by my fingers on my iPhone onto this ‘thread’ I have FINALLY found out after thinking and pondering if I was really just crazy or INSANE!
    Honestly, I am so profoundly content with just finding others in this world that FEEL what I am FEELIING, not just physically but emotionally RIGHT NOW! This made my month for absolutely sure! Maybe even the year! I hope everyone the best possible outcome

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      How long has this been going on for? Have you ever read any pain science material like Adriann Louw’s “Why do I Hurt?”

  • Joshua
    14 February 2015 at 10:26
    Leave a Reply

    The scapular winging is due to an injury to the Long Thoracic Nerve. I have been dealing with this for 3 year now. I went to my local neurologist and had an EMG test done to confirm. I have no clue how I injured this nerve. After two years if it isnt any better it probably will not get any better. I had Dr. Nath in Houston, TX perform a decompression of this nerve and the Bracial Plexus nerves about a year ago and the pain is much less now. I still have another year for improvement.

    You can do all the PT you want, you probably need surgery to correct or at least make it better. There are not many Dr.s that specialize in this injury….

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      Hey Josh, keep in mind that everyone will have pain / dyskinesia for different reasons. If I suspect someone has nerve entrapment somewhere up the chain causing dyskinesia then treatment will focus there. I will say that having a specific palsy of the long thoracic nerve isn’t as common as other causes.

  • Joshua
    14 February 2015 at 10:26
    Leave a Reply

    One more comment. The issue with winging scaplua is due to weakness in the serratus anterior muscle which stems from the long thoracic nerve not working properly. You can try to strengthen this muscle and see if it helps. I tried PT for almost 2 years to get my serratus working again but ultimately opted for surgery.

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      Good point. Depending on the dyskinesia it could be a specific weakness in a muscle like the serratus anterior but could also be happening due to pain. best to get an eval from a specialist to figure it out more.

  • Phil
    18 February 2015 at 10:26
    Leave a Reply

    I sure hope this thread is still going as i recently realized i too have a winged scapula :/ My left trap sits higher than my right and i experience a dull tooth ache like pain just underneath my left shoulder blade. I first realized it when i had shoulder pain from doing over head movements like shoulder press, or chest press. It’s from a muscle imbalance i believe due to weak middle trap/rhomboid area. My back workouts always consisted of pullups and chinups and other exercisies emphasizing the lats. My middle back would always get the short end of the stick during the workouts. After doing extensive research online i came across the “scapular pushup” for a rehab technique and the first time i started doing them i heard “pop, pop, crack crack” but in a good way. I found instant relief and doing these scapular pushups released the knots or tension in the scapular region. However, i realized thatafter periods of inactivity or losing posture while sitting down for periods of time the tension would start to creep back and thus i would do these scapular pushups 4 – 5 times throughout the day spread out a few hours. I took pictures of my back and the left scapular is raised up a bit higher and sticks out a little bit compared to my left but nothing too drastic. In my workouts i stay away from all overhead pressing and emphazise my middle back with bent over dumbell rows, t bar rows, and seated rows all in the 10 – 12 rep range. Ive started to see improvement due to the scapular pushups and have only been doing the emphasized middle back workouts for 2 weeks so im not sure how much they have been improving.

    Is there a chance i could send u pictures of my back and get a diagnoses of how bad my condition is?

    Also are there any serratus anterior or middle back exercises that worked well for you and that you recommend?

    Please help! ive been lifting seriously for just over a year now and it changed my life around and is now something i love to do. I just want to be pain free and know im making progress!

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      Ya sure, send a pic. I’m currently writing another article about winging.

  • Jodie C
    28 May 2015 at 10:26
    Leave a Reply

    Hi Dan,

    Thank you for writing this article. All that you said is very true. After a year of rehab work, constant soft tissue work, chiropractic, and PT, I am mostly pain free from a shoulder impingement. I just need to now get stronger stabilizers. Constant work, but totally worth it.

    Looking forward to reading some of your other articles.

    Take care,
    Jodie

  • Shoulder Pain and Dyskinesia: Correcting Medial Border Prominence During Pushups | FITNESS PAIN FREE
    28 June 2015 at 10:26
    Leave a Reply

    […] I’ve been reading and listening to probably what is more than a healthy amount of scapular research and rehabilitation lately.  It’s great for me because I’m currently working with a few athletes with scapular dyskinesia and shoulder pain.  I wrote a bit about scapular dyskinesia some time back and it’s easily one of my most popular …. […]

  • Alex
    21 July 2015 at 10:26
    Leave a Reply

    Great article, many thanks. I would like to ask if the upper trap is dominant during improper shoulder flexion why do we tend to see individuals with sloping shoulders on the effected side?
    If the upper trap were dominant we would expect to see more muscle mass and tension which should raise the shoulder on that side and upwardly rotate it. Instead what we see is a downardly rotated and depressed position of the scapula.

