The serratus anterior, often heralded as the "boxer's muscle," plays a quintessential role in orchestrating upper limb mobility and the stability of the scapulothoracic junction. This article will dissect its complex anatomy and biomechanics, emphasizing its significance in the kinetic chain and its integration within the Motion Specific Release (MSR) framework.
We will explore the serratus anterior's influence on scapular motion, including protraction and upward rotation, which are vital for overhead activities and proper respiratory mechanics. We will also examine the implications of serratus anterior dysfunction, such as winged scapula and its impact on musculoskeletal health. Additionally, we will present MSR techniques designed to enhance the performance and coordination of this muscle, which are pivotal for clinicians aiming to address conditions affecting shoulder girdle function and thoracic movement.
Article Index:
Anatomy & Biomechanics
The serratus anterior, a pivotal muscle in thoracic and upper limb biomechanics, is instrumental in the stabilization and movement of the scapula. Extending from the upper nine ribs at the side of the chest to the anterior part of the medial border of the scapula, this muscle plays an integral role in the protraction and upward rotation of the scapula, facilitating the raising of the arm above the head and contributing to the expansive movements necessary for deep breathing.
Origin and Insertion:
The serratus anterior originates from the external surfaces of the lateral parts of the first to ninth ribs and their fascia and inserts onto the anterior aspect of the medial border of the scapula. The muscle is typically divided into three parts: superior, intermediate, and inferior, with the fibers running in different directions to enable the complex movements of the scapula.
Innervation:
This muscle is uniquely innervated by the long thoracic nerve, which arises from the fifth, sixth, and seventh cervical nerves (C5-C7). The precise innervation is critical for the serratus anterior's role in scapular dynamics, and any compromise to this nerve can lead to significant dysfunction, characterized by winging of the scapula.
Biomechanical Role:
Biomechanically, the serratus anterior is essential for several functions: it anchors the scapula to the thoracic wall, allowing for effective arm elevation and rotation. It also plays a role in the scapulohumeral rhythm, a fundamental biomechanical concept describing the movement relationship between the scapula and the humerus. During arm elevation, the serratus anterior works with other scapular muscles to tilt the glenoid cavity upward, increasing the range of motion of the arm.
Biomechanical Dynamics:
In terms of dynamic stability, the serratus anterior, along with the trapezius muscle, forms a force couple that stabilizes the scapula against the thoracic wall. The upper fibers assist in upward rotation, the lower fibers in upward rotation and depression, and the middle fibers in protraction. The interplay between these fibers is complex and is crucial for smooth, coordinated upper limb movements.
MSR Perspective:
From an MSR standpoint, the serratus anterior is approached as a critical muscle in a larger kinetic chain that includes the thorax, shoulder girdle, and arm. Dysfunction in the serratus anterior can lead to altered scapulohumeral rhythm and compensatory patterns elsewhere in the body. MSR interventions aim to restore optimal muscle function and neuro-fascial interaction, with techniques that address not just the muscle itself, but its fascial relationships and the neuromuscular components that are essential for efficient movement patterns and shoulder stability.
Motion Specific Release (MSR) Treatment
Initial Setup:
Patient Position: The patient is in lateral recumbent positioned to allow the practitioner comprehensive access to the serratus anterior muscle, spanning from the first to the eighth rib and inserting at the medial border of the scapula.
Practitioner Stance: The practitioner assumes a stance that enables effective application of MSR techniques to the serratus anterior muscle, considering the extensive area it covers from the ribs to the scapula.
Basic Technique:
Treatment: The practitioner begins by identifying the lower border of the scapula and applying manual pressure across the serratus anterior muscle's origin from ribs one to eight.
Support Hand: Using the opposite hand for motion control, the practitioner may apply traction and guide the muscle through its functional movement to aid in the release.
Synchronization: Careful, synchronized movements are used to engage the serratus anterior effectively.
Pressure Application: Gradual pressure is applied to work deeply into the muscle tissue, being mindful to communicate with the patient and adjust based on their feedback.
