Muscle Mondays: Serratus Anterior

One of the most interesting muscles I have encountered on my Massage journey is the Serratus Anterior.
I had always wondered why my ribs would ache, or why people would talk about Bruised Ribs, but after reading about this interesting muscle which lies between the ribs, everything became clear.


Serratus anterior normally originates by nine or ten attachments at either the first to ninth ribs or the first to eight ribs. Because two attachments usually arise from the second rib, the number of attachments is greater than the number of ribs from which they originate.


The muscle is inserted along the medial border of the scapula between the superior and inferior angles. The muscle is divided into three named parts depending on their points of insertions: the superior part is inserted near the superior angle; the intermediate part is inserted along the medial border; and the inferior part is inserted near the inferior angle.


The main action of the Serratus Anterior is to move the scapula forward and up, which is one of the principal components in raising the arm. As this moves the scapula in the opposite direction to the rhomboids, these two muscles work together to control it's position. It is not often injured, but since it is attached to the ribs, tension can build up in association with other chest muscles. In activities such as swimming or climbing, this muscle can become damaged through over use, and it is important to treat it as part of any general massage for people involved in these types of activities.

All three parts described above pull the scapula forward around the thorax, which is essential for medial rotation of the arm. As such, the muscle is an antagonist to the rhomboids. However, when the inferior and superior parts act together, they keep the scapula pressed against the thorax together with the rhomboids and therefore these parts also act as synergists to the rhomboids. The inferior part can pull the lower end of the scapula laterally and forward and thus rotates the scapula to make elevation of the arm possible. Additionally, all three parts can lift the ribs when the shoulder girdle is fixed, and thus assist in respiration.

The serratus anterior is occasionally called the "big swing muscle" or "boxer's muscle" because it is largely responsible for the protraction of the scapula — that is, the pulling of the scapula forward and around the rib cage that occurs when someone throws a punch.The serratus anterior also plays an important role in the upward rotation of the scapula, such as when lifting a weight overhead. It performs this in sync with the upper and lower fibers of the trapezius.

Injuries of Serratus anterior

If you are suffering from serratus anterior injury, you will start to experience pain below your armpit area. Your side and mid back at the lower end of your shoulder blade may become painful as well. Since this muscle also serves as an auxiliary breathing muscle, most clients experience pain when they try to take normal and deep breaths. Known as serratus anterior dysfunction, this condition may affect the muscles in the neck and cause other symptoms such as jaw pain, headaches, and dizziness. It is possible to treat this condition through trigger point therapy, a highly effective form of self-treatment.

A winged scapula refers to a condition wherein the scapula no longer lies flat against the back. Its medial side will start sticking out of the body, thus resembling a chicken wing. Although the winged scapula isn’t the injury of serratus anterior in itself, its symptoms can cause you a lot of discomfort. The usual cause of winged scapula can be the damage along the thoracic nerve which innervates serratus anterior. Doctors usually use the wall to test and diagnose injuries in the thoracic nerve. They will let patients face the wall and push against it with their palms at waist level. In the case that one of the scapulas starts to pop out, it can imply that serratus anterior is no longer capable of holding the scapula flat.

If your winged scapula is caused by damage in your serratus anterior, you may need to undergo a surgical procedure. The repair of an acutely damaged thoracic nerve may lead to significant improvements in those who are suffering from a winged scapula. However, a tendon transfer from the pectoral muscle may be required to address scapular winging in cases that are more chronic. When employing the therapy with trigger point to cure the dysfunction of serratus anterior, you will need to press the trigger point located in your most prominent rib. You can perform self massage to your serratus anterior muscles which can relieve the pain caused by this condition.

Serratus anterior workouts

The best way to prevent the injury of serratus anterior is to strengthen the muscle before it can acquire damage. Various dumbbell exercises such as incline shoulder raise & incline shoulder press are both ideal for strengthening the muscle and improving its range of motion. On the other hand, yoga poses and handstands are great for conditioning the muscle along with the other muscles which are responsible for stabilizing the scapula. You can also try the hand walkout, which engages your anterior muscle. You can do this by standing on your hands and feet while holding your buttocks up in the air, walking your hands away from your feet, and assuming the push-up position.

A plank exercise is also great for strengthening serratus anterior muscle. You can do it by using your forearms, elbows, and the balls of your feet to assume the push-up position. Keep your body off the floor and keep your body rigid by squeezing the muscles in your stomach and buttocks. Scoop up your ribcage and stomach, tuck your pelvis downward, and hold the position while breathing deeply at least three times. You can also try a plow, which is also an exercise that is performed in push-up position. Place dry washcloths under the balls of your
feet, assume the push-up position, and slide one foot in while bending the knee toward your ribs.

The inclined shoulder raise is also a great serratus anterior exercise that you can try at home. Assume the usual incline bench press position and hold the barbell around shoulder width while bringing it over your upper chest. Instead of letting your shoulder blades to pinch back as you would in a regular bench press, you will have to keep your hands straight. Instead of lowering the barbell, lift the weight by allowing your scapula to travel forward. Go as far forward as you could, then as far back as you could for improved range of motion. You can also do this exercise with dumbbells because it puts direct work on your anterior muscle.

