What is Snapping Scapula Syndrome?
Snapping Scapula Syndrome is when there is a snapping, popping, clicking and/or grinding sensation (collectively known as “Crepitus”) in the area between the shoulder blade and spine.
The sound/sensation is generated as the shoulder blade rubs against the rib cage.
(Ideally – the shoulder blade should glide smoothly on top of the rib cage without causing any sounds.)
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. For more information: Medical disclaimer.
What causes Snapping Scapula Syndrome?
The following factors will reduce the normal gap between the shoulder blade and rib cage.
This will increase the likelihood of the bones (… and/or soft tissue in between the bones) rubbing against each other.
a) Rounded shoulders
When your shoulders are rounded forwards, the scapula is generally in a position of Anterior Tilt.
On top of this – The weight of the arm can drag and pull the scapula down onto the rib cage.
These 2 factors brings the upper portion of the scapula closer to the rib cage which can cause grinding of the 2 bones (+/- the involvement of the soft tissue in between them).
b) Atrophy of the muscles underneath Scapula
A reduction in the muscle bulk (atrophy) of the Subscapularis and/or Serratus Anterior will reduce the gap between the scapula and rib cage.
c) Changes in bony structure
Any changes in the shape of the rib cage (eg. previous fractures) and/or scapula (eg. Luschka’s tubercles, Osteochondroma, fractures) may result in increased friction between the surfaces.
(Unfortunately – it is not likely to significantly reverse any changes in the bones without surgical intervention.)
d) Postures that affect the rib cage
The following postures may affect the ability of the shoulder blade to sit evenly onto the rib cage.
Snapping Scapula Syndrome Test
Instructions:
- Place both palms at the back of your hips.
- Slouch forwards.
- Perform shoulder rolls in a backwards direction.
- Aim to move the shoulder blade as much as possible.
Results: If there is a grinding sensation as you move your shoulder blades, then it is likely that you have Snapping Scapula Syndrome.
Is Snapping Scapula Syndrome dangerous?
Clicking between the shoulder and spine is not inherently an issue.
However – it may lead to the following:
a) Scapulothoracic Bursitis
There is a fluid-filled sac (called the bursa) that sits between the scapula and rib cage.
If these 2 bones grind against each other, it can compress the bursa and eventually lead to inflammation of the bursa (Scapulothoracic bursitis).
This can result in pain around the shoulder blade region.
b) Irritation to structures
Other structures such as the bone, tendons and muscles can also become inflamed as the bones grind against each other.
c) It’s annoying!
Although having Snapping Scapula Syndrome does not necessarily mean that there will be pain, it can still prove to be very annoying!
… Who wants a shoulder that makes a grinding noise every time you move it?
Snapping Scapula Syndrome Exercises
1. Releases
The following releases will target the muscles responsible for placing the scapula in a sub-optimal position.
(Note: If you are not sure where the following muscles are located, I recommend that you use Google to help you find out.)
a) Chest/Front of shoulder
Instructions:
- Locate the following muscles:
- Pec Minor/Major
- Subclavius
- Anterior Deltoid
- Coracobrachialis
- Short Head Biceps
- Lie on your stomach.
- Place a massage ball underneath the target muscle.
- Apply an appropriate amount of body weight on top of the ball.
- Perform a gentle rolling motion to cover all areas.
- Continue for 1 minute per area.
b) Latissimus Dorsi
Instructions:
- Locate the Latissimus Dorsi.
- Place a foam roller underneath this muscle. (see above)
- Apply an appropriate amount of body weight on top of the ball.
- Perform a gentle rolling motion to cover the entire muscle.
- Continue for 2 minutes.
2. Stretches
These stretches will address the muscles that are pulling the shoulder blade closer to the rib cage.
a) Chest
Instructions:
- Place your hand onto a door frame. (see above)
- Lunge forward.
- Do not arch your lower back.
- Keep the lower rib cage down.
- Aim to feel a stretch in the chest region.
- Hold for 30 seconds.
b) Front of shoulder
Instructions:
- Sit on the edge of a chair.
- Place both hands on side the of the chair.
- Pull your shoulders BACK and tip them BACKWARDS.
