foreign
ERS today I'm going to bring you a video on a wing scapula and some of the things
to look for this is Chris all right my new model Elizabeth couldn't be here so we got Chris and
um I don't know if all of you know this but you know there are 17 muscles that attach to
the scapula however only six of those muscles move it which is the rhomboids major minor that's two
levator scapula trapezius PEC minor and serratus anterios the sixth one that's the one I'm going to
focus on because serratus anterior is the one that usually gives you a wing scapula and I'm going to
show you what to look for and this is why I have this ruler here because it's going to give you
some tips on what to look for if a client comes in before you work on them so that way you know what
to look for so one of the things you need to look at is there's scapula you know draw a line through
their the scapula and it should be a little bit tilted up going up and here's a pretty even he
doesn't have one lower than the other a lot of times you can tell if they're lower than the
other and his are pretty even so that's good the highest point are your acromium that's part of the
scapula it's a like a crow on your shoulder that's the highest tip of the scapula it's your chromium
process so you want to make sure that they're even and you can also tell when he's laying a supine
how high off the table they are so I'll show you that so now he's going to turn around and um this
is another way to tell if uh he's got a winged scapula so this is your spinous process is right
here and I kind of Drew how far apart they are from the spinous processes the normal is usually
two inches or unless you have a larger person then it's three inches but on this side he has two and
a half inches from the spinous processes to the edge to the medial part of the scapula and on
this side it's three it's a three and a quarter so this one's a little bit more wing and as you can
tell there's a little bit Hollow here so you can tell a wing scapula when it's a little bit more
Hollow and it's further you know from the spinous processes than the other side so those are the you
know the things that you can look for the clavicle the chromium process how how far away they are and
if it's a little bit Hollow so that's how you can tell if somebody has a winged scapula and a winged
scapula comes really from the serratus anterior you can turn around again the serratus anterior
is the main muscle for you know that moves the scapula and there are three serratus muscles so
I want to tell you guys a little bit about that because the serratus anterior is the largest
one right here and it's it's against the thoracic cavity however you also have a serratus posterior
Superior and a serratus posterior inferior and remember that if you have serratus anterior if
it's two words that automatically tells you that there's another one that means that if there's an
anterior then there's a posterior otherwise it would just be serratus just like trapezius it's
just trapezius it doesn't have two words because it's only one so if you have serratus anterior
you have a serratus posterior and if you have a serratus posterior Superior what does that tell
you that you have an inferior one two so there are three serratus muscles I'm going to address them
and I'm going to show you some techniques okay so now he's laying supine so I'm going to work
the serratus anterior from here and the PEC Minor remember the PEC minor and originates from ribs
three four and five and it inserts at the coracoid process and the coracoid process is part of the
scapula so this is one of the muscles that moves the scapula and you want to be real careful here
real gentle when you palpate you know when you start palpating see if he's got any trigger points
and you know after you've kind of done some petrosage and maybe a little bit of you know
effleurage I'm going to start with a little bit of oil here it's just to kind of soothe that muscle
this is tender area so you really don't want to start like right away poking you know and you
want to be gentle when you're palpating you know you want to be gentle with your palpation you want
to do some petrosage over the coracoid process you can go you know in go inferior and you can also go
you know um go up like this here Superior you can try to grasp the PEC minor
all I'm doing is just grasping grasping just trying to loosen up the fibers first
before I start working any trigger points or anything on you know going deep on the PEC minor
and obviously if you have a female you want to keep them covered and
if it makes them feel better you can have them cup their breasts out of the way over
the covering just so that you don't you know go near any sensitive areas for them
otherwise if it's a guy you know it's okay they don't mind most of the time
so anyway I'm going over the coracoid process just real gentle movements all the way up to
the acromion process because remember that the clavicle and the scapula make up the shoulder
girdle and you've got your acromioclavicular joint which is right here and that's another
way when you're sitting down I forgot to mention that at the very beginning when you're sitting
down here at the edge of the you know of the table here you can see where I drew his
acromion processes and I measure with my thumbs to make sure that they're even and actually this
left side is slightly higher than the one on the right side it's lower it's about a
it's a good inch lower this one's higher so they're kind of like this a little bit so I
can tell that this one's a little bit more winged this is the one that has a little
bit more Wing anterior tilt of the scapula so that's another way that you can measure the
chromium processes when you are Lane your clients Lane supine so let's say okay now I have finished
warming up the muscle so now I'm going to do a little bit of some pin and stretch you can
use fingertips finger pads or you can use your palm if you are using your palm just make sure
that if it's a female that you're not cupping down that you're you know you're cupping away
okay and then I am going to stretch some of that Peck
okay you know some pin and stretch that's all I'm doing it's just some pin stretch and I'm moving my
palm as I move closer to the origins and I'm going to move his arm a little further out just to get
a bigger stretch on that pick okay now that's a passive uh range of motion I'm going to ask him to
move his arm and move it across there you go that like you're hugging somebody okay and back okay so
that's protraction of the scapulas okay so that's protraction and retraction of the scapula there so
