Therapy Notes – Serratus Anterior

Start by Understanding the Anatomy.
About the coloring of the illustrations…

Serratus anterior is a fan shaped muscle that pulls the shoulderblade forward from the back border. It is highly variable. Read more in this post about serratus anterior.

This muscle is often overlooked and not treated until other muscles, which produce similar pain patterns, have been treated. These patterns include scalenes, rhomboids, erectors, pectorals, and multifidi.

Serratus anterior can be hard to resolve when the shoulder girdle is chronically protracted by a weight problem. The chronically protracted shoulders act as a counter-balance to the weight. Weight gain is gradual, and the serratus anterior usually adjusts over time. Extrinsic muscles of the upper back usually appear as the problem in this scenario unless the serratus gets overworked or traumatized. It can be overworked through exercises like planks or vigorous twisting with a bar or the elliptical machine. It can be traumatized through a fall on the shoulder or something that jerks the arm back like a big dog on a leash.

When the pectoralis minor muscle minor is strong, and the serratus anterior is weak, the shoulder blade wings out in the back.

When the lower bellies are overstretched, and the pectoralis minor muscle is weak, the shoulders sit high and hook forward. Middle traps, levator scapula, and rhomboids become chronically shortened and need to be addressed as well.

Serratus anterior doesn’t have a close relationship with joints that need to be resolved but the sternoclavicular joint and acromioclavicular joints should be freed up before treating the belly of the muscle.

Ice-and-stretch is really bothersome for most clients but can be quick on offering relief. Gentle hot stone work is more palatable but must be done with great sensitivity. Also, hot stone work can be problematic around large breasts. Recumbent side posture makes this muscle more accessible without intruding on breast tissue.


This protocol allows better access to the serratus anterior by placing the client in a recumbent position so that breast tissue falls out of the way where it is easily draped. This position opens the lateral wall of the rib cage for access under the shoulder blade.

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.

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Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your pain?

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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*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read, more accessible, and
to include more patterns with better self-care. In the meanwhile, there will be inconsistency in formatting, content, and readability until we get the old posts updated. Please excuse our mess.