right shoulder blade protruding again?!

[debbei]

Lynn,

The serratus anterior muscle holds the scapula down toward the ribs, and keeps it from "winging out". Much of the burning pain people report here between the top of the shoulder blades can be attributed to rhomboid overstretching caused by serratus weakness. It makes sense one side would be weak after the correction they achieved with you.

I saw where you were starting PT, and I'm sure they'll address it if it applies. Hang in there and don't assume a moving curve.

Regards,
Pam

Pam & Lynn,

I have no idea which muscles have caused my problems, but the tightness/pain around both shoulder blades (particularly the left one) have driven me crazy since day 1. It's getting progressively better, but sometimes I present my back to my husband and command "rub my spot". He presses his fingers right along the shoulder blade and rubs up and down, sometimes quite hard. It feels REALLY good for maybe 30 seconds and then I can't stand it any more and tell him to stop.

So Pam, are you saying that when the serratus muscle gets stronger, Lynne won't notice the shoulder blade sticking out so much? How to you strengthen that muscle?

It's nice to see you posting today.

[txmarinemom]

I have no idea which muscles have caused my problems, but the tightness/pain around both shoulder blades (particularly the left one) have driven me crazy since day 1. It's getting progressively better, but sometimes I present my back to my husband and command "rub my spot".

LOL at "rub my spot", Debbe. I don't have a resident "spot rubber", so I have to go pay someone ;-).

One thing I've found that helps for that shoulder blade pain is lying on a tennis ball on "that spot". I usually keep 2 of them handy, and will place them along my spine (especially in my lumbar area) when I find knots. Without fail, if I have a knot on the right side, there's a knot on the left side just a few inches away. Lying on them for a little while makes a difference for me between massages.

So Pam, are you saying that when the serratus muscle gets stronger, Lynne won't notice the shoulder blade sticking out so much? How to you strengthen that muscle?

I obviously don't know for sure this is Lynn's issue, but it's a common cause for a winged scapula. Her PT would be the one to make that determination (and prescribe appropriate exercises for her), but I wanted to voice there could be something causing the scapula to "wing" that's much more palatable than a moving curve.

There are yoga poses (namely the Dolphin) which focus on the serratus anterior, but Lynn, and everyone, check with your doctor before doing anything I list below that I'm doing and/or have done.

A more gentle way to reach the serratus is simple isometric scapular protraction and retraction.

Debbe, one simple exercise I've been doing at home combines scapular retractions, chest wall stretching, and bench press type actions for the shoulders and pecs.

DISCLAIMER: I'm 15 months post op - and am not suggesting anyone do this unless they clear it with their surgeon.

Anyway, this exercise has been very beneficial for relief of pain/tightness/burning around my shoulder blades, and it keeps my pecs and shoulders stretched. When the pecs get tight they pull everything forward and you won't believe what a difference it makes in your back by keeping them loose.

The exercise is really easy:

• I stand about a foot away from a doorframe, feet spread shoulder width apart, hands placed flat on the doorframe or wall at shoulder height.
  
• As I inhale, I slowly lean into the doorframe until I feel a good stretch across my chest, and hold for 5 seconds. You can add to this by squeezing your shoulder blades together.
  
• On the exhale, consciously releasing the scapular retraction, I push back up to the starting position.

I try to do 3 sets of 10 reps, but I usually throw in extras during the day when I'm going through a doorframe and think about it.

Another note ...

Fusion, by it's very nature, causes some degree of muscle atrophy - particularly in the erector spinae (a large bundle of 3 muscles that runs from the cervical to lumbar spine).

This group of muscles function to hold the spine erect, and are no longer called upon in that capacity - at least to the normal extreme - when instrumentation is placed. The rods hold your spine erect. Just because the muscles aren't needed as much doesn't mean atrophy can't contribute to back fatigue. I know I notice it much more (just to the sides of my spine), when I don't work them.

