Scapular Pain

Scapular Pain

This is a tough one to get rid of. I see people in the gym, constantly rolling on foam, lacrosse balls, trying to stretch it, usually to no avail. Let me be clear, scapular pain is poorly understood, and what I’m proposing is my opinion only. 

Disclaimer: there are serious conditions that can refer pain to the scapular region such as cardiac or lung issues. These have to be cleared by a healthcare provider. 

Assuming the pain is not referred pain, there are mechanical reasons for this type of pain. The scapula is like a floating bone that rests on top of your rib cage. Therefore, the resting tone in all the muscles that attach to it dictate its resting position. The force couples that affect the position can get complicated as you can see in this picture:

Scapular force couples

If there are imbalances in the muscles, it will affect the position of the scapula. For example, if serratus anterior is weak, it will allow the bottom part of the scapula to lift off the rib cage, giving a winged appearance. 

One of these muscles in particular, I find to be the most common culprit; the rhomboids. The rhomboids act to bring the scapula closer to the spine. If you look at the posture of most people, you will notice that their shoulders round forward. This means that the rhomboids are not doing their job well, and they are being placed on tension. In other words, they need to be strengthened, not lengthened. They are already lengthened, so stretching may feel good at the moment, but it the opposite of what you should do. 

Why is this happening? It’s probably a combination of factors, but let’s get the unpopular one out of the way: posture. The internet is ablaze these days with claims that posture does not matter. I will say that the way you move is probably more important than your resting posture. However, resting posture reveals something about the tone in your body. If you lay on your back and look at your feet, do your feet point down? If so, your calves are tight. Or rather, tighter than the muscles on the opposite side of the joint (tibialis anterior). This is what we call ‘relative tightness’. The same principle applies to the scapular area. If the front of your body has more tone than the back of your body, your scapula will rest slightly out and away from your spine. So I don’t think posture is the culprit, rather it’s a symptom and an expression of muscular imbalances. 

Why does this imbalance occur? Well, our life is in front of us. Driving, cell phones, laptops, are all in front of us, most of the day. Our bodies are masters of adaptation. If you spend 40 hours a week in front of a computer, the tone in your chest is going to adapt and begin to tighten up. Go ahead and put some pressure on your pec minor, I’m sure it’s tender: 

pec minor

I’m a fan of the idea of ‘reverse posturing’. If you sit hunched over for 40 hours a week, you should spend at least a few hours trying to counteract that position. What does that look like? Thoracic extension. You can do it in your chair:

thoracic extension

Additionally, you have to take a hard look at your programming if you work out. I ask many of my male patients if they include back workouts, and they always say yes. But when I pry some more, it turns out that they do do 6 sets of bench, 3 incline and decline, and flies. Then on back day, they do 3 sets of pull-ups and rows. Not exactly equal. 

The overall strategy should be to increase the length in the chest muscles, and increase tone (i.e. make it tighter) in the scapular musculature. Other than stretching the chest, you can mobilize it with a lacrosse ball, or do self-massage. For the back, it’s all about retraction. If you squeeze your shoulder blades together, you are activating the rhomboids. Add a squeeze of the shoulder blades when doing anything on back day, particularly with rows or band pull aparts. If you have to sit for work, keep in mind the idea of reverse posturing to promote a better position for your upper back. 

Christopher EllisComment