- (Lock this position in throughout the stretch!)
- Keep your elbows pointing backwards.
- Slowly sink your body downwards. Your elbows should start to bend.
- (Do NOT let those shoulders tip forwards!)
- Aim to feel a stretch at the front of the shoulders.
- Hold for 30 seconds.
c) Latissimus Dorsi
Instructions:
- Assume the position above.
- Hold onto a door frame with your hand.
- Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
- Use your body weight to sink into the stretch
- Twist your pelvis away.
- Aim to feel a stretch on the upper side of your torso.
- Hold for 30 seconds.
3. Increase The padding behind scapula
These exercises are aimed at increasing the size of the muscles that are located between the scapula and rib cage. This will minimize friction between the surfaces.
a) Serratus Anterior
Instructions:
- Lie on your back with your knees bent.
- Whilst holding onto a weight, lock your arms straight in front of you.
- Use a weight that you are able to control properly.
- Push the weight up towards the sky whilst keeping the arm completely straight.
- The scapula should tilt backwards and wrap around your rib cage.
- Hold for 5 seconds.
- Make sure you can feel the Serratus Anterior engaging throughout the exercise.
- Return to starting position.
- Perform 10 repetitions/3 sets.
- Progression: Use a heavier weight.
- (For more exercises: Serratus Anterior exercises.)
b) Subscapularis
Instructions:
- Anchor the resistance band at elbow height.
- Hold onto the band and stand side ways to the door.
- Tilt your shoulder blade backwards.
- Do NOT allow your shoulder to tip forwards during this exercise.
- Pull the band towards your body.
- Keep your elbow in contact with the side of your body throughout the movement.
- Repeat 10 times.
- Perform 3 sets.
4. scapula control
If you do not have control of the scapula, then it will be challenging to position the shoulder into a more optimal position.
a) Posterior Tilt
Instructions:
- Maintain wide and long shoulders.
- Perform a Posterior tilt: (see above)
- “Rotate the shoulder blade BACKWARDS.”
- Imagine the bottom of your shoulder blade digging into your ribs.
- This movement can also be described as a “back flip of the scapula”.
- Aim to FEEL the muscles contract at the base of the scapula.
- Hold for 30 seconds.
- Repeat 3 times.
b) Retraction
Instructions:
- Maintain wide and long shoulders.
- Perform a Posterior Tilt FIRST.
- Perform Retraction: (see above)
- “Pull your shoulder blades together.”
- Do not allow your shoulders to tip forwards.
- FEEL the contraction between the shoulder blades.
- Hold for 30 seconds.
- Repeat 3 times.
c) Elevation
Instructions:
- Position your scapula in a Posterior tilt and Retraction.
- Perform Shoulder Elevation.
- “Shrug your shoulders.”
- Feel the contraction of the upper trapezius.
- Hold for 30 seconds.
- Repeat 3 times.
5. Strengthening exercises for Snapping Scapula Syndrome
The following strengthening exercises will help engage the appropriate muscles that help place the scapula into the correct position.
a) Elbows flares
Instructions:
- Position the scapula:
- Perform Posterior Tilt, Retraction and Elevation.
- Place both hands (with elbows forward) on the sides of your head. (see Start position)
- Bring your elbows all the back. (see End position)
- Do not allow your shoulders to tip forwards!
- Feel the contraction between the shoulder blades.
- Hold for 5 seconds.
- Repeat 20 times.
b) Hand lifts off wall
Instructions:
- Place both hands high up on a wall in front of you.
- Lean firmly into your hands.
- Position the scapula:
- Perform Posterior Tilt, Retraction and Elevation.
- Lift your hands off the wall without moving your torso.
- Aim to feel the muscular contraction between your shoulder blades.
- Hold for 30 seconds.
- Repeat 3 times.
c) Wall push
Instructions:
- Stand with your back to a wall.
- Position the scapula:
- Perform Posterior Tilt, Retraction and Elevation.
- Place the back of arms along the wall to the over head position. (see above)
- Push the arms into the wall.
- Hold for 30 seconds.
- Repeat 3 times.
