Shoulder pain is one of the most common injuries to people of all ages and it is also one of the most difficult and complicated areas of the body to work with. The shoulder is very unique in that there are so many dynamic movements this joint can complete but this dynamic mobility with extreme ranges of movement leaves the joint vulnerable to imbalances, instability, and injury. When there is a muscular imbalance around the shoulder it can lead to diminished scapula control that result in postural dysfunctions like winging of the scapula and shoulder injuries like shoulder impingement and rotator cuff tears. One of the main muscles responsible for these imbalances is the serratus anterior which is a prime mover of the scapula and along with the lower trapezius plays a critical role in providing normal scapulohumeral rhythm and motion. The biggest problem with the serratus anterior is that many of the best exercises to strengthen this muscle are also the most problematic and painful movement to execute making it very difficult to restore back to full strength. In this article, I will discuss exactly what the serratus anterior’s function is and how you can restore full strength if you have suffered a shoulder injury.
What Is The Role Of Serratus Anterior?
The picture below provides you a great visual of where this muscle is located as many people would have no idea where it is, yet alone understand what it does.
The main function of the serratus anterior is to protract and stabilize the scapula when you move your arm in front of you as seen in movements like boxing or push-ups but also in many daily activities when we use our arms to open doors or lift objects. It also plays a critical role in providing posterior tilt and upward rotation the scapula whenever you lift your arm out to the side. In order to do this it must work in tandem with the lower trapezius and upper trapezius enabling your shoulder to safely execute a multitude of movements.
Without all these muscles firing together correctly at the right time, your body will compensate and this is when postural adaptations occur such as the winging of the scapula, reduced mobility, trigger points activated, and ultimately pain surfacing at the end.
Of all the shoulder problems we see you will find the serratus anterior is a massive contributor to the winged scapula.
To get a better understanding of this in action watch the video where I show these scapula movements using a skeletal animation.
Okay so it is clear that serratus anterior is very important to the shoulder so how do you strengthen it and make sure it works like it is supposed to?
Well this is where the problem lies for the movements that make it stronger and more efficient are also the most painful to do when you have weakness or pain. Care has to be taken and you need a strategic plan to do this.
The Two Problems That Make It Difficult To Strengthen Serratus Anterior
The first problem associated with trying to strengthen serratus anterior is that it is often inhibited by pec minor.
This is because these two muscles work together to provide protraction during pushing actions and the pec minor easily dominates these movements. When this happens it begins to pull the front part of the humeral head forward out of the socket leading to instability creating trigger points and stiffness before ultimately leading to pain.
The pec minor cannot influence scapula protraction or posterior tilt like the serratus anterior for it does not attach to the scapula and pulls the shoulder downward instead of upward.
Why does this happen?
This is called muscle inhibition and Vladimir Janda was the first to come up with these terms and he describes in great detail about this in his book “Assessment & Treatment of Muscle Imbalance”. In simple terms tonic muscles are prone to tightness or shortness, and the phasic system muscles are prone to weakness or inhibition.
The Phasic muscles are commonly recognized as the muscles that are mainly responsible for movement, whereas the Tonic muscles are mainly responsible for stability, posture and stabilization. When there is a muscle imbalance or faulty movement at work the tonic muscles take over and the phasic muscles basically shut down.
In this case the phasic Serratus Anterior is being “inhibited” by the “tonic” pec minor to complete protraction of the scapula and pushing actions of the shoulder. The longer this imbalance remains the tighter and more dominant the pec minor becomes but worse than that is the serratus anterior becomes very weak and lazy.
When the serratus anterior becomes lazy and weak, this is a disaster to the shoulder for it the body will not be able to maintain the scapula in the right position through during movement!
The second problem is that the best exercises to strengthen serratus anterior are pushing actions and these are often very difficult to do when it is weak and even painful. This is because the arm must be abducted to execute pushing actions but due to the poor scapula movement the humerous rubs the supraspinatus tendon causing pain.
While the lower trapezius can also be a weak muscle it is often a lot easier to activate and find exercises to use this muscle that don’t cause pain as pulling actions will do a great job, whereas the serratus is very limited for you really need pushing exercises.
This means you have to be very calculated and strategic in your exercise selection so you can find the best exercises without irritating the shoulder and causing more pain.
The video below gives you a quick summary of these points and some exercises I will discuss in more detail shortly.
Let’s take a much more detailed look at what I would do to restore full strength and function to the serratus anterior.
Release The Pec Minor First
The first step in restoring strength and function to is to shut down the dominating pec minor. You can do this via stretching, mobility work, and massage and you are not necessarily trying to make the muscle more flexible but trying to prevent it from overworking by deliberately weakening its dominance. This usually gives some relief to the person but do not fall into the trap of only doing this for it will be useless if you do not complete the stabilizing exercises that I am about to show you immediately after.
