The Serratus Anterior: An Unsung Hero of Overhead Stability
“Overhead stability.” This vague phrase strikes fear and anxiety into the hearts of many crossfit athletes, Olympic Weightlifters, gymnasts, and even throwing athletes. The majority of athletes that are seen in the clinic have some degree of difficulty with coordinating shoulder movements, whether it be a snatch, jerk, overhead squat, push up, or even a baseball pitch. We’ve all seen it on a regular basis in the gym: athletes shrugging their shoulders to their ears when trying to hold the barbell overhead, shoulder blades flapping in the wind with push ups, or throwing athletes getting wild with their pitches and having to sit out due to injury. But what exactly does “overhead stability” even mean? Why is it even important in the context of sport? And what is missing in many athletes’ accessory work that is allowing this issue to continue?
For the purposes of this article, I will be referring to “shoulder stabilization,” “muscular coordination,” and “muscular balance” synonymously. I will not be talking about true joint instability, aka dislocation, which is a serious medical condition and would be a blog for another day. Shoulder and overhead stability in the context of sport performance is a vague phrase describing an athlete’s ability to coordinate his or her shoulder girdle muscles in order to position the scapula and shoulder joint in an optimal position to generate the force output demands of the sport. For an overhead athlete, it is necessary to engage the muscles in the front and back of the shoulder blade, as well as the small stabilizing muscles of the shoulder joint itself, in order to rotate the scapula upwardly, establish adequate contact of the scapula to the ribcage, and maintain that position under heavy loads. All too commonly, however, athletes struggle to either rotate the shoulder blade upwardly and to keep the shoulder blade flush with the ribcage. When these two deviations occur, especially the latter, the athlete is less able to rely on their static structures (aka bones, ligaments, and joints) to achieve stability in the overhead position, and instead must rely on the surrounding muscle groups to pick up the slack. Common compensations include shrugging the shoulders in the overhead position, rounding the upper back to help maintain the scapular contact, inability to achieve a fully overhead position, and/or allowing the bar to travel far past the back of the head in an overhead squat position. There are many ways to address these issues, the most common of which including strengthening of the upper back (interscapular) muscles, rotator cuff, and overhead technique work. These are all fantastic approaches, but many fail to include one important component: Serratus Anterior training.
The Serratus Anterior is a large and often overlooked muscle that originates on the inside surface of the shoulder blade and wraps around to attach to the outside of the ribs. It is responsible for protracting the shoulder blade and keeping it flush with the ribcage, as well as upwardly rotating the shoulder blade with overhead movements. It can best be thought of as being part of the shoulder “core;” while the muscles in the back of the shoulder blade pull at various angles to retract the scapula and rotate it upwardly, the Serratus works as a counterbalance to those forces by pulling the scapula forward into the ribcage and assisting in upward rotation. This push-pull effect of the Serratus in the front and the scapular retractors in the back acts as a “guy wire” system to help ensure that the scapula acts as a stable base on which to support heavy loads overhead without tipping excessively forward or backward or relying too much on one specific muscle group.
When the Serratus is particularly lacking in strength or is not being engaged properly, common movement deviations include scapular winging, decreased overhead mobility, and excessive shoulder shrugging in order to support the weight overhead. While the role of these movement deviations in injury risk is up for debate, they certainly do not help when attempting to progress in sport and optimize efficiency with overhead lifts. Furthermore, research has indicated that incorporating strengthening and motor control training of the Serratus Anterior muscle can help to reduce neck and shoulder pain.
So if you’re trying to improve your overhead stability and performance or reduce pain in the shoulder or neck, incorporating some Serratus Anterior exercises into your warm up or accessory routine can be a great way to get you quick results! Here is one included below to get you started.
Sliding reverse bear crawls
References
Neumann DA, Camargo PR. Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 1: serratus anterior. Braz J Phys Ther. 2019;23(6):459-466. doi:10.1016/j.bjpt.2019.01.008
Andersen CH, Andersen LL, Zebis MK, Sjøgaard G. Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial. J Occup Rehabil. 2014 Jun;24(2):316-24. doi: 10.1007/s10926-013-9441-1. PMID: 23832167; PMCID: PMC4000422.
Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate Andreas Christos Panagiotopoulos, Ian Martyn Crowther SICOT-J 5 29 (2019) DOI: 10.1051/sicotj/2019029
Dr. Brooks Kenderdine
PT, DPT, CSCS, USAW-1
Co-owner
The PATH Rehab & Performance
