Shoulder and neck pain we have all had it and it can be very frustrating and even at times scary. Most commonly we see pain arise from postural stressors but this isn’t always the case or can just be the tip of the iceberg in regards to the dysfunction leading to your pain.
Today we are going to discuss the serratus anterior muscle and it’s role in moving the shoulder blade and when it’s not working how it might be causing your pain.
First of all though what are the symptoms of serratus anterior dysfunction so you know this article is for you?
- Winging of the shoulder blade (one or both shoulder blades stick out) this is most commonly noted when sitting on a firm chair and you can feel your shoulder blade bones sticking into the chair.
- Pain in the shoulder or neck when reaching or holding your arm overhead.
- Shakiness or weakness when doing pressing motions overhead or bench movements at the gym.
- Clicky or clunky shoulder as you reach in front and overhead.
- Numbness or pins and needles down the arm into the hand. Most commonly this will affect the fourth and fifth fingers.
If you have any of these symptoms I’m going to teach you a way to self assess dysfunction and if it is found that this may be your problem how to then retrain this muscle to fix how that shoulder girdle moves to deload all those angry tissues.
Before getting into the nitty gritty of how to fix the muscle however we need to know what exactly this muscle is and what its purpose is.
The serratus anterior attaches to the outside edge of the shoulder blade and then connects to the ribs. Its purpose is to protract or pull around the shoulder blade as we reach forward. By protracting the shoulder blade the bone is in a more supportive position to allow the rotator cuff to do its job. When this operates correctly it means the scalenes and traps which attach into the neck don’t have to overcompensate which is a incredibly common cause of neck and shoulder pain. The nerve that controls this muscle is the long thoracic nerve which travels from the side of the neck and down to the muscle. One factor causing issues of this muscle is compression of this nerve on its path however the most common issue is shoulder internal rotation.
Internal shoulder rotation from either chronic postural stress or overuse of the internal rotators (pecs, lats, subscap, teres major) is the major contributing factor in dysfunction of this muscle. With the shoulder pulled forward the serratus anterior is in a chronically tight position with the shoulder blade slightly protracted around the body and lifted higher in the thorax. Over time this becomes the new normal for its position and the muscle stays in a partially contracted state. Without the ability to full lengthen and contract movement is altered. When lifting the arm it now no longer smoothly rotates along the thorax but can actually lift too high and pinch the rotator cuff. In pressing motions it can’t be in its correct position so the serratus anterior is functioning to its full potential and excessive load is then placed on the cuff again. This gradually worsens over time and this is what creates overload and stress on surrounding tissues and ultimately the pain you’re struggling with.
Now we know what the muscles purpose is lets check and see if yours is working correctly. The gold standard in assessing this muscle is the push up test. Now if you don’t have the upper body strength don’t worry you can drop to your knees for this one but the more load put through the shoulders the easier it is to identify. For this test you’ll want to expose your back and get someone to film from over the top so you can see your shoulder blades. Move through three push ups then hold the last one for a moment. When you check the video look for asymmetry between the two. The number one tell for a dysfunctional serratus anterior is winging or lifting of the shoulder blade is seen with this picture.
Now for the fun stuff, fixing the issue! The next three videos demonstrate exercises to reactivate and redevelop the muscle.
Now unfortunately if you’re one of those unlucky people with poor posture you’re going to need to do a little extra work to make sure this doesn’t come back. Key to achieving better posture is firstly opening up the chest and deloading the shoulder internal rotators and secondly mobilising the mid back to allow it to naturally stack into a more upright position called thoracic extension mobilisation.
My favourite stretch to open the chest is done in the corner of a room elbows and wrists touch the wall and then leaning your chest toward the corner. Hold this for 3 sets of 30 seconds.
To mobilise the thoracic spine the two easiest and most effective ways to quickly change spine posture is foam rolling and wall angels exercises against the wall. Foam rolling should be comfortable. Roll up and down the roller to start then find the tight spots and lean back over these mobilising each segment.
The second mobilisation is back in the wall angel position placing the arms against the wall and then slowly sliding them up keeping the elbows and wrists on the wall. If they come off the wall that is the point where you go back to the start position. Work 3 sets of 10 and gradually the range of motion will increase.
It should take about three weeks of consistently doing these exercises to begin seeing a difference but depending on the severity may require 8 weeks total. Limiting factors however may be if this injury has been present for a long time a nerve entrapment of the long thoracic nerve which supplies the serratus anterior may have developed or secondary issues to the rotator cuff.
Elite Health and Performance therapists treat this injury daily and would love to help with your injury. Pick up the phone or book online to get started on fixing your shoulder, stopping your pain and performing at your best today.