The purpose of this first step and the second step is to create a window of opportunity to complete the stability and strength exercises without the stiffness and dominating muscles stealing the work from the serratus.
Below is a video of how you can stretch your pec minor.
Mobilize The Thoracic Spine
In addition to the pec minor mobility work you need to ensure the thoracic spine has enough mobility with extension and rotation before starting any stability or strength work. This is an area that is often neglected and ignored but make no mistake this is very important for the scapula is closely related to what happens at the rib cage.
You can read more about this in the article – Why lack of thoracic mobility is the hidden source of pain
Some of my favorite drills for assessing and improving this are shown in the video below.
Simple Scapula Exercise
Before rushing to strengthening exercises it is important to use some simple stability exercises first. These enable you get a feel for how the scapula moves and the positions you need to learn before you start adding load.
The video below is a great exercise I use in the early stages and gives the person a chance to find where the pain trigger is hiding and how they can slowly work around it.
Wall Slides
This exercise is arguably my favourite shoulder exercise for not only does it teach posterior tilt and upward rotation of the scapula it mimics overhead movements. This makes it a great functional stability exercise that can change the activation of muscles during daily movements as opposed to the previous exercise which isolated muscles without function.
This is the first time the serratus will be used with protraction and while the load is minimal it is good to start with as mistakes do not lead to pain or stiffness.
You can read more about this exercise in the article – Why I love using the serratus anterior wall slides exercise
Once you have mastered this you can move to the more strengthening type of exercises.
Push-ups
The reason I will start with push-ups and floor based exercises is that this exercise uses a closed kinetic chain which allows for enhanced stability. Before going straight to a full push-up I often start with simple protraction exercises first and gradually work my way towards the more integrated and functional movement.
The video below gives you a good visual of the winged scapula in the push-up action and a simple way to correct this using the protraction of the scapula with serratus being the main muscle involved.
Once I am confident the action is okay I can progress to kneeling push-ups, then full push-ups and eventually Yoga push-ups. I like to use a few different positions with the push-up action for I know if I get it right I will be making some big strength gains with the shoulder.
Watch the video below for some other ideas I might use with the push-up.
Single Cable Push
The single cable push is my next preferred strength exercise for its unique position allows for great thoracic mobility but more importantly it provides the most protraction of all the pushing actions. This mimics the throwing action and more specifically a punch as seen in boxing which is why the serratus anterior is commonly referred to as the “boxers muscle”.
This is fantastic for giving the serratus anterior mechanical leverage to complete its action more effectively. The dual arm action and dumbbell chest press exercises tend to bring the pec minor back into the mix which can undo all your good work.
I like to stick with the simple exercise shown at the start of the video for some time before progressing to other progressions to enhance its strength and function. The value of the anterior sling and its relationship to the core cannot be overstated either and another reason why this exercise is superior to most other strength exercises for the shoulder.
Read the article about the slings of the core to see more on this.
Adding Back Overhead & Other Functional Movements
This last step I begin to add more of the complex dumbbell and overhead actions and use a resistance band to encourage the rotator cuff muscles to work together with all of the muscles of the shoulder girdle. This is called reactive neuromuscular training and is a clever way to overcome the muscle inhibition and compensation that I discussed earlier.
This step would obviously come months after completing the other steps first and only used once there is no pain or mobility restriction. If you are able to complete these exercises you are pretty much back to full strength and function.
What To Do If Things Go Wrong?
In a perfect world you would get all of this process right and nothing goes wrong. But, we know this is not reality and the chances of making mistakes with shoulder injuries are very common so you need to know what to do when this happens. I made a video about this a few years ago to give to my clients anticipating that this would happen which you can watch below.
Do You Need More Help?
As this article only covers just a small piece of what to do I encourage you to get our special report How To Get Rid Of Shoulder Pain Forever that takes you through all of the steps. With over 95 pages of information complete with pictures, instructions and even video links you have the ultimate resource for restoring your shoulder to full strength. Click here or on the image below to see more and get your copy today.
Summary
Serratus Anterior is a key muscle for keeping healthy function of the shoulder and plays a pivotal role in preventing neck pain and shoulder injuries. Learning how to move correctly and teaching the body how to use this muscle with the other muscles supporting the scapula is the key. To avoid irritating the shoulder you should begin with mobility exercises in combination with stability exercises before progressing to strengthening.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Shoulder & Scapula Injuries in Athletes – By Chris Mallac
•Corrective Exercise Solutions for the Hip & Shoulder – by Evan Osar
•Movement – By Gray Cook
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Anatomy Trains – by Thomas Meyers
•Motor Learning and Performance – By Richard A Schmidt and Timothy D Lee
•Assessment & Treatment Of Muscle Imbalance – By Vladimir Janda
•How To Eat, Move & Be Healthy by Paul Chek
•Scientific Core Conditioning Correspondence Course – By Paul Chek
•Advanced Program Design – By Paul Chek