Let’s talk shoulders. We love a good shoulder down and back look for a broad open chest and “good posture.” But sometimes we can overpack or pull our shoulders down and back too much causing shoulder pain and discomfort. This is where other shoulder stabilizing muscles come in to help balance out all the packing to decrease shoulder pain. Welcome Serratus Anterior: Get to know this muscle, good friend. Why? Because the way we cue in strength training can completely miss the serratus anterior, a muscle that helps move and stabilize the scapula, controls rib movement, and plays a major role in breathing. Here’s how you can make sure you’re activating the serratus anterior properly when you lift.

Here’s the deal: When we cue in strength training, we think about “packing the shoulders,” “tucking the shoulder blades into your back pockets,” “pulling your shoulders down and back,” or simply, “chest up.” These cues are not bad, but I find that they can make us over-cued.

I can’t emphasize this enough: These kind of verbal cues activate some of the major shoulder stabilizing muscles, such as the latissimus dorsi, lower traps, and middle traps. But if we focus only on packing the shoulders, we are missing a major player: the serratus anterior. As you know, we don’t move in muscle isolation, but we should know how to assess and identify when the serratus anterior is not integrated, and then get this guy to come as an active player to the game.

Why is serratus anterior so important in strength training?

In the first years of life, we learn our movement patterns in a particular order, or motor sequence. Babies move in a specific way, hitting milestones driven by their central nervous system, from head and trunk control, to rolling over to pulling oneself up to crawling, standing, and walking.

At the Urban Wellness Clinic, we believe it’s important to train our clients the way we learned to move on a primal level ie like babies.

You never see a well developing baby pull their shoulders down and back. You never see a baby suck their belly button up and in, and you never see a baby over-engage the gluteus medius. Babies who present with these habits can have one or more problems, such as:

-They are usually not developing well.

-They have been pushed to develop too quickly, such as walking before they master crawling.

-They have a neurological deficit.

At the Urban Wellness Clinic, we believe it’s important to train our clients the way we learned to move on a primal level. As babies, we did a lot of pushing moves, including pushing the floor away, living on hands and knees and crawling. Once we spend the majority of our day upright, we start to lose this time loaded on all fours.

This essential time on our hands, loading the shoulder joints, helps the humeral head develop properly in the socket and creates muscular co-activation around the shoulder joint so that the humeral head sits properly in the socket. Without this developmental time, our movement patterns won’t develop properly and the compensations will follow us for the rest of our lives, possibly leading to pain and injury.

What’s the anatomy of serratus anterior?

The serratus anterior is a fan-shaped muscle that begins on the first through ninth ribs, inserting at the front of the scapula. It runs along the outer edges of the ribs. It has three parts: superior, intermediate, and inferior, which is the most powerful part of the muscle. Bottom line: The serratus anterior allows us to rotate the arm forward, pulling the scapula forward and laterally and lift the arm above 90 degrees.

How do we identify serratus anterior is not firing?

At the Urban Wellness Clinic, we offer a two-minute Essential Assessment that takes you through the Essential 7 strength training moves. Our experts look for shoulder blades to be connected to the ribs and equidistance from the spine. Once the shoulders start to wing, especially at the inferior medial tips, we look for this in a plank walk out and walk back, through the push up, and standing.

Under load, we see scapular winging commonly in a racked hold and pressing overhead. This winging can come from a lack of deep intrinsic core stability, a lack of an abdominal brace, not being able to breathe down and wide, chest breathing, and hypertonicity of overactive superficial core muscles like rectus abdominus and external obliques.

Many trainers will focus on getting the shoulder blades connected back to the ribs, yet overlook breathing the ribs back to meet and create integration and connection to the shoulder blades.

Another more specific movement assessment of the serratus anterior invohttps://www.youtube.com/watch?v=29ULXL4yIyclves getting down on hands and knees and rocking back and forth and side to side. Shoulder blades should stay connected to the ribs. Why does this matter? Sometimes our shoulder blade will wing if we are jutting our chin forward, losing deep neck flexor stability, and putting tension on the upper traps and pec minor.

