Anterior Tilt of the Scapula
The scapula has a very important role in shoulder function. It forms the socket for the shoulder, has several layers of muscles that attach to it, and it forms three joints. One of these joints, the scapulothoracic joint, is of particular interest. It is not a true joint; it sits on top of the rib cage with a layer of muscle between. In a sense, it is floating on the rib cage and the resting tone in the muscles that attach to it dictate its position. If there are imbalances, it can change the angle that the scapula rests. Depending on severity, this can cause symptoms. There are several planes of motion that the scapula can move within. One plane in particular can become problematic; anterior tipping.
There are two particular muscles that have a strong influence on the degree of tipping of the scapula: pectoralis minor and lower trapezius. Pec minor attaches to the scapula at the coracoid process. If it is tight, it will pull it forward.
On the back side of the scapula, the lower trapezius attaches by the spine of the scapula. It acts to pull the scapula downward. If you have a weak lower trap and a tight pec minor, the resting position of the scapula will bias towards anterior tipping.
So how do we test for this? An easy way to see it, is to lay on your back. Do your shoulders comfortably rest on the floor? Or is there a gap between your shoulder and the floor? If the answer is yes to the last question, your pec is tight in relation to your trap.
So how do we address this? Most people are familiar with pec stretching or how to use a lacrosse ball or foam roller to lengthen the pec. The part most people leave out is to address the tone in the lower trap. The prone “Y” is probably the best way to strengthen the lower trap.
Another area that often gets overlooked is the thoracic spine. If you have too much kyphosis (think hunchback), it will contribute to this situation. You can test this out for yourself. Sit with back posture and slump your upper back. Now try to raise your arm overhead. It will stop prematurely or even given you a pinching sensation. Now sit up straight. Do you suddenly have more range overhead? That is because kyphosis of the spine is another way to produce and anterior tip of the scapula. This slight change in angle affects the rotator cuff and can lead to shoulder impingement. There are ways to address kyphosis of the spine, but this is best done with a physical therapist as self treatment can easily be done wrong and cause other issues.