Hyperextension exercises are the easiest, gentlest way to target them, but definitely check with your doctor before trying these if you have a lumbar fusion - and particularly a few remaining UNfused vertebra below a lumbar fusion (CHECK WITH YOUR SURGEON *ANYWAY*):

One exercise I do is a slow-paced, alternating leg/arm hyperextension:

• Lie prone on the floor, lift your right arm/left leg as high as is comfortable (but you want to feel a stretch), hold for 5 seconds and lower.
  
• Repeat with the left arm/right leg.

Another option is the Swimmer's Stretch. This video also shows a less stressful version of the prone hyperextension above.

You can also perform a more challenging hyperextension by including a balance ball.

Another exercise is called the "Good Morning", and although it's usually performed as a counter exercise for squatters, you don't have to use a barbell or weights with it. I'm using 5 lb dumbbells, but again, I am not newly post-op.

Wikia Sports describes it fairly clearly:

"Good-morning is a weight training exercise in which a barbell or two dumbbells are held on the shoulders, behind the head.

• The person bends forward bow at the hips and recovers to upright.
• The good-morning is so called because the movement resembles bowing to greet someone.
• It involves the hamstrings but is primarily used to strengthen the lower back; the degree of knee bend used will change the focus -- nearly straight-legged involving the hamstrings most.

It is important to note that the spine does not twist or round at any point during the movement. The lifter should rather concentrate on pushing the hips back while keeping the spine straight ..."

Here's a video that demonstrates the exercise with a barbell. As I said, I use dumbbells held up on my shoulders, but initially, there's no reason you'd even have to use weights.

These bends can also be performed from a sitting position to completely isolate the erectors.

One more time ... clear ANYTHING with your doctor. These exercises have helped me with the same pain/tightness a lot of us have, but get an okay before you even think about it!

Regards,
Pam

[LynnMarie74]

Thanks Pam...I can always depend on you for some good info. Maybe you can teach my surgeon something?! lol Really, tho....thanks for the info. Hopefully I will be starting PT this week!

[txmarinemom]

Thanks Pam...I can always depend on you for some good info. Maybe you can teach my surgeon something?! lol Really, tho....thanks for the info. Hopefully I will be starting PT this week!

I hope they get you started with PT also ... it's worked miracles with most who've done it, and it really seems to lessen pain sooner and hasten recovery.

Before you know it you'll be back to doing whatever you want!

Pam

[Sherie]

Lynn,

The serratus anterior muscle holds the scapula down toward the ribs, and keeps it from "winging out". Much of the burning pain people report here between the top of the shoulder blades can be attributed to rhomboid overstretching caused by serratus weakness. It makes sense one side would be weak after the correction they achieved with you.

I saw where you were starting PT, and I'm sure they'll address it if it applies. Hang in there and don't assume a moving curve.

Regards,
Pam

Pam

Thanks for this information. This sounds to me a very likely cause. Sheena's also been under a lot of pressure with school and has been having increasing discomfort in her thoracic area which I'm sure is due to tension. I'm thinking of putting her in physical therapy to learn how to stretch this area but I may have her try the simple exercises you posted for the time being and see if it helps.

Thanks

[Sherie]

Sheri--thanks for the info...that term doesnt sound familiar but I guess that doesnt mean that it wasnt used. He very well may have told my husband/myself post op and I just dont recall. Also, thanks for explaining about her shoulder......I guess I will know more on Thursday!

Lynn

Did you ever get a response from your surgeon? I emailed Dr. Lenke, he's out of town for another week but the nurse sent me her 1 year post op photo and told me to take another one to compare and send back to them. She didn't have an answer for me.

I think Pam's right on the money with the muscle issues, Sheena's not athletic and doesn't do anything to build up those muscles so I'm considering PT this summer.

[txmarinemom]

Lynn

Did you ever get a response from your surgeon? I emailed Dr. Lenke, he's out of town for another week but the nurse sent me her 1 year post op photo and told me to take another one to compare and send back to them. She didn't have an answer for me.

I think Pam's right on the money with the muscle issues, Sheena's not athletic and doesn't do anything to build up those muscles so I'm considering PT this summer.

Sherie,

I hope PT/exercise helps Sheena, and I'm so sorry she's been in pain. Sending good wishes y'all's way!

Regards,
Pam