    Many thanks for your thoughts

    • djpope
      28 September 2015 at 10:26
      Leave a Reply

      Check out some of Phil Mcclure’s research. People with shoulder pain don’t generally adopt a certain position. They usually have aberrant motion but not standardized across a population.

  • Sarah
    24 July 2015 at 10:26
    Leave a Reply

    Hi! My mother has had shoulder pain for over 2 months now. She went to a chiropractor who did an x-ray and told her her lower spine was slightly curved and therefore cause her right shoulder to be 0.5 inches lower than her left one. In addition, an MRI was also taken, showing a tendon is being pinched (possibly starting to tear as there is leaking involved). According to the doctor, two shoulder bones are pinching the tendon. Surgery was recommended and she is waiting for her appointment date. In addition, now her left shoulder is undergoing major pain as well as her back shoulder blades. Why is this happening?

    • djpope
      28 September 2015 at 10:26
      Leave a Reply

      I can’t tell this online. Has she seen a physical therapist?

  • Robin Best
    18 October 2015 at 10:26
    Leave a Reply

    I have a partial tear in my supersanatius, after 12 weeks of therapy,and meds it’s gotten worse. The muscle pain in my neck and trapezius is unbearable. The IME doctor released me back to full duty and my job is very physical. After one week back at work I’m ready to throw in the towel. This pain is unbearable. Any advice? Thank you

    • djpope
      1 November 2015 at 10:26
      Leave a Reply

      I’d definitely go back to the doc at this point.

  • Mark D
    18 October 2015 at 10:26
    Leave a Reply

    Apparently this is a weird, un-solvable case:

    I had a sore right shoulder last november and tried to work through it. I ended up not being able to move my arm for about a week. Ortho told me to wait a couple weeks since there was no traumatic event before getting an MRI. Since I had Tommy John on the same arm ten years earlier I didn’t want to get news that I would have to have another surgery which would cause me to be useless during my son’s first year of life. By January, I had some range of motion back but the pain was still intense so I got an MRI and it came back clean. The doctor said it was probably just biceps tendinitis and maybe a little bursitis and told me to rest, ice, and stretch. So I did until the pain subsided more (about mid Feb) and then started to try and lift again. About a month later, I couldn’t lift anymore because of the pain. The pain was constant. I would wake up from it, it hurt driving, it hurt typing at my desk, and I still couldn’t lift it straight above my head. I went to physical medicine and had an MRI on my neck that came back clean. I saw a neurologist and got a brachial plexus MRI that came back clean. He put me on Gabbapentin but it did no good. I saw physical medicine again to get an EMG done and other nerve tests – those were clean. I saw two more orthos; one gave me a round of oral steroids and the next gave me two cortisone shots. I had one shot in my bicep tendon and one in the back of my shoulder. There’s been some relief but the pain is still very much there. I had yet ANOTHER MRI that came back clean. The pain persists and is very bad in my lat/teres minor area. I went to a physical therapist and he said that it’s very tight in my infraspinatus and teres minor – yeah no duh. He told me to keep foam rolling, icing, resting from lifting, and continue my rubber band exercises and it should get better. I’ve been doing all the right stuff. I foam roll daily on my back, lat, shoulder, bicep, triceps, and pec. I stretch and ice twice a day and yet there is still pain when I move certain ways – but not predictable – and a ton of superficial pain. Is there ANYTHING I can do?!!!

    Thanks,

    • djpope
      1 November 2015 at 10:26
      Leave a Reply

      Did you just do 1 visit with the therapist? How long have you been doing exercises? The physio had no diagnosis?

  • Kristi
    29 May 2016 at 10:26
    Leave a Reply

    I have been told I have impingement in one shoulder and am now having the same symptoms in the other shoulder. I am frustrated I have Kaiser and they just want to give me nsaids how can I fix this on my own

    • djpope
      29 May 2016 at 10:26
      Leave a Reply

      Did they offer physical therapy at all?

  • 3 Great Lower Trapezius Exercises You’ve Never Thought Of | FITNESS PAIN FREE
    23 June 2016 at 10:26
    Leave a Reply

    […] kind of a big deal.  They help us do cool stuff in the gym and help keep our shoulders healthy.  What goes on in the shoulder blade is very important from a shoulder impingement perspective.  One overlooked but important muscle in this whole ordeal is the lower trapezius.  During […]

  • Juan posada
    26 July 2016 at 10:26
    Leave a Reply

    I’m 18 years old and I’ve been experiencing a painful burning and bothersome sensation across my shoulder blade and my medial and rear delt does that sound like something scapular winging would cause ? Not sure how to get treated.