- Note: If you are having difficulty with this exercise, you can perform the same action whilst lying down on the floor.
d) Shrugs over head
Instructions:
- Assume the 4 point kneel position.
- Position the scapula:
- Perform Posterior Tilt, Retraction and Elevation.
- Lift and reach out a straightened arm in front of you so that your hand is pushing and holding a ball against the wall. (see above)
- Try to be as far away from the wall as possible.
- Roll the ball in a circular motion.
- Keep your neck relaxed.
- Continue for 30 seconds.
- Repeat 3 times.
6. What Is The Correct Shoulder Position?
The shoulder blade position is important! Here’s a quick way to place your shoulders in a better position.
Shoulder reset
Instructions:
1. Elevation
- “Gently float/hover your shoulder blade on top of your rib cage.”
- Imagine that air can be blown in between the scapula and rib cage.
- Do not let the weight of you arms drag your your shoulders downwards.
2. Serratus Anterior activation:
- Reach and stretch out your hands as far to opposite sides as possible. (see above)
- “Keep your shoulders wide and long.”
3. Retraction
- Bring your arms slightly backwards.
- Aim to feel a gentle contraction between your shoulder blades.
- (Do NOT over squeeze your shoulders back together.)
4. Posterior Tilt
- Rotate your arms backwards as far as you can so that your thumbs are almost pointing towards the floor.
Final step:
- Whilst maintaining this new shoulder position, slowly lower the arms by your side.
- Perform this reset technique as often as required.
7. surgery For Snapping Scapula Syndrome
If the cause of the Snapping Scapula Syndrome is due to structural changes to the bony surfaces of the rib and/or scapula, surgery can be used to smooth out the contact points.
The most common surgeries performed:
- Resection of the bone that is involved with the grinding.
- Removal of the bursa that is getting irritated (Bursectomy).
8. How long does it take for Snapping Scapula Syndrome to heal?
My recommendation: Persist with the exercises mentioned in this blog post for at least 3-6 months before considering surgery.
Conclusion
Although clicking between the shoulder blade and spine does not always mean that there will be pain present, it can lead to eventual irritation of the structures in the region.
Persist with these Snapping Scapula Syndrome exercises for at least 3-6 months before considering surgery!
What to do next
1. Any questions?… (Leave me a comment down below.)
2. Come join me on the Facebook page. Let’s keep in touch!
3. Start doing the exercises!
[edit to fix original comment] Thanks for this training regime, it’s helped deal with a shoulder impingement issue that’s been keeping me from climbing.
I have a strange issue with the shoulder elevation step of the routine listed above.
When I do the shrug on my right side with a little weight added, I get a cramp in my left lower back (I can’t work out if it’s my glute medi/mini or a muscle above the iliac crest in a similar area)… Any idea why this might be happening? I have a problematic few trigger points down the left side of my spine and generally issues on that side of my body (knee, shoulder)*.
Hey Pete,
Thanks for the comment.
If you get a cramp in the left lower back whilst performing an exercise on the right shoulder, it’s likely that the muscles on that left lower back region are trying to counterbalancing the weight on the right side.
If you hold weights in both hands, do you get the same sensation?
Mark
Thanks for your reply Mark!
No I don’t get it if I do both at the same time.
Nor do I get that if I do it with the left shoulder for the right lower side of my back.
I concentrate on keeping a centred spine and staying solid on both feet when doing it on the right shoulder… but still the same cramp.
I’ve been having lower and mid-back pain issues for a long while now (especially aggravated by sitting, extremely so when knees are higher than waist e.g. in the car or I don’t walk regularly) – and have ongoing left knee and ankle issues…
So I’m wondering if that area (Left glute mid, min, QL etc) might have something to do with it? Any thoughts appreciated!
Hey Pete,
You might have weakness or some other issues (?tightness/overactivity) in that left lower back region.
If it is weak, you can strengthen with exercises such as a suit case carry or a standing side bend whilst holding an appropriate amount of weight in the right hand. Gradually increase the weight to make sure no cramp is triggered.
If this region is tight or over worked, you might benefit from some stretches. You can start with these ones to see if it helps
– QL stretches
– Glute Med Stretches
Mark
Thank you so much for the list, Do i need to do all of these different movements? Or should i pick a certain amount.
