Here is some pretty extreme evidence of loss of scapula control and scapula winging on one of Elise’s @elisemulvihill patients!
This patient presented to the clinic with a history of right anterior shoulder pain which had been gradually worsening over the past couple of months. He complained that his pain was predominantly aggravated by barbell bench pressing movements. His pain is not being helped by these poor scapula-humeral mechanics that you can see in both the still images and the video.
Scapular “winging” refers to dysfunction of the stabilising muscles of the scapula where the medial border of the scapula lifts away from the rib cage, resulting in an less than ideal motion of the scapula. As you can see for this patient, although he gets good abduction of the scapula at full flexion range, his serratus anterior is not doing a great job at controlling the scapula at the start or at the end. The serratus weakness is even more apparent in a 4 point position when he attempts to protract and retracts the scapula. (Which is more relevant to bench press position which causes him Shoulder pain). His shoulder pain is coming from loading stress in the shoulder joint and rotator cuff because the scapula is not in an ideal position during the movements.
In terms of rehab, addressing serratus strength, scapula setting below shoulder height as well as rotator cuff strengthening is a must. We started him on some basic isometric exercises to get his serratus anterior activating, alongside some rotator cuff banded work with an added focus of setting his scap in these exercises too.
Stay tuned to see his progress with his rehab!
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