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PILATES FOR THE WINGED SCAPULAE AND

SHOULDER HEALTH

Tanya Koutchina

June 20th 2016

Beach Pilates, Toronto, 2016

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Abstract

Winged scapulae is a problem that afflicts many people. The musculoskeletal reason behind this

deviation can be successfully treated with a well-designed and executed exercise program. The

BASI Pilates block system provides a program map to correct angel wings and improve overall

shoulder health. The individual involved in this program experienced improvement in overall

shoulder strength and mobility. However, if problem of the winged scapulae is to improve it will

require both time and dedication on the part of the participant to see meaningful results.

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Table of Contents

Abstract………………………………………………………………………………………………………………………………….….2

Definition……………………………………………………………………………………………………………………………….….4

Anatomy…………………………………………………………………………………………………………………………………….5

Case study…………………………………………………………………………………………………………………………….……8

Prescribed program……………………………………………………………………………………………………………………9

Conclusion……………………………………………………………………………………………………………………………....11

Bibliography…………………………………………………………………………………………………………………………….13

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Definition/Description

The term “winged scapulae” describes a postural condition in which the medial boarder of

the scapulae visibly protrudes posteriorly.

The scapula, or shoulder blade, has a large number of muscles attaching it to the shoulder joint.

These muscles work in tandem to move the arm and keep the shoulder blade firmly attached to

the back. Traumatic injury and damage to the nerves in the area can cause one or more of

muscles in this complex system to malfunction. Poor posture causes strain and spasm in muscles

which, in turn, pull the scapula out of alignment. Over time, the misalignment can cause the

scapula to detach from the upper ribcage resulting in a winged appearance. If this postural

distortion is allowed to continue, the likelihood that the symptoms will become worse is very

high.

Clinical presentation for the musculoskeletal winged scapula 4

There are three types of scapular motion deviation:

1. A visible inferior angle and a pronounced anterior tilt of the scapula can be observed.

The causes for this type are: shortening of the Pectoralis Minor, shortening of the posterior

joint-capsule and muscular unbalance of the Upper Trapezius and the Serratus Anterior.

2. A visible medial boarder and an intern rotation of scapula can be observed.

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The causes are: shortening of the posterior joint-capsule, shortening of the Latissimus Dorsi and

muscular unbalance of the Trapezius and the Serratus Anterior.

3. A visible inferior angle and a downward rotation of scapula can be identified.

The causes are: shortening of the Levator Scapulae and muscular unbalance of the Lower

Trapezius and Upper.

Anatomy1

The scapulae is part of the shoulder complex that has two more bones: the clavicle and

humerus.

The clavicle articulates with the acromion of the scapula and the sternum. The sternoclavicular

joint is the only attachment site between the appendicular and axial skeletons.

The scapulae is the triangular shaped bone that plays a major role in stabilization and movement

of the arm, and is the point of attachment for sixteen muscles. The scapula glides across the

thorax forming the scapulothoracic joint.

The arm’s bone humerus articulates with the scapula forming the glenohumeral joint.

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The main sixteen muscles that form an attachment to the scapula are:

Serratus Anterior Levator Scapula

Supraspinatus Infraspinatus

Subscapularis Deltoid

Trapezius Pectoralis Minor

Teres Major Biceps Brachii

Teres Minor Rhomboid Major

Triceps Brachii Rhomboid Minor

long head Coracobrachialis

Latissimus Dorsi

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Movements of shoulder

Movements of scapulae

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Case Study:

Tanya Koutchina, 52 years old

Tanya was unaware that she had an “angel’s wings” until the physiotherapist mentioned it three

years ago. She has a recent history (approximately 5 years) of suffering with pain in her shoulders.

The main reason for her shoulder pain is physical activity (over exercising or performing exercises

incorrectly); there is also the possibility of poor alignment of the shoulder girdle that results in

pain. Her goal is to try to strengthen the muscles that are involved in the scapula stabilization

and movement and correct the condition of winged scapula with the hope of eliminating her

shoulder pain all together.

A visible medial boarder and an intern rotation of scapula can be observed that relates to type

two scapular motion deviation (according to physiopedia).

The causes are: shortening of the posterior joint-capsule,

shortening of the Latissimus Dorsi and muscular unbalance of the

Trapezius and the Serratus Anterior.

Even though she has been studying and performing Pilates exercises for some time, there is a

need for a concerted effort to re-train her movement patterns; precision is a key element of

Pilates philosophy and it will be focus of these sessions. Starting from a warm up and through

every block she should pay attention to her scapula position not only when her shoulders are

involved in the movement but when her scapulae is in the relaxed position.

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She will start at the beginner’s stage, and will progress to a more elaborate choreography when

she is ready. In each block she will need to concentrate not only on the muscles that are involved

in the movement but to pay special attention to the scapulae and shoulder girdle in general.

BLOCK BEGINNER PROGRESS PROGRESS +

WARM UP MAT: MAT: CADILLAC: Goal is to warm up whole body. Precision is paramount. Focus on keeping scapulae in place.

Roll down Pelvic curl Spine twist supine Chest lift Chest lift w/ rotation

Roll down Roll up Spine twist supine Double leg stretch Single leg stretch Crisscross

Roll down Roll up with RUP Spine twist supine Mini roll-ups Mini roll-ups oblique Roll up top loaded

FOOT WORK WUNDA CHAIR: REFORMER: CADILLAC: Goal is to warm up feet and work on foot/ankle/knee/leg/hip muscles. Actively involve shoulders from the beginning by various positioning of the arms while sitting on a chair. Keeping shoulders down and stable in the supine position.

