Winging It! Date: 20 January Course year: Live & Breathe Pilates, Dublin, Ireland

Transcription

1 Winging It! Name: Louise Carey Date: 20 January 2018 Course year: 2016 Location: Live & Breathe Pilates, Dublin, Ireland

2 Abstract Scapular winging is a rare and usually painful condition where the shoulder blade, which should rest flush against the posterior ribs, protrudes. As Pilates instructors, the most common cases we see are less severe, where a client struggles with stabilising their shoulder blades during Leg Pull Front for example. There are many reasons for this difficulty in stabilising, ranging from repetitive motion injuries such as washing the car and digging, to non-traumatic injuries such as viral illnesses and medical conditions. This paper will focus on the former type repetitive motion injuries and in particular an office worker who sits at a desk all day, hunched over a computer/laptop, repeatedly using a mouse on one side. The purpose of this research paper is to look at how to overcome this type of office worker posture with exercises outside of, and indeed within, the working environment. 2

3 Table of Contents Abstract... 2 The Science Shoulder Anatomy... 4 Introduction... 7 Case Study Details... 8 BASI Programme... 8 Conclusion Bibliography

4 The Science Shoulder Anatomy The shoulder complex is just that- complex! The shoulder girdle is composed of one clavicle and one scapula, and the shoulder complex includes the humerus (as illustrated in Figure 1 below). Figure 1: Source - The scapula has no direct attachment to the spine or skeletal arrangement but rather, slides along the ribcage with only muscles connecting it to the spine. In fact, the only bony attachment of the arm to the axial skeleton is at the sternoclavicular joint (see Figure 1 above). Because of this, shoulder mechanics and movement are very dependent on the surrounding muscles (thus the complexity), resulting in imbalances in this area having a large impact on the efficiency of shoulder movements. For example, the arm (humerus) should be able to move independently of the scapula but this commonly is not the case. 4

5 At it s most serious, scapular winging is often associated with a weak serratus anterior muscle and trapezius muscle (see Figure 2 below), stemming from damage to the long thoracic nerve and spinal accessory nerve respectively. Figure 2: Source US National Library of Medicine, National Institutes of Health ( The serratus anterior assists in 3 movements: 1. allowing the scapula to rotate when the arm is lifted overhead 2. protracting the scapula (moving shoulder blades away from each other) 3. rotating the inferior angle (bottom tip of the scapula) upward and laterally (to the side, either toward the spinal column or away from it) 5

6 At its simplest, the trapezius muscle works to: 1. elevate the scapula (shoulders to ears) 2. retract the scapula (draw the shoulder blades together) 3. rotate the scapula (scapula movement when lowering arm by side or lifting overhead) Figure 3: Source - 6

7 Introduction This research paper focuses on the struggle with scapular stabilisation, and in particular medial winging of the scapular of someone winging it too much (extreme case photographed in Figure 4 below). It seeks to address how this may occur in the office environment and what can be done to mitigate these causes. Figure 4: Source - The case study is based on a 34 year old female. Although on a daily basis she sits at an office desk for a minimum of 9 hours a day, she is also active. However she struggles with scapula stabilisation in all her training, particularly (being a right-handed person) on the right hand side. This does not cause her any pain or discomfort, but rather is something that her personal trainer and Pilates instructor have observed in her movement. 7

8 During the course of the research, the focus was placed on strengthening and isolating the serratus anterior and trapezius muscles. Case Study Details The case study is Emma Browne a 34 year old intermediate Pilates student who cycles to and from the office each day (30 minutes each way) and then sits at her desk for a minimum of 7 hours. She described her computer as being slightly to the right of her desk so her sitting position is slightly rotated to the right. Emma has a good level of fitness, regularly doing weight and spin classes. Outside of difficulty with stabilising the right shoulder blade, Emma struggles with tight hip flexors particularly when her legs are in table top for any length of time, and also during exercises such as teaser. She has never seen a physiotherapist or received any treatment for any of her issues and advises that she does not suffer any pain in these areas. BASI Programme Being an intermediate student, the BASI programme selected for Emma over 10 sessions included foundation and intermediate exercises, adding advanced exercises in later sessions to add challenge. The exercises, reason for selecting these particular exercises and the desired results are listed below (note, not all exercises where used at every session): 8

9 BLOCK Exercise(s) Apparatus Focus of Exercise Reason for selecting and Desired Result Warm up Footwork Abdominal Work Roll down s X3 Roll Up Supine Spine Twist Double Leg Stretch Single Leg Stretch Criss Cross Parallel heels/toes V position toes Open V heels/toes Calf raises Prances Prehensile Single leg heel/toes Breathing with the push through bar Mat (actually performed on reformer with platform extender for fluidity of class) Reformer (3 red Cadillac (medium spring) Focus of these exercises are mainly abdominals and obliques. Muscle focus - abdominals for pelvic stability - hamstrings - quadriceps - foot plantar flexors This exercise works on the abdominal muscles while improving coordination, balance and breathing. Warming up body in preparation for the class. Want to include spinal articulation and rotation as well as warming up the core. Particular focus was put on keeping serratus anterior activated by reaching through the little finger during roll up. Emma did footwork lying supine in order to help her feel the heaviness and breadth of the shoulder blades on the carriage. One of Emma s favourite exercises so it was included regularly throughout the sessions for her enjoyment! Hip Work Full Pike Single Leg Supine Series Frog Down/up Circles Wunda Chair (medium to heavy Cadillac (leg spring medium to heavy) While this exercise takes much abdominal strength, Emma also focussed heavily on getting the serratus anterior working. Hamstrings and adductors are the main focus of these exercises. Emma worked on the cue of ballooning her thoracic area to keep the shoulder blades broad and stable, as well as pushing the Wunda Chair into the ground throughout. This helped with the serratus anterior engagement Good exercises to help Emma focus on engaging the back of her thigh (rather than the dominant 9