Hi Elyas,
It’s a good idea to try all of the exercises to begin with. After some time, you’ll gain a sense of which exact exercises are most helpful. Focus on these ones.
Mark
Hey Mark,
Hope all is well, thank you for all the exercises. I find that when I do the Posterior Tilt I have a pain in my collarbone, I’ve had collarbone pain also when I wake up and do a circle shrug with my shoulders, what do you think that means/what should I do? Thanks again Mark! God bless!
Best,
Nate
Hey there,
You might have tightness in the Subclavius muscle. This muscle pulls the collar bone downwards and if tight, can hurt if you do the circle shrug.
You can try releasing the area with your fingers and re test the shrug movement to see if that makes a difference.
Mark
Hi Mark,
I’ve been feeling this nagging pain on the left side of my body, inside my left scapula and around it and I can’t seem to find the exact cause. I started doing exercises to improve scapular movement and noticed that during scapular pushups or serratus anterior exercises with similar scapular motion I get this sharp stabbing muscle pain inside the scapula when protracting the scapula. It feels like it spasms when I try to wrap my shoulder blade around. It also clicks in that area and feels like it catches something. What could be causing that pain when protracting? I should also mention my shoulders are uneven and the left shoulder is higher and has worse overhead mobility than my right, and also my torso is rotated a little bit to the right.
Hi Veronika,
Can you reproduce the pain by pressing directly into the painful region?
The most common cause would be associated with the lengthened position of your rhomboids. If this is the case, releasing the area with a massage ball will help. Follow it up with improving your shoulder and overall posture (ie. address the torso rotation/tilt)
If the pain is only reproduced by the protraction, I wonder if you may be placing tension on the nerves in the scapula area. Are your shoulder drooping downwards?
Mark
I can’t reproduce the exact pain I get with protraction because it feels somewhere deep inside. Massaging the rhomboids with tennis ball feels good but doesn’t have any effect on my symptoms. If I go lower closer to the spine and push on the spot where lower trapezius overlaps the lats massage becomes intensely painful not in a usual trigger point massage way, but like the area is bruised and I am pushing on a nerve, Massaging the area around I have a tender spot on the left side of the lower ribs, which is painful upon pushing, also clicks and pops with certain movements, like breathing out deeply. When I contract my abs it feels like lower ribs go on top of abs/pop out of place. Could it be the slipping rib syndrome? Shoulder doesn’t droop, but I filmed myself when I do scapular pushups for example, the right side moves as it should, retracting and protracting as it should, but the left stays somewhat higher and doesn’t retract normally. I also tried pendulum exercise for rotator cuff and it was really painful. I had gone to the physical therapist and was told that I have upper crossed syndrome because of certain overdeveloped muscles and that I should activate and strengthen transversus abdominis muscle, I tried those exercises, they feel good, but parts of them produce either the same pain in shoulder blade (second part of protraction in trx body rows or rear delt butterfly) or clicking in the ribs (when doing transversus abdominis exercises). Thank you so much for replying and have a nice day!
Hi Veronika,
If you can’t physically touch the painful area, have you tried touching underneath the shoulder blade bone?
Here’s how to do it:
– Lie down on your stomach.
– Place your hand behind your lower back.
– Relax your arm.
– You’ll need a helper to gently lift the medial border of the scapula and press underneath the shoulder blade. (and perhaps around the ribs as well).
Let me know how this goes.
Mark
Its caused by ligament and tendon instability, get prolotherapy and PRP to fix it 100%
Hello,
Is it possible for me to continue with excercise (i mostly do bodyweight training/calisthenics atm), or is it better to dont excercise at all while i try to fix my scapula. I feel like it is for sure going to slow the procces down, but i just want to know if iam not just making things worse for myself. My scapula doesnt snap when i excercise, it only snaps in upper part when i do posterior tilt from normal shoulder position. But it definitely feels a bit wierd while excercising, compared to the healthy one.
Thank you for usefull information,
Victor
Hey Victor,
I would encourage you to continue with your training. You might need to consider addressing some technique issues if you have any that might be contributing to the scapula issue.