These are only some of the things you need to consider when strengthening and caring for your scapula, anterior muscles, and long thoracic nerve. With the best serratus anterior workouts, you can finally get the chance to strengthen and protect it from unnecessary damage.

Symptoms of Serratus Anterior Injury

Symptoms of Serratus anterior injury can manifest itself in many ways; prime among them is pain on the side of the ribs located on the upper side of your torso. Serratus Anterior Injury is one of the most uncomfortable experiences you can ever have because this kind of injury can pose difficulty in breathing, ranging from slight pain to extreme pain while breathing, or coughing.. Many people experience serratus anterior injury because of the wrong way they perform the serratus anterior workouts. Other causes of serratus anterior injury are strained muscles due to overworking exercises, or external causes like being hit in the area, falling, or hard contact with sharp objects. It can also limit the range of your movement, including decreased motion in your arms due to the pain. You will also have trouble in lifting weights, even with light loads. Serratus anterior injury can also manifest itself with pain when you touch the area.

Treating Serratus Anterior Injury

If you want to treat serratus anterior injury on your own,  trigger-point therapy is the best method you can apply. The trigger point is a location found approximately 1.5 inches on the lower end of your shoulder blade. What you can do is to press the trigger point gently, not roughly. The pressure must be somewhat bearable to the person. Release the pressure, and you will notice a slight improvement in your breathing and your pain in the serratus anterior.

You can try pressing different points on your lower shoulder blades where your serratus anterior is located. Do this if your first press does not relieve you of the pain.

You can also treat your serratus anterior injury by leaning against a ball like a tennis ball or baseball. The tennis ball is more preferred because it is softer. Lean against your side on the wall with the tennis ball in between, and allow the pressure of your body weight fall on the tennis ball. Position the ball on your serratus anterior injury.

Allow the tennis ball to roll over the injured area of your body, but be careful about applying too much weight on your ball to avoid further injury. Just gently apply weight on the area depending on what makes you feel relieved or comfortable.

Exercises to Strengthen Serratus Anterior

There are exercises you can do to avoid the risk of serratus anterior injury. This includes dumbbell pullovers. Lie on your bench and do the pullovers with the appropriate weight you can lift. Other forms of exercises are sports. Swimming is a perfect way to strengthen your serratus anterior, because the pressure of the water as you make your freestyle strokes work on your serratus interior for support and strength.Other sports that are good for your serratus anterior are tennis and golf. Strengthen serratus anterior with exercise and sports to avoid serratus anterior injury


As most of the muscle lies between the shoulder blade and ribs, it is difficult to reach without specially positioning the client. side-lying the client with the upper arm abducted over the side of the head, the therapist can apply stroking techniques to the lateral fibres, below the armpit. in the supine position the arm can be fully abducted to draw the scapula out from the ribs. the therapists fingers can then stroke and friction between the ribs

Muscles: Erector Spinae

Ever wondered what holds your body up?
Those muscles that run along your spine and hold you upright and together are a group of muscles called the Erector Spinae muscles. Along with the deep spinal muscles, Spinalis, Interspinalis, Multifidis and Semispinalis they form a complex network of muscles which bind your spinal column together.

The Erector Spinae muscle group get their name from the Latin: Sacrum, sacred and Spinalis, Spinal.

The Erector Spinae muscles function in the following way:


Origin: Thoracolumbar Aponeurosis, Posterior Ribs
Posterior ribs, Cervical transverse processes


Origin: Thoracolumbar Aponeurosis, Lumbar and thoracic transverse processes
Cervical and thoracic transverse processes, mastoid process
Action: Bilaterally - Extension of the Spine, Unilaterally - Lateral flexion of the spine


Origin: Ligamentum nuchae, cervical and thoracic spinous processes
Cervical and thoracic spinous processes, occipital bone
Action: Bilaterally - Extension of the Spine, Unilaterally - Lateral flexion of the spine

These muscles are often affected by heavy lifting which can cause acute strains. Over use tension from repetitive, occupational or postural stress can lead to imbalance and postural alignment issues.

Referral pain from problems with the Erector Spinae muscles can often be felt in the Cervical area, due to the muscles being shortened by a curvature of the spine.
The Mid-Thoracic region, as many of the muscles which come from above or below this region attach here, which can subject it to stress from movements in the opposite direction.
Finally in the lumbar region  due to shortened muscles causing a forward tilt of the pelvis and weakened abdominal muscles. Running, jumping and other activities which can cause compression in the lower back can also aggravate this area.

Any back massage that you receive to treat back pain will address the erector spinae group. An assesment of your posture will be done and when lying in the prone position (face down) Long massage strokes will be used to warm the tissue with deep pressure being used on specific areas to assist with treating curvature.
When treating tight or damages muscles of this group, the therapist will work across the muscle, that is in opposition of the direction that the muscle runs (against the grain) to help break down scar tissue and release any trigger points.

