This blog post contains effective physiotherapy exercises, stretches and strategies to help fix a Winged Scapula.

What Is A Winged Scapula?

A Winged Scapula (also known as Scapula Alata) is when the medial (inner) border of the shoulder blade protrudes off the rib cage.

(Ideally – it should conform to the shape of the rib cage.)

In This Blog Post:

• Is It Bad?
• Causes
• Test
• Winged Scapula Exercises

Is It Bad?

Although there is nothing inherently wrong with having a winged shoulder blade, it can be associated with:

• Impaired Scapulohumeral rhythm
• Drooping shoulder
• Thoracic Outlet Syndrome
• Uneven shoulders
• Upper Trapezius Pain
• Poor shoulder muscle strength/endurance (Early Fatigue)
• Limited shoulder movements
• Shoulder Impingement
• Pain Between the Shoulder blades

(Keep in mind – You can have a winged scapula and have no issues at all.)

causes

The exercises that you will need to focus on will depend on what is causing your winged scapula in the first place.

Here are the main causes:

Pectoralis Minor Tightness/Over-Activity

A tight and/or overactive Pectoralis Minor (along side a tight Levator Scapulae, Upper Trapezius and the short head of biceps) can pull the medial and inferior border of the shoulder blade off the rib cage.

Pectoralis Minor tightness is commonly seen in people with rounded shoulders.

Serratus Anterior Weakness/Inhibition

The Serratus Anterior is the primary muscle that anchors the scapula flat onto the rib cage.

It attaches onto the under surface of the shoulder blade and to the side of the rib cage.

If you do not have strength and/or control of this very important muscle, it can lead to scapular winging.

(This whole blog post will be going through a range of different Serratus Anterior Exercises.)

Long Thoracic Nerve Palsy

The Long Thoracic Nerve (which originates in the neck) innervates that important Serratus Anterior muscle as mentioned in the previous point.

If there are any issues with this nerve (e.g. impingement or traction injury), it may result in the inability to activate the Serratus Anterior.

With impaired muscle activation, it will be difficult to stabilize the scapula on the rib cage.

Other nerves (when damaged) that may result in scapular winging include:

• Dorsal Scapular Nerve (Innervates Rhomboids and Levator Scapulae)
• Spinal Accessory Nerve (Innervates Trapezius)
• Brachial Plexus

In order to completely address winging of the scapula, the nerve issue must be resolved first.

Flat Thoracic Spine

The shoulder blade and rib cage have a matching curved shape. (Concave-Convex relationship)

If the upper back is flat, it can result in the mismatch between the surfaces.

This will prevent the shoulder blade from conforming to the shape of the rib cage. (… no matter how many Serratus Anterior exercises that you do!)

Test For Winged Scapula

Here are 3 simple tests to determine if you have a Winged Scapula:

Static Test 

Instructions:

• Stand with a relaxed posture.
• Keep your arms by your sides.
• Get someone to take a photo of your back.
• Observe the medial (inner) border of the scapula.
• Does your shoulder blade stick out?

Dynamic Test

Instructions:

• Take a video of yourself performing a movement such as:
  • Push up against the wall
  • Raising/lowering your arms or
  • Pulling motion
• Observe the position of the scapula during movement.

Isometric Muscle Test

Instructions:

• Stand in front of a wall.
• Place your palms on the wall with the fingers facing downwards.
• Keep your arms straight.
• Push firmly into the wall.
• Get someone to observe your scapula whilst you are performing this test.

Winged Scapula Exercises

Note: The following exercises for Winged Scapula are designed to be gentle and pain-free.

STEP 1: Releases
STEP 2: Stretches
STEP 3: Serratus Anterior Activation
STEP 4: Strengthening Exercises
STEP 5: Flat Thoracic Spine
STEP 6: Things To Avoid
STEP 7: Correct Position Of Shoulders
STEP 8: Other Areas To Address

1. Releases

The first step when addressing a winged scapula is to release the tight muscles that may be pulling your shoulder blade out of the ideal position.

Pectoralis Minor

Instructions:

• Stand in front a wall.
• Place a massage ball between your chest and the wall.
• Lean a suitable amount of body weight onto the massage ball.
• Proceed to perform a circular motion over the ball.
• Make sure to cover the entire muscle.
• Duration: 1-2 minutes

Levator Scapulae/Upper Trapezius

Instructions:

• Locate the Levator Scapula muscle.
  • (Use Google if you are not sure of the location.)
• Stand in front of a wall.
• Lean forwards and place a massage ball between the top of your shoulders and the wall.
• Lean an appropriate amount of weight onto the massage ball.
• Make sure to cover the entire muscle.
• Duration: 1-2 minutes

2. Stretches

Once the releases have been performed, the next step is to stretch the tight muscles.