Mark
How long would this take to fix? my shoulder blades stick out a lot- which looks horrendous, and my shoulders snap and click whenever i ish them back, i just want to look normal lol.
Hi there Kristin,
Hard to say exactly how long it will take to fix. But generally speaking – you should notice a difference after 4-6 weeks for sure.
When you say your shoulder blades stick out, does this mean you have winged scapula? (See post: Winged Scapula). If so – you may need to address that.
Mark
How often should I be doing all of these? Everyday? Can I split them up into different days?
Hi Chloe,
You can try it 3-4 times a week to see how you feel.
From here – you can adjust the frequency depending on what your body needs.
Mark
What kind of specialist should I see for this issue? I have been dealing with this for 15 years without resolution. I am guessing I need surgical intervention.
Hi Jonathan,
Is it causing any pain? Or limiting function? Or is it mainly that you don’t like the snapping noise? In my opinion – Try to avoid surgery as much as you can.
Any health care provider should be able to address this issue.
Is there a video of these exercises please thanks
Hey Paul,
This is something that I need to do!
Mark
Some people does things for money, and some does it for pleasure, and to make the world a better place.
And still I am sure that you don’t have to worry about how to make a living.
Amazing expert. Thank you.
My question: I was doing this levator scapulae stretch, while my th5 was slipped under my th4 after the injury, detailed below…, and the rib popped out maybe, or something happened where my scapula connects to the muscle, but it felt like a sudden click in my c1 or atlas, where the muscle connects, It was strange.
A few days before that, I destroyed my back in a vagous nerve flare up, caused by my forward head posture-kyphoscoliosis. (you know, scared to death, this is the end, etc…) I guess I pinched it at the nerve root, somewhere between c1 and c2… I was twisting in left direction with my hips and head, and in the right direction with my arms, intended, to get to feel better, and of course I created a total instability in my back, overstretching many ligaments in my back.
when that was not work, I tried to get on dog position, and tried to force things back to the right position, but I just created more damage to myself.
I was so unstable, that I could not walk for hundred meters without dislocating my th4-5 and maybe th8.
After three prolotherapy sessions,and about a half year of rest, I feel like ok, just like Brian after the spaceship alien abduction scene, but this right scapula still tends to click away a bit from the ribs, (or the rib from the scapula?) and I feel irritation at the top inward corner of it. Is this because of the levator scapulae, or the injury of some soft parts under the scapula? Sometimes my th4-5 still dislocates, that time, those four-five vertebrae squeezes inwards a bit, and I need to sit and move carefully, to make them find their right position. (We did not really get there with my prolotherapy yet,) But even like that, this scapula is not that stable. and plus once, when I pushed myself up from the bed, from a resting on my back position, I’ve placed more weight on my right arm, my th4-5 dislocated under load, and my right shoulder joint gave a cracking sound pretty loudly, and that was painful. Since then, when I do large arm circles, backwards, when my arm is in horizontal position, my right shoulder joint clicks. If I keep doing this, my arm’s upper part becomes painful on the side. feels like, my shoulder joint is loose.
Right under the armpit, the muscle on my ribs, where my scapula meets it (in arms hanging down position), is a little painful. (somewhere around latissimus dorsi or teres major, but the outside muscle)
So I want to understand, if these are just stretched ligaments under my scapula, or something with levator scapulae, or the weak costotransversal, costovertebral joints?
My shoulder is also mysterious. I want to know, where the doctor should direct the sugar injections, if I want to fix my scapula, and my right shoulder joints, and if this can be treated like that, or not.
Funny enough, when my spine is in the good position, I can not feel pain in my upper inside corner of my right scapula.
I hope you give answer, because here in Hungary I have not too much hope with the local doctors.
Sounds like crazy stuff…
I wish it never happened to me.
Omg!!! Thankyou so much for sharing! You’re amazing.
My pleasure!
Hi Mark. This is a great resource. I was wondering how often I should be performing these exercises in a week.
You are amazing Mark. I have a huge respect for you. Thanks
Thanks Tabassum!
Hope you found the exercises helpful.
Mark