The Scapula is that flat bone behind your shoulder, triangular in shape. Not truly flat, it has a ridge or ‘spine’ and a piece that pushes out to the front of your body, the Coracoid process. One client has a Scapula that sticks out, ‘winging’ like an Angel’s wing, but a lot smaller. Could I do something about it?
Like all medical massage cases, I can run through a list of possibilities and expand on those that are more likely, triaging and tackling them in sequence. Topics include, not prioritized, weak muscles, strong muscles, tight muscles, fascia – tight or loose, Nerve pathways, underlying ribs shape, anatomical differences to ‘normal’, adaptation – to physical stress and tensions, prior trauma to the area, sleeping habits, any Scoliosis present?, emotional involvement, bone attachment problems, blood supply to the area, maybe a mini-stroke? A one-sided issue tends to preclude systemic factors.
A medical history helps, especially onset, family history of anything similar, maybe a ‘frozen’ shoulder?, physical working conditions, surgeries, medications. Hands on evaluation often separates massage therapists from Doctors, the tissues tell us more than words.
Anatomy lets me know there are 12 muscles attached to the Scapula and two more that cross over and capable of influencing the Scapula. Some naturally produce winging as well as other motions, others reduce winging. Those producing winging include: Serratus Anterior; Pectoralis Minor, plus Pectoralis Major if it rounds the shoulder excessively, Latissimus Dorsi can pull the arm closer to the spine then the Scapula has to go somewhere. The Rotator Cuff muscles could produce winging if the arm is held tight or fixed, unlikely. Checking those muscles for tightness or over-toned, and just looking may give an answer.
If it’s weak muscles, exercise may remove the symptoms, it may or may not remove the cause, a reason and action then required to heal the person, not leave the client having to exercise for the rest of their life.
If it’s blood supply, a thermal evaluation, for colder areas can indicate what needs to be done, in Visceral Manipulation this is done at 4” off the body and again further out.
I counted 5 Nerves supplying this area, next is to find out where they leave the spinal column, a pinching there can weaken or irritate muscles, not many vertebrae involved.
Tight fascia comes from extended use of muscles, continuing after getting tired; the fascia assists by tightening. Physical trauma to an area can tighten fascia as well as produce scar tissue, that’s easy to remove, converting it to functional tissue. Trigger points occur with acute overloading of a muscle, more added along the length of the muscle over time.
If the ribs protrude, pushing up the Scapula, simply check the front of the body, for the attachments at the Sternum and for any overt difference in shape comparing both sides of the body.
If the client sleeps only one-sided, that may be a factor.
Scoliosis – check the spine for any curvatures.
Bone attachment issues, check range of motion both sides; any joint issue will quickly show up.
Pain present? The body shies away from pain, adapting posture to reduce pain. Emotional issues can also affect posture, rounding of the shoulders is common to shield the person from possible problems.
So many possibilities, only a hand’s on assessment can discern what needs to be done. One, maybe two sessions needed, plus some stretches or exercise for the client to maintain the regained functionality while the body adapts to its new normal.
One thing I learned after graduating, sometimes the problem can be found at the ‘opposite’ side of the body, in this case, at the attachments of the Pectoralis Minor.
Rarely, the therapist has to keep their own history out of the picture, I have fond memories when as a pre-teen, of showing off how easily I could get both my Scapulae to wing out. Not helpful for this client, but my inner child is more than willing to show off, again.