Therapist Notes – Serratus Posterior Superior

Effective relief starts with an understanding of the anatomy.

About the coloring of the illustrations…

This muscle is made of thin, flat strips that help to lift our ribs as we breather. Learn more in this post about serratus posterior superior.


Serratus posterior superior is strongly governed by the costovertebral joints of the upper thoracic spine. These fixations are almost always associated with locally displaced vertebrae, especially the shearing of C7 and the upper thoracics in Forward Head posture.

Serratus posterior superior is involved in shoulder pain over 90% of the time and should be checked even if it is not directly indicated.

Serratus posterior superior straps the ribs onto the vertebrae like a 5th scalene muscle. Like the scalenes, it is used to raise the ribs while breathing when the diaphragm is inhibited because the body is bent forward.


Breathing while slouched forward perpetuates the constant pain generated in this pattern. Because of this, treatmetn approach usually involves mobilizing joints, soft tissue release and changes in postural habits and exercises that counter Forward Head Posture.

It is hard to get a sustained release of this muscle unless you can free up the displaced rib heads with lamina groove work or some other soft joint mobilization. Clients also need help with posture so that they do not naturally slouch while seated.

Be aware that, although the common complaint of this trigger point is pain under the shoulder blade, it is not always the case. Many people have blocked out the pain under the shoulder and start complaining when the wrist or elbow bothers them. When asked, they often remark that the pain under the shoulder is constant and that they ignore it.


Prepare the area by loosening the spine. Pay extra attention to the vertebrae around the base of the neck, where serratus posterior superior connects.


Direct treatment of the area will be easier and more effective, after the lamina groove protocol.

This NMT protocol is great for mobilizing vertebrae and melting down the lamina. It starts with the sub-occipital area, which helps with Forward-Head Posture.

Review this routine on the treatment of the Rhomboids and Serratus Posterior Superior from The workbook of Classical Neuromuscular Therapy.

Getting a good home program can be essential to long term success. There are great strategies in this post.


This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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