Injury blog: Winging of the shoulder blades

Hey everyone! We hope you are keeping well. We’re carrying on with life as close to normal as possible, so here is your monthly reading material. Perfect time for a tea or coffee we say! This month we’re taking a close look at the shoulder, specifically a condition that affects the shoulder blade. Do you have, or have you ever seen someone whose shoulder blades stick out on their back and look a little bit like wings? This condition is aptly named ‘winging’ of the shoulder blades.

Anatomy

Osteopaths love a bit of anatomy! The shoulder blade or ‘scapula’ is a largely flat bone that sits on the back of the rib cage and is an important ingredient in what makes up the various joints of the shoulder. As well as the larger flat part, a few extra lumps and bumps makes for a very odd shaped bone when looked at in isolation. One of the bony protrusions actually makes up the ‘socket’ part of the ball and socket joint in the shoulder. The ‘ball’ part being made from the head of the upper arm bone (aka the ‘humerus’).

Interesting fact… There are 18 muscle attachments on the shoulder blade. It is through fine balancing of these muscles which keeps the shoulder blade stabilised and flush to the back of rib cage, and allows us to move our shoulders through an extremely large range of motion. As you can imagine, keeping all of these muscles in full working order takes a bit of co-ordination. And with so many players involved, there is room for dysfunction to creep in and movement to become affected. Sometimes the dysfunction is great enough to cause the shoulder blade to flip outwards from the rib cage, and this is what we refer to as ‘winging’.

Causes of winging

The causes of shoulder blade winging can be broadly broken down into:

•           Muscular: As we previously mentioned, lots of muscles are responsible for controlling the position and movement of the shoulder blade. Injury to these muscles, or an imbalance in the strength, length and function of the muscles over a prolonged period may lead to this issue. The main muscles involved here are the Serratus Anterior (a muscle which attaches to the ribs and the underside of the shoulder blade), and the Trapezius (a kite shaped muscle which covers the back of the neck, shoulders and upper back… Aka ‘traps’). It’s more complex and there are more muscles involved, but these are the key players when it comes to winging.

•           Neurological: Muscles require a nerve supply in order to move, so if any of the nerves that supply the key players (i.e. Serratus and Traps) are injured, this can stop the muscles from being able to perform their job. Nerves can be injured through entrapment, where something presses on a nerve as it travels from the spine down to the muscle it supplies. Other causes may be from acute traumas as seen with car or sporting accidents where the shoulder takes a direct blow while the arm or neck are suddenly pulled.

Other ways these injuries may come about include prolonged wearing of a heavy backpack, complications following surgery, or as a result of a viral infection that affects the nerve.

Signs and Symptoms

The main sign is a shoulder blade that doesn’t sit snug to the rib cage, particularly when trying to move the arm upwards in front of the body or out to the side. Many people with scapula winging feel no pain whatsoever, but this can be a very painful condition if the cause is from a severe nerve injury. Another key sign is the inability of a person to lift their arm above their head.

Treatment

The treatment of shoulder blade winging very much depends on the cause. If the shoulder blades are winging because of a muscular imbalance, these are a little easier and faster to rehab. After careful assessment of your shoulder, neck and other spinal movements, we will aim to restore full functioning of the muscles that control the position and movement of the shoulder blades. This might include techniques which aim to lengthen short or tight muscles which are pulling the shoulder blade out of position. If there is a weakness to a particular muscle or group of muscles, we will also prescribe you strengthening and movement re-training exercises which aim to return the shoulder blade to its functional position.

Winging caused from nerve entrapment or injury is notoriously harder to treat. If entrapment of the nerve is caused by muscular tension in another part of the body, or because you’ve been carrying a heavy backpack for too long, then we will work on the relevant muscles and nerves to release the entrapment and pressure. We might also need to adjust how you wear your backpack and how much weight is inside while we focus on improving your physical impairments. Nerve-related injuries can take much longer to resolve. Winging caused by paralysis of the nerve which supplies the Serratus Anterior muscle has been known to take up to two years to resolve. The good news is, most people will make a full recovery in this time with surgical procedures saved only for more complex or unresolved cases. Which if you ask any Osteo, is always the goal!