Technique:
Contact: The practitioner uses a flat hand, heel of the hand, or dorsal surface of hand to softly compress the serratus anterior against the ribs and scapula, addressing the muscle from different angles to ensure a thorough release.
Combining Procedures:
Combined Actions: The practitioner integrates movements such as circumduction and bilateral traction to enhance the muscle's release. This method takes into account the serratus anterior's functions of scapular protraction and upward rotation, innovated by the long thoracic nerve.
Serratus Anterior Release - MSR Demonstration:
In this video demonstration, Dr. Abelson demonstrates effective MSR procedures for releasing the serratus anterior muscle, highlighting its importance in scapular and arm motion.
Best Practices:
A patient-specific approach is emphasized for the mobilization of the serratus anterior muscle, ensuring a comprehensive treatment tailored to the individual's needs. The serratus anterior has fibers arranged in a sawtooth pattern, angled obliquely from the first to ninth ribs to the medial border of the scapula.
Kinetic Chains:
The practitioner considers the serratus anterior's role within the kinetic chain, acknowledging its significance in upper limb and scapular mechanics.
Precautions:
The practitioner prioritizes safety, avoiding contraindications, and ensuring informed consent before performing MSR techniques. Responsive methods are adopted, with continuous patient feedback guiding pressure and movement adjustments for a customized MSR experience.
Functional Kinetic Chains
The serratus anterior is a cornerstone in the functional kinetic chains of the upper body, contributing to a harmonious interplay between the chest, shoulders, and arms. Recognizing its synergy with surrounding structures is vital for comprehending its biomechanical and functional significance.
Direct Myofascial Connections:
The serratus anterior is intricately linked to the functional anatomy of the upper body through robust myofascial connections, including:
Anterior and Posterior Layers of the Thoracic Fascia: These layers envelop the serratus anterior, integrating its actions with the movements of the ribcage and the scapula, thus influencing breathing and upper limb movements.
Intermuscular Septa: These fibrous partitions separate the serratus anterior from adjacent muscles, such as the external oblique, allowing for smooth, coordinated movements and serving as conduits for neurovascular structures.
Synergists:
Muscles that synergize with the serratus anterior include:
Pectoralis Minor: Aiding in scapular stabilization and protraction, it works in tandem with the serratus anterior, especially during arm elevation and reaching movements.
Rhomboids and Levator Scapulae: These muscles act as synergists during upward rotation and elevation of the scapula, balancing the protraction force of the serratus anterior.
Stabilizers:
Muscles that provide stabilization alongside the serratus anterior include:
Trapezius Muscle: The trapezius works in a force-couple relationship with the serratus anterior to stabilize the scapula on the thoracic wall, particularly during arm abduction and overhead activities.
Rotator Cuff Muscles: As stabilizers of the glenohumeral joint, these muscles function in concert with the serratus anterior to maintain the integrity of the shoulder joint throughout its extensive range of motion.
Antagonists:
Muscles that serve as antagonists to the serratus anterior include:
Latissimus Dorsi: While the serratus anterior protracts and stabilizes the scapula, the latissimus dorsi can oppose these actions by mediating scapular retraction and downward rotation.
Posterior Deltoid: This muscle can act antagonistically during specific phases of shoulder motion, providing a counterbalance to the serratus anterior's protraction and upward rotation actions.
MSR Perspective:
From the perspective of Motion Specific Release, the serratus anterior is not an isolated entity but a crucial component in a comprehensive biomechanical system. This perspective allows for the development of MSR techniques that recognize and address the interconnected nature of these kinetic chains. By understanding the myofascial relationships and neuromuscular dynamics involving the serratus anterior, MSR interventions can be strategically applied to rectify dysfunctions and enhance the integrity of movements across the upper body. This systemic approach ensures that treatment is not just localized to the serratus anterior but also harmonizes the function of related muscle groups and fascial planes.
Exercise
The best exercises for the serratus anterior are those that engage its primary functions—scapular protraction, upward rotation, and holding the scapula against the thoracic wall. These exercises often involve pushing and overhead movements, which can be enhanced by resistance to strengthen the muscle and improve its coordination with other muscles of the shoulder girdle. Here are several effective exercises:
Push-Up Plus (Scapular Protraction):
Begin in a standard push-up position.
