From the Waist Up

From the Waist Up

From the Waist Up


A couple of months ago as I lined up for the Lilac 10k in Rochester, I found myself standing behind one of Central New York’s premier female runners, who shall — for reasons relating to my continued good health — remain anonymous. At any rate, I couldn’t help but notice this woman’s postural alignment, especially since the area of her anatomy most dysfunctionally positioned — her shoulder blades (scapulae) — was at eye-level.

What I saw in this individual was a condition called “winging scapulae,” a term used to describe an outward protrusion of the medial (side closest to the spine) border of the shoulder blade. The scapulae normally lie flush against the posterior rib cage, held in place by a muscle crucial to efficient and properly timed shoulder girdle movement, the serratus anterior. If this muscle is weak and/or overstretched, it is unable to hold the scapula tight against the ribs and the person’s upper back begins to take on the appearance of a ’57 Chevy.

The implications of such malposition of the scapulae can be quite significant. Gross movements of the upper extremity (e.g., lifting the hand above the head) require a complex series of perfectly timed contractions of a large number of muscles — the serratus anterior being just one — affecting not only the shoulder joint, but most importantly the shoulder blade, which acts as the “anchor” for shoulder girdle movement. If the scapula is not stabilized well, or does not move through it’s proper range at the proper time, movement patterns of the shoulder joint (the ball-and-socket part) will become abnormal. This can cause a whole host of problems, the most common of which are rotator cuff tendinitis, impingement syndrome, bursitis, thoracic outlet syndrome, and more. (If you don’t know what these are, don’t worry about that now. Trust me — they’re not good things!) Furthermore, since the scapula has muscles attaching it to the cervical and thoracic spine, improper muscle balance can cause a variety of neck and upper back problems.

What I’ve described is essentially an above-the-waist version of “the tail wagging the dog.” But why should this concern runners, assuming they are not running on their hands? The answer is that many runners seem to be prone to developing this condition of scapula muscle imbalance because of the manner in which they carry their arms when they run. For example, a common faulty movement pattern is the “shrugged shoulders” position in which the shoulder girdle is held elevated, as if they are trying to support their ears with the shoulders. Another is the “arms-crossed-in-front” pattern, in which all of the upper extremity movement occurs in front of the body. If you watch this runner, you’ll hardly see the elbows come back behind the trunk. This pulls the entire shoulder girdle forward, weakening the important posterior scapula stabilizers.

These postural and movement abnormalities will most likely not cause shoulder or neck injuries while you run. Rather, the imbalances created by them will set you up for problems which can occur during typical everyday use of your arms. It would be way beyond the scope of this column to try to describe these various injuries and ways to treat them via corrective exercise, but I will make a suggestion that is in the realm of prevention. In one word — RELAX! Try to be aware of your shoulder girdle position and arm motion while you run. Most important — avoid tension in your neck and upper shoulder girdle muscles (the traps). Worry less about your leg movement and think more about what’s going on from the waist up. Besides helping to avoid some of the problems described above, you’ll also most likely increase your running efficiency!

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).