Therapy Notes – Serratus Anterior

This muscle is often overlooked and not treated until other muscles have been treated, which produce similar pain patterns. 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. Exrinsic muscles of the upper back usually appear as the problem in this scenario unless the serratus gets over worked or traumatized. It can be over worked though exercises like planks of vigorous twisting with a bar or eliptical machine. It gets traumatized through a fall on the shoulder or something that jerks the arm back like a big dog on a leash.

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

When the lower bellies are overstretched and pec minor 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.

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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