Serape effect

What a fun funky word! What does it mean? A serape is a scarf-like blanket worn crisscross by natives of central American countries and Mexico. There are fascial lines in the body — think Tom Meyers’ Anatomy Trains® — and we believe that we move along and through these fascial lines. There’s is one facial line we look to often, especially if we see shoulder instability or scapular winging, and it involves the crisscross design of the body’s core muscles.

The serratus anterior and external obliques are practically glued to one another. In an anatomy lab, you’d have to peel them away from one another. Often times, if the serratus anterior is inhibited, you will also find the same side external oblique or contralateral internal oblique to be inhibited.

How does this show up visibly in a movement pattern? Bottom line: In a Turkish get-up, you’ll find it in the first move off the floor, or pushing up onto the hand, with a winging shoulder blade or a lateral side bend collapse in the side body of the ribs. This shows a clear lack of the ability to own pushing the floor away and creating shoulder and core integration together.

How do we get the serratus anterior kicking on during strength training?

Here’s the Urban Wellness Clinic serratus anterior checklist:

1. Get the deep intrinsic core kicking in first. Use 360 breath- breathing down in the lower abdomen, wide into the waistline, and sending the breath into the low back.
2. Brace. Keep that tank of strength on the exhale as you brace.
3. Own “Stacked.” This means ears over shoulders over hips to create full tension potential and minimize injury by not falling into posterior compression in the low back and neck. In DNS, this is also known as “open scissor” or PRI a bilateral PEC pattern.
4. Use progressions we for deep intrinsic core integration. We always get the breath and brace first, then start to activate oblique slings which helps integrate serratus anterior and the obliques.
5. Use cueing corrections. We can give in some common strength moves, such as video-plank, push up, TGU, and paloff press. We always start off on hands and knees, in a beast plank or top of a push-up. We like to see hands under the shoulder, middle fingers parallel to one another, fingers spread, and, here’s the secret sauce, root the index knuckle down to the floor. This helps create a connection to the serratus anterior. Then point your elbow create to area your thumb, avoiding over-rotating, which many hypermobile clients will love to do. Do it with just enough external rotation of the arm to kick in the serratus that much more. Sometimes we cue, “Breathe your ribs towards your shoulder blades or the sky,” or, “Long neck, soft chin,” which will also help create a connection of the shoulder blades to the ribs.

What are some limiting factors to getting the serratus anterior to turn on?

There are a few things to consider:

1. Old abdominal scars can affect the serratus anterior, especially those in the abdomen, limiting deep intrinsic core stability, such as appendectomy, gall bladder removal, liposuction, abdominal hernia repair, inguinal hernia repair (usually on the opposite hip) or C-section scar. Also: belly button piercings.
2. Old shoulder surgery scar tissue will affect how the scapulohumeral rhythm and if not rehabbed correctly will create bicep tendinitis and shoulder impingement down the road.
3. Favoring standing on one leg more can cause problems. What’s the real story? Let’s say we favor loading and shifting into our right leg more due to work habits or life habits but not so much on our left. We will have a serratus anterior on the left that is harder to fire and integrate.
4. Trigger points in the serratus anterior are important.
5. Poor belly breathing and bracing can cause problems.
6. Old sprained ankle can interfere. We’ve seen this every day in clinic. Someone comes in with poor shoulder protraction and a sloppy shoulder on the right and just happens to have an old sprained ankle on the left. Just gaze at this fascial line for a while and we’ll cover this in a future blog post.
7. Old break in arm limiting full elbow extension
8. Hypermobility leading to a top mobile elbow and inability to stabilize the shoulder.

Trainers: Please join our private Facebook group, where you can drop your strength training comments and questions. We’d love to open up a line of dialogue to share what we love most: movement and form.

MARK YOUR CALENDAR: Essential Movement Method Certification is coming in September 15-16, 2018!

Best in health,

Dr. Emily Kiberd