If you have any questions about the Erector Spinae group that you would like answered, or any aches and pains you would like addressed, please comment below, or Email Me.

I would like to thank Charlie Watson at Advanced Massage therapeutics for some of the information contained within this article.
Also used as resources was:
Sports & Remedial Massage Therapy by Mel Cash
Deep Tissue Massage: A visual guide to techniques by Art Riggs
The Concise Book of Neuromuscular Therapy by John Sharkey


Muscles: Levator Scapula

Do you feel like you suffer from a "stiff neck" on occasion?
Do you find it difficult to turn your head to one side or the other?

Shrug your shoulders, go on, you do it often enough.
That action that you just performed used your trapezius muscles, but it also used todays muscle which is the Levator Scapula.

The Levator Scapula gets its name from the Latin: Levare, to lift and Scapulae, Shoulder blades.

The Levator Scapula muscle functions in the following way:

Origin: C1 to C4 (Transverse Processes)
Insertion: Medial border of the Scapula, from superior angle to the root of the spine of the Scapula.
Action: Elevation -Raises the Scapula, Downward rotation of the Scapula or rotates and side-bends the head

Agonists: Upper fibers of the Trapezius
Sternocleidomastoid, Scalenes

The most common thing that causes injury to the Levator Scapula is carrying around heavy bags on our shoulders. That means no one is safe from potential pain in this region. School children with their heavy books, Ladies with their handbags, Men with their toolbags, our laptop bags, gym bags, shopping bags, each of these can place a heavy weight on the Levator Scapula causing it to become over stretched and painful.

The most likely area of pain is that curve between your neck and your shoulder, the spot where you probably cradle your phone.

Specific neck massage can be used to relieve pain in this area, as well as trigger point work to ease headaches and neck and shoulder pain which can result from injuries to this muscle.

Long strokes are used to warm the tissue and deep friction can be used to break down scar tissue, often some stretching exercises will be recommended to help with the healing and strengthening process.

A warm compress can be used at home for pain relief between sessions, and a tennis ball can be rolled along the muscle to aid in self massage and easing the stiffness.

If you have any questions about the Levator Scapula that you would like answered, or any aches and pains you would like addressed, please comment below, or Email Me.

I would like to thank Charlie Watson at Advanced Massage therapeutics for some of the information contained within this article.
Also used as resources was:
Sports & Remedial Massage Therapy by Mel Cash
Deep Tissue Massage: A visual guide to techniques by Art Riggs
The Concise Book of Neuromuscular Therapy by John Sharkey


Muscles: The Rhomboids

Do you suffer from bad posture, and rounded shoulders?
If you do then there is a chance that you may have overstretched (or weak) Rhomboids.
The Rhomboids (Rhomboids Major and Minor) are posterior shoulder muscles which have the appearance of a Christmas tree on your back.

The Rhomboids get their naame from the Greek word Rhomb, a Parallelogram with oblique angles and only the opposite sides equal.Which describes their shape.

Origin: The Rhomboids Originate on the Spinous processes of C7 through to T1.

Insertion: They insert along the Medial (vertebral) border of the Scapula

Actions: The Rhomboids primary action is to retract the scapula, which is the action when you squeeze your shoulder blades together, moving them closer to your spine. They stabilize the Shoulder blade, and assist when you move your arm from above your head, down towards shoulder level.

The most common problem that you would experience with these muscles is tenderness, pain or aching between the shoulder blades. This occurs if the muscles are tight.
If the muscles are overstrertched you will experience rounded shoulders.
The rounded shoulders are also assisted by your Pec Muscles being too tight, pulling your shoulders forward, and overstretching the rhomboids.

You can strengthen the Rhomboids in many ways, including Rowing, Lat. Pull Downs and using a Pulley for Shoulder adduction.

The Rhomboids are mostly treated in the Prone (face down) position.
The use of several techniques including Stripping, Myofacial release, static friction and Trigger point work when massaging the Rhomboids can help relieve pain, and release taut bandsin the muscles. However in the case of overstretched Rhomboids, Strengthening exercises would also be recommended.

Trigger points in the Scalenes can often refer pain to the Rhomboids, and around the medial border of the shoulder blade, so should also be treated when addressing pain in this area.

If you have any questions about the Rhomboids that you would like answered, or any aches and pains you would like addressed, please comment below, or Email Me.

I would like to thank Charlie Watson at Advanced Massage Therapeutics for some of the information contained within this article.
Also used as resources was:
Sports & Remedial Massage Therapy by Mel Cash
Deep Tissue Massage: A visual guide to techniques by Art Riggs
The Concise Book of Neuromuscular Therapy by John Sharkey

Muscles: The Trapezius

Are you slouching? I know that's one problem I have as I spending so much time in front of a computer. I can tell when my slouch is bad too, because my shoulders are practically up at my ears. This "Elevation" of your shoulders can be caused by several muscles, but one of the main muscles whose action is "elevation" of the shoulder is your Trapezius and more specifically, the "Upper Trapezius".
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