Pectoralis Minor

Instructions:

• Place your hand high up on a door frame. (see above)
• Tilt your shoulder blades backwards.
• Lunge forwards.
• Aim to feel a stretch in the chest area.
  • Do not arch your lower back.
  • Do not let your ribs flare outwards.
• Hold for 30 seconds.

(For More Stretches: Pec Minor Stretches)

Levator Scapulae

Instructions:

• Sit down on a chair.
• Use your hand to hold underneath the seat.
• Lean your body away from the hand holding onto the chair to lock the shoulder blade down.
• Tilt your head towards the opposite arm pit.
• Place your hand behind your head and pull your head towards the arm pit.
• Aim to feel a stretch in the region between your neck and shoulder blade.
• Hold for at least 30 seconds.

(For More Stretches: Levator Scapulae Stretches)

Upper Trapezius

Instructions:

• Tilt the head towards the side.
• Place your hand on the side of the head.
• Apply a downward pressure.
• Aim to feel a stretch in the area between the neck and shoulder.
• Hold for 30 seconds.

Short Head Of Biceps

Instructions:

• Stand with your back facing towards a door.
• Hold onto the door handle with your palms facing upwards.
• Tilt your shoulders blades backwards.
• Keep your torso up right.
• Lunge forwards.
• Do not flare your ribs out.
• Aim to feel a stretch in the Biceps.
• Hold for 30 seconds.

3. Activate the Serratus anterior

This is the most important section of this blog post.

To completely address a winged scapula, it is vital that you understand how to activate the Serratus Anterior muscle.

The main function of the Serratus Anterior is to keep your shoulder blade flat onto your rib cage.

Serratus Anterior Activation

Once you understand exactly how to ACTIVATE and FEEL this specific muscular contraction, let’s get started with the following Serratus Anterior exercises.

4. Strengthening Exercises For Serratus Anterior

The following exercises help strengthen the Serratus Anterior (… along side the other shoulder muscles.)

LEVEL 1: Isolate The Serratus Anterior
LEVEL 2: Serratus Anterior Exercises (With Resistance)
LEVEL 3: Serratus Anterior Activation (With Shoulder Movement)
LEVEL 4: Weight Bear Exercises (Both Arms)
LEVEL 5: Weight Bear Exercises (Single Arm)

Level 1: Isolate the Serratus anterior

Rock Back

Instructions:

• Assume the plank position with your knees on the floor.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior.
• Push your forearms into the floor.
• Rock your body backwards as far back as possible.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Return to the starting position.
• Repeat 30 times.

Push Up Plus (Against The Wall)

Instructions:

• Assume the push up position on the wall with your arms straightened.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior.
• Push your hands into the wall.
• Whilst keeping your arms completely straight, proceed to protract your shoulder blades.
  • Think of your shoulder blades gliding around the rib cage.
• Do not shrug your shoulders.
• Hold this end position for 5 seconds.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Slowly retract your shoulder blades back to the starting neutral position.
• Repeat 30 times.

Push Up Plus (Plank Position)

Instructions:

• Assume the plank position on the wall. 
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior.
• Push your forearms into the wall.
• Whilst keeping your forearms on the wall, proceed to protract your shoulder blades.
  • Think of your shoulder blades gliding around the rib cage.
• Do not shrug your shoulders.
• Hold this end position for 5 seconds.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Retract shoulder blades back to the starting neutral position
• Repeat 30 times.

Kettle Bell Hold

Instructions:

• Hold onto a kettle bell.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Bend your elbow to 90 degrees.
• Lift your elbow up to shoulder height.
• Have your elbow pointing forwards.
• Activate the Serratus Anterior.
• Hold this end position for 30 seconds.

Leve 2: Serratus Anterior Exercises (+ Resistance)

Push Up Plus (With Resistance Band)

Instructions:

• Hold onto a resistance band as shown above.
  • (Make sure you choose a resistance that you can handle.)
• Assume the above position on the wall with your arms straightened.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior.
• Whilst keeping your arms completely straight, proceed to protract your shoulder blades.
• Hold this end position for 5 seconds.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Retract the shoulder blades back to the starting neutral position
• Repeat 10 times.

Protraction (Lying Down)

Instructions:

• Lie on your back with your knees bent.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Whilst holding onto a weight, lock your arms straight in front of you.
  • Use a weight that you are able to control properly.
• Activate the Serratus Anterior.
• Push the weight up towards the sky whilst keeping the arm completely straight.
• Hold for 5 seconds.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Return to the starting position.
• Repeat 10 times.
• Progression:
  • Whilst holding the arm in the same vertical position as seen above, roll your body to the side.

Level 3: Serratus Anterior Activation (+ Shoulder Movement)

Wall Push Up

Instructions:

• Assume a push up position on the wall.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus anterior THROUGHOUT movement.
• Perform a push up.
• Keep your shoulders wide and long.
• Repeat 10 times.