If you notice winging of the shoulder blades, or difficulty with achieving full shoulder range of motion, then get in touch today on 0439379847 and get you on the road to recovery as soon as possible.

Safety at work

The great thing about Osteopathy is that it’s not just about ridding people of their pain. It is a way of life. Yes, people come to see us to get rid of pain, but once they are in our caring hands, our work doesn't stop there. We are huge advocates of ‘prevention is better than cure’. So, we will delve deep into your life - your diet, sleep patterns, hobbies, job and more. We look at you and your life as a complete package and will help you work out what areas need adjustments so you can live a long and healthy life (which is as pain-free as possible!).

Work is a big part of most people’s lives and is often a significant contributing factor to their pain. This month we’re giving advice on two key areas to ensure you are looking after yourself at work, so you can avoid injury and keep food on the table. All in the name of ‘National Safe Work Month’! Read on to ensure you are giving yourself the best possible chance of staying injury-free at work.

Lifting posture

We see lots of people coming in for treatment because they have hurt their back, neck or shoulders in a lifting-related incident. Our advice for you…

1.     Plan ahead to make sure you have a clear path from A to B for the object you are carrying. Make sure the object is stable and is not going to topple over whilst you are carrying it.

2.     Get close to the object and with your feet hip-width apart, and whilst keeping a straight back, bend at the hips and knees to get low to the ground (key words here – “STRAIGHT BACK”!).

3.     Ensure you have a firm grip of the object and whilst keeping your back straight (there it is again!), lift from your hips and knees until you reach an upright position.

4.     Always move using your feet rather than twisting or leaning through your back.

5.     Always keep the object close to your body. Never try to hold it out in front of you with your arms, as this places a great deal of stress on your shoulders, neck and back.

6.     Always get help from another person(s) if the object is too heavy for you alone. It is NEVER worth the risk of injury by tackling a task that may be slightly beyond your physical capabilities.

Desk set-up

Postural strain from a seated desk job is another common work-related injury we treat. To ensure you are sitting pretty, our advice to you is…

1.     Ensure the top of the screen is level with or just below the level of your eyes, and centred in front of you.

2.     Sit with relaxed shoulders, elbows bent at 90 degrees and avoid cocking the wrists back when typing (adjust your desk height to suit this if possible).

3.     Adjust the tilt of your chair to allow the hips to sit at an open angle of 100-110 degrees.

4.     Adjust the backrest of the chair to ensure you are supported in an upright position whilst seated.

5.     Avoid slouching back on to your tailbone. Instead, gently roll your pelvis forward to sit on your sitting bones and bring the curve of your low back into its natural position.

6.     Take regular breaks from sitting. Get up out of your chair every 30-45 minutes to allow your body to move and stretch.

So there you have it. Our skills are much more than just our hands. We’re full of good advice! No matter what job you do, we’ll help you break it down to make sure you are getting the most out of it and not putting yourself at risk of a workplace injury. Here’s to a happy workday, every day!

Find the Balance: Upper Crossed Syndrome

FINDING THE BALANCE: UPPER CROSSED SYNDROME

This month we’re focusing some attention on postural balance throughout the body. It’s the 21st Century, and our lives are filled with lots of weird and wonderful technology, such as TVs, laptops, computers and mobile phones, just to name a few. While we are thankful for being lucky enough to surround ourselves with such luxuries, they often come at a cost. All this technology and entertainment means we tend to sit a lot more… Sit to watch, sit to play, sit to work! And over prolonged periods, this can wreak havoc on our bodies, altering our posture, and placing undue strain on our muscles and joints. One common condition that might come out of this said lifestyle is Upper Crossed Syndrome (UCS). Read on… (Please sit with a good posture to read!)

 

What is Upper Crossed Syndrome?