Parallel feet Parallel toes V-position toes Open V-heels Open V-toes Calf raises Single leg heel Single leg toes

Parallel feet Parallel toes V-position toes Open V-heels Open V-toes Calf raises Prances Single leg heel Single leg toes

Parallel feet Parallel toes V-position toes Open V-heels Open V-toes Calf raises Prances Single leg heel Single leg toes Hip opener

ABDOMINAL WORK WUNDA CHAIR: REFORMER: CADILLAC: Even though focus is on the abdominals, scapular stabilization; and shoulder extensors/flexors control are paramount.

Standing pike

Hundred Coordination

Roll up bottom loaded Bottom lift w/ RUB

HIP WORK REFORMER: CADILLAC : REFORMER: Goal is to strengthen hip adductors keeping pelvis stable. Keep scapulae stable and down while working on the hip/leg muscles

Frog Circles DN/UP Openings

Frog Circles DN/UP Hip extension Bicycle

Circles DN/UP Extended frog Extended frog reverse

SPINAL ARTICULATION

CADILLAC:

REFORMER:

Muscle focus is abdominals. Keep shoulders stable articulating the spine

Monkey original Long spine

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STRETCHES REFORMER: CADILLAC: REFORMER: Hold the stretch for 5 breaths cycles. Tilt pelvis posteriorly to increase hip flexor stretch and anteriorly to increase hamstring stretch. Control shoulder positioning. For shoulder stretch: move slowly through full range of motion focusing on shoulder rotators.

Standing lunge Shoulder stretch Full lunge

FULL BODY INTEGRATION F/I

CADILLAC:

REFORMER:

Stabilization is required not only for the trunk but shoulder region on the reformer. Shoulder extensor control and adductor stretch are among objectives on Cadillac.

Sitting forward Side reach

Down stretch Up stretch 3

ARM WORK REFORMER:* CADILLAC: REFORMER: Keep scapulae under control with small movements that adjusted to arm movements; developing shoulder mobility and stability.

Extension Adduction Circles UP/DN Triceps

Shoulder adduction single arm Sitting side prep Sitting side

Rowing back 1 Rowing back 2 Rowing front 1 Rowing front 2 Deltoid reach Cross arm pull

FULL BODY INTEGRATION A/M

REFORMER:

Shoulder extensors and hip extensors are main focus of the movement. Keeping the scapulae stable and depressed.

Balance control back

LEG WORK REFORMER: CADILLAC: MAGIC CIRCLE prone: Shoulder girdle is stable during all leg work that focuses on gluteals and leg muscles

Single leg skating Side split

Squats Ankles bent knees Ankles straight knees Hamstrings

LATERAL FLEXION/ ROTATION

REFORMER:

MAT:

MAT:

Shoulder mobility and stability are important in all chosen exercises.

Mermaid Side bend Twist

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BACK EXTENSION MAT: MAT: MAT: Focus on back extensor muscles. Keep scapulae stable. In Rocking – shoulder and chest stretch.

Swan dive prep Cat stretch

Rocking prep Cat stretch

Rocking Cat stretch

Finish with roll down and breathing exercises.

*Note:

Even though the shoulder girdle is involved in every exercise in the program, it would be

beneficial to begin the process of learning to perform the arm work on the reformer while in the

supine position. This is would be helpful due to the weight of the body preventing “winging” by

compressing the scapula against the thorax and allows for full shoulder range of motion.

Conclusion

The program as designed addresses the whole body according to BASI Pilates principals: you

cannot separate the troubled areas to target for improvement without it influencing and being

influenced by other muscles and joints and associated connective tissues. The focus must be to

execute each and every movement with precision and integrity paying special attention to the

shoulder girdle. The most difficult part will be to keep the shoulder blades down and wide (there

is a tendency to squeeze the shoulder blades). After starting the beginner’s stage of this program

six weeks ago a definite improvement in the overall strength of the arms and shoulders are

observed. The progression to the next level will be work done on the arms on the Cadillac which

then creates new challenges. Even though the speed of improvement may seem very slow,

discipline and consistent work towards the goal of pain free and strong shoulders will be

achievable. Improvements in the winged scapulae is a work in progress but even in the short

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time in which she has been involved in the program the results are already becoming evident:

she is consciously thinking about the positioning of her scapulae in everyday life. She is

constantly returning to the beginner’s stage of this program to reinforce the principles of proper

movement, and to apply the principle of “overload” to gain more strength.

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Bibliography

1. Biel, A. (2014). Trail guide to the body (5th ed.). Books of Discovery.

2. Isacowitz, R. (2014). Pilates (2nd ed.). Human Kinetics.

3. Isacowitz, R., Clippinger, K. (2011). Pilates anatomy. Human Kinetics.

4. Winged scapula. (n.d.). In Physiopedia. Retrieved June 3, 2016, from http://www.physio-

pedia.com/Winged_scapula

5. Kaselj, R. (2012). Scapular muscles. Retrieved June 2, 2016, from

http://exercisesforinjuries.com/scapular-muscles/

6. Isacowitz, R. (2013). Study Guide. Comprehensive Course. Costa Mesa CA: Body Arts and

Science International.

7. Franklin, E. (2012). Dynamic alignment through imagery. (2nd ed.). Human Kinetics.