10 BLOCK Exercise(s) Apparatus Focus of Exercise Reason for selecting and Desired Result Hip extension Bicycle quadriceps) while keeping the pelvis stable Spinal Articulation Stretches Full Body Integration (Fund/Inter) Tower Prep Shoulder Stretch lying side Cat Stretch Kneeling Arm Work Pole Series - Shoulder Stretch, overhead stretch, side stretch, spine twist Cadillac (medium Step barrel Cadillac (medium Box and Pole This exercise is for abdominals and hip extensors This exercise focuses on stretching the latissimus dorsi and pectoral muscles Working abdominals and back extensors while putting particular focus on scapula stabilisation during the shoulder stretch phase The shoulder stretch in particular focuses on the trapezius muscle This is a good exercise for Emma, not only to get her hip extensors activated, but also for the scapula stabilisation that is required throughout. Broad shoulder blades were always cued Another exercise that Emma specifically requests she enjoys the open sensation this gives across the front of her chest and shoulders after a long day at work. Emma has to pay particular attention to reaching down and forward into the push through bar during this exercise to keep her right shoulder blade stabilised. Not only does the Pole Series work the trapezius and shoulder muscles, it is also a great posture exercise, the learnings of which, Emma can take to the workplace. Full Body Integration (Advanced/ Master) Shrugs Triceps Press Sit Balance Control Front Wunda Chair (medium Reformer (1 red spring) The muscle focus of shrugs is the trapezius so Emma returned to this exercise regularly. Specifically working on abdominals and deltoids. Helps to isolate and strengthen the lower trapezius muscle to depress the scapula. Wanted Emma to get the sensation of always pushing the shoulder blocks to the floor to keep shoulder blades broad across the back 10

11 BLOCK Exercise(s) Apparatus Focus of Exercise Reason for selecting and Desired Result Tendon Stretch Wunda Chair (medium to heavy Leg Work Hip Opener Wunda Chair (light to medium Lateral Flexion/ Rotation Back Extension Mermaid Swan on floor Finished with Roll downs Reformer (1 red spring) Wunda Chair (light spring) Abdominals and the serratus anterior are the muscle focus for this exercise The focus of this exercise is the hip external rotators The main focus of this exercise is obliques, however scapula stabilisation is also of utmost importance The trapezius is the muscle focus for this exercise to depress the scapula as the back extends. Similarly to the full pike, looking for abduction and depression of the scapula during this exercise so Emma had to focus on pushing into the Wunda Chair and ballooning the thoracic area. From sitting and cycling, Emma is very dominant in her quadriceps and hip flexors. This brings focus into the hamstrings and hip external rotators. Challenging Emma to stabilise the scapula in rotation, and keeping it depressed while bringing the carriage back to the stopper. Also nice open hip sensation for her. Not only does this exercise focus on the trapezius (one of the muscles this case study wanted to focus on), it also is great upper back work which is always important for office workers who can become tight and rounded in the front of the upper body. 11

12 Conclusion After 10 sessions, Emma had an increased awareness of the movement of her shoulder blades, particularly on the right side. She started to recognise the difference between using and not using her serratus anterior in exercises such as the full pike. Following an ergonomic assessment of her workstation, Emma adjusted her desk and computer so that she was facing straight on, at the right head (eyeline in line with the top of her screen). She alternates using the mouse on the right and left side when using her computer in work and has found that, along with her Pilates return, this has significantly improved the winging scapula on the right side. Emma is conscientious about correcting her posture at her desk during the day using the cues and alignment learned during her sessions, as well as performing small range thoracic extensions at the desk at regular intervals. All of these factors have culminated into Emma feeling less restricted in her pectoral muscles and with greater control of her shoulder blades. 12

13 Bibliography 1. Calais-Germain, B. (2014). Anatomy of movement. Seattle: Eastland Press. 2. Innovations in Pilates, Matwork for Health and Wellbeing. (2018). 1st ed. Hurstbridge: Rebus Press. 3. Isacowitz, R. and Clippinger, K. (2011). Pilates anatomy. Champaign: Human Kinetics. 4. Pilates, J., Miller, W., Robbins, J. and Van Heuit-Robbins, L. (2012). Pilates' return to life through contrology. [Place of publication not identified]: Presentation Dynamics. 5. Shoulderdoc.co.uk. (2018). Winging Scapula ShoulderDoc. [online] Available at: [Accessed 20 Jan. 2018]. 6. Physiopedia. (2018). Winged scapula. [online] Available at: [Accessed 23 Jan. 2018] 7. Martin, Ryan M., and David E. Fish. Scapular Winging: Anatomical Review, Diagnosis, and Treatments. Current Reviews in Musculoskeletal Medicine, Humana Press Inc, Mar. 2008, [online] Available at: 8. Author Mollie Martin Contributor Mollie is a Study Assistance Consultant at the American Council on Exercise who holds a BS in Psychology. She is an ACE Certified Personal Trainer. Muscles That Move the Scapulae. ACE, 13