Winging scapula

[annaren]

I was wondering if someone could give me some advice. I am an amateur swimmer who used to swim every morning for approximately 50 mins. Occasionally I used to get severe pain in my right shoulder but after a few weeks rest it was fine and I got back to swimming. However after the same thing happened last year it never got better. I went to the physio and they diagnosed me as having a winging shoulder but I have beeen seeing them now for a year and despite doing all my daily shoulder stabilizer exercise every day it is still not better. It really only bothers me when I swim but I am extremely keen to get back to proper swimming so really want to get it fixed. Another contributing issue is that I have been severely underweight for many many years yet still pushed my body to do a severe amount of exercise. This is something I am in the process of doing something about but I hope it has not damaged my muscles and tendons long term as in general my muscles have much less stamina that they used to and I am constantly getting injured. Does anybody know if long term malnutitrion affect muscles and tendons?
I know I have put a lot of different things in this mail but they are all related.

I am truely grateful for anybody who can give me some advise,
Anna

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• winging scapula

[sixphysio]

hi anna

winging scapula's are very rarely the cause of your problem. if you've cracked on with exercise for a year, and you're pretty much the same, then it's fairly obvious that this is not the problem.

what stroke do you swim most and do you have shoulder pain (if so where) or shoulder blade pain?

not sure it got too much to do with malnutrition.

cheers

sixphysio

[annaren]

I used to swim the front crawl most but now I am restricted to using a float interspersed with a few breast stroke and back stroke but it still aches when I finish. The pain is an ache around the edge of my scapula and I can feel the scapula sticking out quite a bit especially after I have been swimming.

[sixphysio]

guessed as much!

your winging scapula is not the cause. your neck is....

you most likely have a stiff thoracic spine, dodgy scapula control (tight rhomboids, poor serratus) and most importantly a jutting out chin. this is made all the worse in breastroke and using the float. because your thoracic spine is stiff you lack extension (or getting to neutral) so you force your mid cervical spine to compensate. this bendy mid section refers pain into the scapula (clowards area).

you need to get your physio to get your thoracic spine to move and then treat your anterior cervical spine - pushing from the front and never the back.

retrain your posture, not your scapula - keep your head on your neck.

cheers

sixphysio

[annaren]

Ok fantatsic I am getting excited that I just may be able to be helped!
So if I am clear the breast stroke isnt really helping!
Can you suggest any exercises. My physio does thing it is due to lack of scapula control and this is what I have been working on. My muscles surrounding the scapula (sorry dont know there names) get tight adn so she massages them out sometimes adn I also rub a tennis ball along thing against a wall when they get painful. My muscles arent really that well developed - well in comparison with other I see swimming but they dont seem to be improving despite all the exercises I am doing. Will trying to swim a small amount while I am trying to improve the control of my scapula etc not help?
Do you think this is something that can improve - ghee I hope so?
I really really really appreciate your responses.
Anna

[Canuck Physio]

Without an analysis of your central key points, and an actual visual examination it would be difficult to say with any certainty what the problem can be associated. However, it is likely to involve the muscles mentioned. Beside hands on massage therapy, you should also be completing specific exercises that will create balance and appropriate alignment of the scapula. Additionally, your technique should be checked and fascilitated to be performed in the biomechanically proficient manner.

[sixphysio]

go for the easy option. i reckon it's more to do with identification of common postural patterns - and this seems pretty above the line.

your exercises to improve you scapula stability will have no effect unless you have enough thoracic spine motion. horse before cart, not the other way around.

easy on the breast stroke, keep your chest up, pull down, don't poke your chin out.

cheers

sixphysio

[annaren]

Thanks. Can you suggest ways to increase thoracic spine motion.
Would front crawl be better than breast stroke. Mind you basically any stroke I repeatedly do hurts. I figured that the best thing is just to a few or everything - float, breast, crawl, back.
Does this sort of problem usually resolve once the correct exercises are being done?
Do I also need to do exercises to strengthen the muscles you mentioned ?
Thanks you so so much

[sixphysio]

get out of the pool, get some treatment on your thoracic spine, learn how to move better, then get back into the pool and get stronger. keep it functional only after you've got your back pushed around

it's not about strength, it's about control of movement. it's not about exercises (you've done enough), yet.

cheers

sixphysio