 In simple terms, UCS is a condition where some of the muscles on the front and back of the upper body become tight, and others become weak, leading to a forward head, rounded shoulders, and increased spinal curves in the mid-back and neck. When you line up the tight muscles from front to back, and the weak muscles from front to back, it forms a cross or ‘X’ shape when looked at from the side.

Who does it affect?

 The most common cause for this condition is people having forward head posture over a long period of time, usually when sitting or standing. Think of your classic desk-based worker, people who watch TV or play computer games for hours on end – even drivers and students!

What does it look like and what are the signs and symptoms?

 Someone with UCS will adopt a posture where they have a forward head, shoulders that rotate inwards and sit forwards, increased inward curve of the neck, and an increased outward curve of the mid-back. They may also experience the following:

•   Neck, shoulder and upper back pain

•   Headaches

•   Tightness in the chest and shoulders

•   Reduced neck and shoulder joint range of motion

•   Pain, numbness and tingling of the upper limbs, possibly down to the hands

•   Jaw and low back pain

•   Difficulty watching TV, reading a book, or driving for long periods

What can be done about it?

 Treatment for UCS usually includes a combination of manual therapy (i.e. visit your trusty local Osteo and exercise… Again, usually prescribed by your awesome Osteo.

 In a nutshell, the manual treatment aims to release the tight muscles around the neck, shoulders and chest, while the exercises aim to strengthen the weakened muscles, and stretch the tight muscles. Your Osteo may need to mobilise (and in some cases manipulate) your shoulder, rib and spinal joints to aid the process. Remember, habits that take a lifetime to build will always take time to undo, so work hard at your exercises, keep every appointment with your practitioner, and between you both, you will get the results that you want in the end.

 Remember to take regular breaks from sitting, think about your posture and desk set-up, and do your exercises! Take a stand (excuse the pun) and say no to UCS!

Choosing the Right School Bag

How To Guide: Choosing the Correct School Bag for your Child

DID YOU KNOW: Australian studies have found that poor fitting backpacks that are heavily loaded can lead to postural problems causing neck and back pain in children, which could lead to permanent spinal damage in later life?

Back pain is more frequently a condition we associate with growing older, but there Is a growing number of children reporting back pain and discomfort. Risks that can be involved in carrying a heavy or incorrectly fitted school bag include:

• Muscle strain
• Distortion of the natural ‘S’ curve of the spine
• Rounding of the shoulders

Why not take the proactive step to protecting your child’s spinal health?

Here are some easy steps and handy tips for you to follow to ensure your child’s school bag is properly fitted:

CHOOSE THE RIGHT BACK PACK:

• A light weight bag so it doesn’t add extra weight and load
• Appropriate for your child’s size – don’t choose one that they will ‘grow into’. However, you may need to re-adjust the shoulder straps as your child grows
• A padded back providing comfort and back support that adjusts to the back of your child. The padding also ensures sharp objects don’t poke through
• Two, wide adjustable shoulder straps and a waist belt to allow weight to be distributed more evenly across the body. A chest strap may further allow this
• Multiple compartments for a more even distribution of weight

HOW TO FIT YOUR SCHOOL BAG:

• The bottom of the bag should sit on or just below your child’s hips, but not too low that it hangs over their buttocks
• The top of the back pack should sit no more than 3cm higher than their shoulders, so they can tilt their head back without hitting the top of the bag
• The back pack should be no wider than your child’s chest
• The shoulder straps should be tight enough that the bag is held against the torso, without digging into their underarms
• If the bag features a waist strap it should sit just below the bony part of your child’s waist. This allows some of the bags weight to be taken by the hips rather than the back and shoulders

HANDY TIPS WHEN PACKING YOUR CHILD’S SCHOOL BAG:

• Plan ahead to limit your child’s load so they are not carrying more than what is needed
• Your child should never carry more than 10% of their body weight for an extended period of time
• They should always wear their bag over two shoulders. They should also be educated on the risks of musculoskeletal pain associated with wearing their bag slung over one shoulder
• Pack heavier items closest to the spine