you can do three or four times in this movement here okay once you're done you know you can
kind of soothe that PEC minor again and like I said if you're gonna feel for the
um coracoid process be real gentle I like to do circular you know movements around it but
be very gentle with it okay because it is very sharp that's the Little Hook of the scapula
so I know a lot of people say wait I thought the scapula was in the back it is but the you know
the coracoid process is right here it's a little knob and it's about an inch below the clavicle
so now that we've warmed up the tissue here I'm also going to work right here
the serratus and I'm going to go to the opposite so contralateral here
and I am going to do some raking from this side to start warming up the tissue here
so what I'm doing the origins of the serratus are from ribs two three four five six seven eight nine
so all of this and it looks like a serrated knife so I'm just trying to warm up the tissue here and
do some raking go the way the thoracic cavity goes because they attached on the thoracic cavity here
you can do some do some slow movements you can use your whole Palm or you can rake
and this is the muscle that the main muscle that gives you a winged scapula the serratus anterior
serious interior along with a triceps is the one that delivers a punch or for people that
are always you know working with her arms and in front of them this is one of the common muscles so
you want to make sure and really work this muscle out if you if you have a wing scapula you've got
to work out the serratus anterior okay so another movement that you can do is you can put this
underneath your head here this really opens up the serratus okay and I'm going to sit down for this
one and this young man likes to go rock climbing he's got all kinds he has a broken bone right now
on his in his wrist and he's still he's still here for us so and then he's got a scar here but anyway
right here this is a perfect place for you to address trigger points now the main trigger points
for the serratus are like almost right here in the axillary area let me see that do you have one here
right right there okay so he has one right there and after I've warmed it up now let me look for my
tools okay remember this is the one for trigger points so if he has a trigger point I can hold
this trigger point right there oh is that too much no is that what's on a scale from one to ten is
that like a five three like a three okay don't take anything above a five and you hold it from
90 seconds to you know no more than 90 seconds and I I like to move it around a little bit so
the main trigger points for the serratus anterior are like right underneath here under the armpit
and also in the posterior part and I'll show you where another one is and please be careful
when you get into the axillary area because remember you have the axillary plexus you have
a Plex a nerve plexus through here so you want to make sure that you're not on a nerve and the
um the nerve that supplies the serratus anterior is the long thoracic nerve and a
lot of times that can cause the paralysis also of the scap of the serratus so you want to you
want to go ahead use a lot of strong long strokes to soothe and to go to the origins
I can tell where the PEC major and pec minor are and the serratus is below that
underneath that so it's a little tricky to get to but you can get to some of the
edges of where they originate and this muscle inserts on the anterior part of the scapula
so I can see his scapula is right here it's sticking out so this muscle like a serrated
knife and it it inserts on the anterior part of the scapula so it's on this side
so like I said I use this for trigger points
especially if there are very muscular and I don't want to
tire out my thumbs I can use this and if I want to use the other one let me see
I also have this one this one's really good too for long strokes
and it doesn't hurt this one's really good to get to
the serratus and the lats you're getting the lats here remember the lats form that
axillary fold the posterior axillary fold this draws out more blood flow to the area
and it doesn't hurt you always want to stay within the pain tolerance of your client
and if you want to go in between the ribs because this is also a muscle that helps
to open up the rib cage along with the serratus posterior it opens up the rib
cage for breathing so if you want to get in between the intercostals this
the bevel tool is the perfect tool to use you know for in between the ribs
and this tool you lay it like at a 45 it's not straight up like this is it a 45 degree
angle and you go like through each between each rib and you're also getting each one of the of
the uh little like fingers from the serratus anterior
I'm just right running it right in between the ribs
so I got all kinds of tools today that I wanted to show you because I know a lot of people have
been asking me how do you use a tool so this is a great place for you to use the tools and having
your arms extend it you know underneath his his neck really opens up the serratus anterior
really really nice and you can just warm up the tissue stretch it out and you know you can even
this is not your broken wrist is it okay good I don't want to be pulling on the broken wrist
you always want to assist your client to put his arm back and another one that you can do and this
was difficult for me to do because I'm small and my hand is small and he's got big muscles here so
you're trying to get movement of the you know the the bulb and socket the glenohumeral joint is you
know it's there's three bones the scapula which is the one we're trying to release and the clavicle
and the humerus so one of the techniques that you can do is you grabs like by the biceps and you're
gonna go from internal rotation to external and then you're going to move you I'm trying to do
this but like I said this one's difficult for me because he's really yeah big biceps and triceps
this is not your broken wrist right trying to be extra careful
so what I'm trying to do is create some movement and that glenohumeral joint
this is where you have a labrum tear though right he's got all kinds of stuff going on
he makes a good client but I'm going up you know close to the head of the humerus and then just
moving down and going from internal to external rotation and if you have a good you know grip you
can really move the glenohumeral joint moving again the scapula okay so after you've done
without the stretches and worked specifically and work the trigger points then you can move on to
the sideline and the prone position so stay tuned because that's going to be part two of the video
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