    • djpope
      5 August 2016 at 10:26
      Leave a Reply

      Go see a local physio you trust and they can square you away.

  • Dave
    9 August 2016 at 10:26
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    I recently had a labrum surgery in right shoulder because my shoulder was in pain and my scapula was winging which was worse when I first felt shoulder tear, in saying that I also felt a tear that seem to be on scapula. Not sure if that was referred pain from labrum tear but long story short did mri of shoulder neck cervical section and torn labrum only came up. Surgeon said he believes scapula was slightly sticking out near the top of traps because of instability cause by the labrum tear and paralabral cyst. Is this true that these can cause scapula or trap issues ?

  • Dave
    9 August 2016 at 10:26
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    I guess I’m just bit nervous to now wait 6-month+ and do a heap of rehab only to find out that it didn’t fix the problem. To add on to the story to explain more clearly that in the beginning the winging was worse but as I first tried to heal conservatively the winging was starting to go away. When I explained everything to orthopaedic surgeon he mentioned to me that it only slightly wings out but only near the top where the traps are and he said that it only start to wing once I move my arm up and down and it starts getting a little tired due to putting pressure on the labrum is when symptom comers out. He seems very confident that il come back to atleast 90% and I can go back to work after rehab and that the shoulder and that winging should go away. Id like to hear your opinion atleast if possible please thank you

    • djpope
      21 October 2016 at 10:26
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      I would just make sure you address the winging issue with your therapist during the rehab process.

  • David
    9 August 2016 at 10:26
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    I recently had right Labrum tear surgery because I had my shoulder and feel a tear that really hurt and also had my scapula are closer to my roumboid feel a snap a bit. My shoulder really hurt and scapula stuck out so got an mri of neck and shoulder. Everything was fine except shoulder anterior Labrum tear and paralabral cyst and so I had surgery which my surgeon said scapula stuck out a bit due to instability in shoulder does that make any sense?? He’s a renowned surgeon but I guess I’m skeptical still because I don’t want to have to wait 6 month to heal and find out scapulA doesn’t fully stop winging. He said it wasn’t due to nerve because it only came out the more I kept lifting my arm up and down and when arm tired it winged a bit more, when not tired didn’t early wing at all

    • djpope
      21 October 2016 at 10:26
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      I would listen to the surgeon. Sounds like he did an evaluation and knows what’s going on.

  • David
    9 August 2016 at 10:26
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    When I felt the scapula near rhomboid area a bit like a tear wasn’t too bad until I felt it in shoulder fully tear that’s when the scapula started winging the next day after shoulder tore. I know about the long thoracic nerve and all that serratus anterior stuff and I bought it up with surgeon but he said it deff wasn’t that but the labrum tear I had that caused it he said my shoulder was unstable and my trap area was raising to compensate for that shoulder to go up and he thinks my scapula was working fine. From what I’ve been reading I havnt found this yet but he’s suppose to be a very good surgeon the best there is where I’m from just a bit nervous since only 4 weeks post op and it seems forever so wouldn’t want to have to find out I need another op down track, surgeon says I don’t need to worry at all though I stressed this with him already

    • djpope
      21 October 2016 at 10:26
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      Sounds good to me. Keep me updated on the rehab and be patient.

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  • kostas
    15 December 2016 at 10:26
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    hi im 23 years old and i dislocated my right shoulder 4 years ago.ever since they put my shoulder back in,my shoulder just doesn’t sit right,it’s more forward than my left and also my neck muscle is tighter from the right side.is there anything i can do about it or do i need surgery to correct it?

    • djpope
      2 January 2017 at 10:26
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      Sorry I don’t know how much I can help you online. I’d imagine having a lot of shoulder and shoulder girdle strength and endurance would be important for you after a dislocation. Having a slightly forward shoulder is not a bad thing and normally on the side where people are dominant.

  • kostas
    15 December 2016 at 10:26
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    also i forgot to say that i’ve done physical therapy for about 3 months and it improved my shoulder stability & strength but it didn’t solve my issue.

  • Cristina
    2 January 2017 at 10:26
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    Hello, I was going to have surgery for my labrum slap tear ,but didn’t because my shoulder pain went away. What I been getting is upper trap paon only. I wish I knew if its because my tear or neck. Xray on my neck appeared to be I have lost my natural curve. I feel as my neck hurts so I try to crack it. I have tried to stopp and is only on the side of where my shoulder is tore. I didn’t want to do surgery and feel the same pain on my traps knowing i have no pain on my shoulder. It’s been almost a year like this.

    • djpope
      25 January 2017 at 10:26
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      Hey christina, very common to have neck and upper trap pain after a shoulder injury. Often specifically strengthening the rotator cuff can help this. I’d get fully evaluated by a medical professional to see if anything else is going on in the neck.

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