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Therapy Notes – Serratus Anterior

The serratus anterior can be tricky to assess and treat through neuromuscular massage and bodywork. The muscle has a number of synergists that are easier to access. As well, it is a common problem in the prevalence of a sedentary lifestyle and the usage of laptops.

Serratus anterior can be hard to resolve when the shoulder girdle is chronically retracted by a weight problem. The chronically retracted shoulders act as a counter-balance to the prodruding abdominal weight. Weight gain is gradual, and the serratus anterior usually adjusts over time. Extrinsic muscles of the upper back usually appear as the problem. However, this scenario overworks and can traumatize the serratus. Also, planks, twisting with a bar and the elliptical machine can be overwork the serratus anterior. In addition, a fall that jerks the shoulder back, like falling off a moving bike, can also strain this muscle.

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.

So many other muscles share the same function. As an extrinsic chest muscle, it is a synergist with the pectoralis major. It is a synergist with the levator scapula, rhomboids, and trapezius (upper) as an elevator of the scapula. It is a synergist with latissimus dorsi, the abdominal section of the pectoralis major, and trapezius (lower) as a scapular depressor. The middle bellies’ ability to elevate and protract the scapula is often confused with the combined efforts of other muscles.

Its indicators are easily confused with the indications for other muscles. Pain between the scapulae is more often seen as a problem with scales or rhomboids. After that, iliocostalis, trapezius, and latissimus dorsi are considered. The referral of trapezius (lower) is difficult to separate without ischemic compression. It is often part of the same postural distortion with elevated shoulders. It is usually easiest to treat the trapezius (lower) and Serratus anterior in the same session.

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

Together, both sides are work to support the ribs during postural extension. So, they are often involved bilaterally. Both shoulders are usually elevated and protracted. Also, a strongly contracted middle trap or levator scapula will often create an overstretched and painful lower serratus anterior on the more elevated shoulder.

Serratus anterior doesn’t have a close relationship with joints. Resolving problems in the sternoclavicular joint and acromioclavicular joints helps before treating the belly of the muscle.

Ice-and-stretch is bothersome for most clients but can be quick in offering relief. Gentle hot stone work is more palatable but requires 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.

Treatment Sequencing

Part of a Bigger Problem

Forward-Head Posture comes sin two distinct postures and both tend to create problems in the serratus anterior.

  • When the shoulder blades are winged, the serratus anterior is weak. It cannot secure the vertebral border on the ribs. Balance the head over the pelvis and use exercises to protract the scapula.
  • The serratus anterior is short and tight when the chest is closed, and the shoulder blades are spread apart. Focus on lengthening the muscle. Consequently, as the shoulder blades retract, it is easier to get the head back over the hips.

Open the Nerve Roots

Serratus anterior is innervated by the spinal roots of C5-C7 or C8 as they pass through the brachial plexus and form the long thoracic nerve. The upper spinal segments innervate the upper portions of the muscle. As the spinal segments descend, the associated sections of the muscle also descend. So, the lower spinal segments innervate the lower portion of the muscle.

Use this cervical lamina routine to open the foramina of the cervical nerve roots.

Local Joint Treatment

Serratus Anterior attaches the scapula to the ribs. The two major joints are at either end of the clavicle.

Mobilize the sternoclavicular joint by lifting it off of the manubrium. The lower hand stabilizes the rib cage or releases fixations in the costovertebral joints near the neck’s base.

Mobilize the acromioclavicular joint with simple distraction. Focus on releasing the acromion by taking it laterally instead of pressing the clavicle back into the manubrium.

Detailed Trigger Point Treatment

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.

Self-Care is Important

Self-care can be critical to changing posture and creating lasting results. To support your work, sure the client has an easy, effective self-care program.

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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 them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.