Perform a push-up and at the top of the movement, push further, separating your shoulder blades and allowing the upper back to round slightly.
This 'plus' motion specifically targets the serratus anterior.
Dynamic Hug (Cable or Band Protraction):
Stand between two cable machines or with resistance bands attached to a stable object at chest height.
With straight arms, bring the handles or ends of the bands together in front of you, mimicking a hugging motion.
The movement of the arms in front of the body activates the serratus anterior.
Wall Slides (Upward Rotation and Elevation):
Stand with your back against a wall, elbows at 90 degrees, and the backs of your arms and hands against the wall.
Slide your arms up overhead, maintaining contact with the wall, and then back down.
This exercise encourages proper scapular motion facilitated by the serratus anterior.
Overhead Shrugs (Elevation and Upward Rotation):
Stand or sit with a barbell or dumbbells held overhead.
Shrug your shoulders up and down, focusing on elevating the scapula.
The overhead position maximizes the engagement of the serratus anterior.
Bear Crawl (Weight-Bearing Protraction):
Get on all fours with your knees lifted off the ground so you are supported by your hands and toes.
Crawl forward, keeping your back flat and core engaged.
The weight-bearing position and movement pattern recruit the serratus anterior dynamically.
Serratus Punch (Anterior Elevation):
Lie on your back with knees bent and a dumbbell in one hand.
Start with the arm straight up towards the ceiling, then push the dumbbell towards the ceiling, lifting your shoulder blade off the ground.
This punching motion targets the serratus anterior's protraction and upward rotation actions.
Conclusion
In summary, the serratus anterior muscle, known for its pivotal role in upper body movement and stability, warrants a nuanced understanding of its anatomy and biomechanical functions. By delving into the intricacies of this muscle, we gain insight into its influence on scapular dynamics, such as protraction and upward rotation, which are crucial for a range of activities from overhead reaching to efficient breathing. Disorders of the serratus anterior, such as a winged scapula, underscore the muscle's significance in maintaining musculoskeletal integrity. Through the application of MSR techniques, clinicians can target the serratus anterior to bolster its function and coordination, thereby enhancing shoulder girdle health and thoracic mobility.
Moreover, appreciating the serratus anterior's role within the functional kinetic chains highlights its interdependence with adjacent structures and its contribution to overall upper body harmony. Whether through direct myofascial connections or synergistic muscle functions, the serratus anterior is integral to the complex motions of the thoracic and shoulder regions. In the context of MSR, addressing this muscle involves a holistic approach that considers its myofascial and neuromuscular connections, aiming to correct dysfunction and promote optimal movement patterns across the upper body.
References
Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.
Clark, M. A., Lucett, S. C., & Sutton, B. G. (Eds.). (2012). NASM Essentials of Corrective Exercise Training. Lippincott Williams & Wilkins.
Ellenbecker, T. S., & Davies, G. J. (2015). Closed Kinetic Chain Exercise: A Comprehensive Guide to Multiple Joint Exercises (2nd ed.). Human Kinetics.
Fardin, P., Negrin, P., & Dainese, R. (1977). The long thoracic nerve: Gross anatomical features in relation to the brachial plexus. Surgical and Radiologic Anatomy, 1(2), 123-128.
Jull, G., Moore, A., Falla, D., Lewis, J., McCarthy, C., & Sterling, M. (2012). Grieve's Modern Manual Therapy: The Vertebral Column (3rd ed.). Churchill Livingstone.
Kisner, C., & Colby, L. A. (2012). Therapeutic Exercise: Foundations and Techniques (6th ed.). F.A. Davis Company.
Neumann, D. A. (2013). Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation (2nd ed.). Mosby.
Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. Mosby.
Standring, S. (Ed.). (2015). Gray's Anatomy: The Anatomical Basis of Clinical Practice (41st ed.). Elsevier Health Sciences.
Wiater, J. M., & Bigliani, L. U. (1999). Long thoracic nerve injury. Clinics in Sports Medicine, 18(3), 539-548.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 85%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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