Wall Slides (With Resistance Band)

Instructions:

• Wrap a resistance band around your upper back.
• Hold onto the ends of the resistance band.
• Assume the wall plank position.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior THROUGHOUT movement.
• Slide your forearms up/down the wall.
• Maintain the pressure on the wall through the forearms.
• Repeat 10 times.

One Arm Pivot

Instructions:

• Assume the wall plank position.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior muscle.
• Push the forearm (on the side of the Winged scapula) into the wall.
  • Maintain this pressure throughout the exercise.
• Whilst keep that arm fixated on the wall, rotate your body away.
• Return to starting position.
• Repeat 15 times.

Arm Raises (With Resistance Band)

Instructions:

• Hold onto a resistance band. (as shown above)
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior THROUGHOUT movement.
• When raising your hand – Try to push your hands as far away from the body whilst keeping your shoulder blades back, down and around throughout movement.
• Raise and lower your arms from your side.
• Repeat 15 times.

Level 4: Weight Bear (Both Arms)

Plank

Instructions:

• Assume the plank position on the floor. (see above)
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior muscle.
• Push the forearms into the floor.
• Hold this position for 30 seconds.
• Do NOT let your shoulder blades cave in.
• Note: If you are unable to maintain a good position of your shoulder blade, you can do this exercise on your knees instead.

Push Up

Instructions:

• Assume the push up position on the floor. (see above)
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior muscle THROUGHOUT movement.
• Perform a push up.
• Do NOT let your shoulder blades cave in.
• Keep the shoulders wide and long!
• Repeat 10 times.

Level 5: Weight Bear (Single Arm)

Straight Arm Plank (With Pivot)

Instructions:

• Assume the straight arm plank position.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior muscle THROUGHOUT exercise.
• Lean your weight into the hand that is on the side of the scapula winging.
• Whilst keep that arm fixated on the floor, slowly rotate your body away. (see above)
• Return to the starting position.
• Repeat 10 times.
• Progression: Go slower

Plank (With Pivot)

• Assume the plank position on the floor.
• Keep your shoulders wide.
• Tilt shoulder blades slightly backwards.
• Activate the Serratus Anterior muscle.
• Push the forearm (on the side you are targeting) into the floor.
  • Maintain this pressure throughout the exercise.
• Rotate your body away as you lift your other forearm off the floor.
• Return to the starting position.
• Repeat 10 times.

5. Flat Thoracic Spine

A flat Thoracic Spine (loss of natural kyphotic curve) can make the back of the rib cage flat as well.

This will affect how the shoulder blade sits on the rib cage.

For a blog post on how to address this issue:

See Post: Exercises For Flat Thoracic Spine

To get you started, try out his exercise:

Posterior Rib Cage Stretch

Instructions:

• Sit up right on the edge of a chair.
• Lower your chin towards the upper chest.
• Place your fingers behind the back of your head.
• Gently pull your head downwards.
• Whilst keeping the chin tucked, slowly curve the upper back downwards.
• Reach your elbows forwards/outwards.
• Aim to feel a stretch on the back of the rib cage.
• Make sure to keep your neck and shoulder completely relaxed.
• Take 3-5 deep breaths in this position.

6. Things To avoid

When correcting the position of your shoulders: DO NOT simply just “squeeze your shoulder blades back together”.

This movement may actually make your scapular winging even worse!

Instead – Check out Step 7 to learn how to correctly position your shoulder blades.

7. How to position the shoulder blades

1. Serratus Anterior Activation: 

• Reach and stretch out your hands as far to opposite sides as possible. (see above)
• Keep your shoulders wide and long.

2. Retraction:

• Bring your arms slightly backwards.
• Aim to feel a gentle contraction between your shoulder blades.
• (Do NOT over squeeze your shoulders back together.)

3. Posterior Tilt:

• Rotate your arms backwards as far as you can so that your thumbs are pointing towards the floor behind you.

4. Final Step

Take note of your shoulder blade position.

Keep this position!

… And gently lower your arms by your side.

8. Other areas to address

If you have persisted with these Winged Scapula exercises and still experiencing issues with the scapula position, you may need to also address the position of the rib cage.

This is influenced by the following:

Scoliosis

Scoliosis refers to the lateral curvature that occurs in the thoracic and/or lumbar spine.

This can affect the shape of the rib cage on which the scapula sits on.

For a blog post on how to address this issue:

See Post: Scoliosis Exercises

Twisted Torso

If your torso is twisted, this can affect how the scapula sits on the rib cage.

For a blog post on how to address this issue:

See Post: Exercises For A Twisted Torso

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Conclusion

Winged Scapula is where the medial border of the shoulder blades protrudes off the rib cage.

Although not inherently an issue, sub-optimal positioning of the scapula may predispose the shoulder to certain issues.

To correct a winged scapula, it is important to activate the Serratus Anterior which is the muscle mainly responsible for keeping the shoulder blade flat onto the rib cage.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.