Scapular Tilting/Winging

[daveuk]

Hi, Have had many shoulder problem before involving stability etc. I am now finding that my scapulae are both tilting (not quite winging, although they do sometimes) upwards. I have been to a physio who has said it's not a true wing but just a problem to do with the rhomboids. My question is, has any else experienced this and what is the best solution? Iv started using a rower a lot and it seems to temporarily help but then I'm not sure if i feel worse the next day. Conflicting articles on the net have lead me to think it can be from either: over tight rhomboids, over weak rhomboids, loose rhomboids etc but no real solution. Do I work on them or do I stretch them/ice relax etc?! The only exercise the physio have me for it was internal rotation with a band, which I beleive is useful for the internal rotator cuff muscles, but the problem is my scap tilt as im doing it! Occassionally winging, although I think Iv got this to a more manageable level. I can tell that there tilting as when I lean against any wall I can really feel protrusion against the lower inner part of the scap. Very annoying and can be painful. I definately think my stability issues are linked with this. Any help would be greatly appreciated.

[hardcore iv]

Hi, Have had many shoulder problem before involving stability etc. I am now finding that my scapulae are both tilting (not quite winging, although they do sometimes) upwards. I have been to a physio who has said it's not a true wing but just a problem to do with the rhomboids. My question is, has any else experienced this and what is the best solution? Iv started using a rower a lot and it seems to temporarily help but then I'm not sure if i feel worse the next day. Conflicting articles on the net have lead me to think it can be from either: over tight rhomboids, over weak rhomboids, loose rhomboids etc but no real solution. Do I work on them or do I stretch them/ice relax etc?! The only exercise the physio have me for it was internal rotation with a band, which I beleive is useful for the internal rotator cuff muscles, but the problem is my scap tilt as im doing it! Occassionally winging, although I think Iv got this to a more manageable level. I can tell that there tilting as when I lean against any wall I can really feel protrusion against the lower inner part of the scap. Very annoying and can be painful. I definately think my stability issues are linked with this. Any help would be greatly appreciated.

Did you mean you are doing external rotations? I've had my fair share of shoulder problems and managed to find some solutions which went against pretty much everything you see on the internet or from most physios.

The key, for my shoulder, was to set the the shoulder in a fixed position while doing external rotations and to work on tilting the scapula back against resistance. Make a loop at both ends of a red thera-band or something similar, just big enough for you to stick your arm through it, like you are carrying a shoulder bag. For external rotations, stick your arm through one loop so it sits tight around your trap and armpit area, and put the middle of the band around a door handle and the other loop in your hand. Shrug the shoulder up and then retract the scapula back and hold it. This is the position to do all external rotations from as you will be building stability rather than having the scapula moving out of position while you do your exercises. With your elbow by your side and bent 90 degrees, externally rotate out to the side and hold at the end for 5 seconds for 20 reps, resetting the shoulder for every rep. As this gets easier you can move your arm out to 45 degrees and eventually 90 degrees. You can also do these lying on your side with a light dumbell (1kg or even less to begin with) and a rolled up towel under your arm just to raise the arm off your body a bit.

For the tilting stuff, loop the band around your shoulder like before and put the other loop around a door handle and step back enough so you can feel some resistance. Tilt your scapula back against the resistance and hold for 5 seconds for 20 reps.

The serratus anterior muscles could also be worth strengthening. Look up scap pushups on youtube and copy that same movement, but with bands, so you can use a lighter load. Keep that same 5 sec hold 20 rep thing going as well as the same scapular position.

I hope this helps.

[daveuk]

Hello mate, cheers for the reply. I have beeb doing external rotations for years, no significant improvment in stability really! I will give what you said a try and let you know how it goes. Can you give me some history of your shoulder probs? Also how are they now? I have had problems now for around 5-6years. Both shoulders! But anyhow, I'm still constantly seeking ways to improve them and regain optimum stability. On a positive, since my surgerys (both 2 and a half and 1 and a half years ago) I have not had a single dislocation. So thats a start! Just a feeling of constant looseness...
Re putting the band around the shoulder Im not sure which part of the scap I should be tilting into the band? From my knowledge of shoulders the scapulae aren't meant to tilt(?) but rather sit flush with the back in order to create a stable ground for the socket to connect to the humeral head.
Re: serratus anterior, I have tried all of these exercises, only prob is when I do them my scapulae wing! From what I gather from physio's etc If when doing push ups plus your scapulae wing, you are not ready to be doing them and infact should be regaining correct scap positioning before doing the serrratus exercises.
Would be very much interested to hear about your shoulder difficulties! Many thanks for prompt response.

[hardcore iv]

I was diagnosed with multi-directional shoulder instability a few years ago. From about 15 years ago I could wing my right scapula and subluxate the shoulder voluntarily and it would often subluxate on its own and it would always be clicky. I would also often get pain along the bicep tendon where it goes over the bicipital groove. The one orthopaedic surgeon I saw said I had stretched ligaments and needed to have them cut and sewed together tighter. I didn't want to do this so avoided it for years and just carried on as best I could. I eventually found a good physio who specialised in shoulders and she showed me the exercises I described, along with a few other ones. The serratus ones came later in my rehab. My shoulder is now at around 95% with occassional clicks, but it never subluxates or causes me problems unless I try to do crazy things with benching and overhead pressing.

re: scapular tiliting. It's technically called posterior and anterior tilting. Anterior tilting can be caused by things like a tight pectoralis minor and a weak lower trapezius.

To save us from any further confusion, I just uploaded some vids of how I do the exercises.

[daveuk]

Many thanks again for your response, and especially thanks for the video's. Has really helped me understand what you mean,using the tube around the shoulder to make sure the scap etc is in its correct position. Never heard of this before but can completely understand the logic behind it.
Also very good to hear that someone with multi directional instability is back to 95% stability, thats really good to hear. I would say mine is a lot less than that now but I'm aiming high. Completely stopped benching or anything with any really heavy weights of any sort. Would love to get back on it so I'm gona give these a try. Cheers mate and all the best with your continual rehabbing of your shoulders. Will keep you updated of any progress/complication etc.