Winged Scapula…Really?

There seems to be a great propensity within exercise professionals to diagnose, and the unfortunate thing is that a lot of the time they don’t even realise they are doing it.

At a recent training sessions I noticed that a lot of instructors were quite comfortable telling their partners that they had ‘winged scapula’.

Now you could argue that that is a generic term for having shoulder blades that stick out from your rib cage but it is the technical term for shoulder blades that stick out from your back because of a neurological issue.

If a member of the public in a class took that phrase to their doctors we would be faced with two scenarios:-

A – the GP would panic they had missed a diagnosis of a neurological condition,

B- the GP would have a wry smile and think ‘Exercise professional talking bollocks again.’

Either scenario is not great for the professional involved and both leave the member of public doubting the knowledge of the experts.

To be fair, when it was pointed out to the exercise professionals that winged scapula was a medical sign of the long thoracic nerve not functioning, which is quite a rare medical disorder, they were horrified they had ever been introduced to the term.  When shown a picture of a genuine winged scapula, none of them had ever seen it.

Let’s compare two pictures.

This is a genuine winged scapula caused by the long thoracic nerve not working.  This nerve innervates the serratus anterior muscle and with it not contracting and holding the shoulder blade (scapula) to the rib cage, the scapula sticks out if pressure is put on the extended arm.

 

You can imagine that this would display itself during press ups.

There is a difference between the person whose shoulders blades stick up in a press up because they are not used to contracting the serratus anterior and the person who can’t contract that muscle. (It’s the subtle difference between ‘you have a winged scapula’ and ‘your scapula are winging’ although the second phrase is usually used by people who don’t appreciate the difference and have grammatically stumbled on the phrase)

 

This second picture is from a site aimed at exercise professional.  It is claiming that this is a winged scapula and that you can fix it with their exercises.  There exercises engage the Serratus so would pull the scapula in but you can see that the person’s scapula isn’t winging, in fact the arrow points to a depression on their back where their scapula is, over hung by the development of their Traps.   Is it any wonder that people get confused.

To further add to the confusion the same site overs to fix something else that isn’t a problem.

Here we can see someone with their finger tips inserted between a scapula and a rib cage – this must be a problem!  Surely this is winging?

No, look at the pose.  The man has his hand around behind him in the small of his back.  This is the pose that body workers use to release the shoulder blade so that they can work on the muscles around it.  If your shoulder blade didn’t come away from your rib cage in this pose you would never be able to get into the pose, your arm wouldn’t go behind you.

Maybe its just trying to demonstrate the problem on someone whose nervous system is functionally properly.  I think they would have been better using a press up and asking him to relax his serratus.  If you can contract it, you can relax it and allow your shoulder blades to splay out (not wing).

The bottom line is that words are powerful.  If you have taken a technical term from another profession then you need to be careful how you use it.  Particularly if the person you are using it with is likely to go across professions (like the public).

The public’s understanding on how their body works is often dubious.  The professions don’t need to add to the confusion by not appreciating what they are communicating.