An Unexpected Perspective of the Serratus Anterior

When I moved to Southern California over 20 years ago, it was not my first choice. But I followed a boy, who later became my husband, and the father of my kids, and then even later my ex husband. But that’s not the story. The story is that moving from Boulder to Southern California was a culture shock for me that took me years to get used to. I missed the mountains and the open space. And no one could convince me of the positive parts about living here. Until recently.

My kids are now teenagers and getting ready to leave the nest. One is off to college and the other one is not far behind. As this chapter of our lives comes barreling down a lot faster than I want it to, both of my kids have remarked, on numerous occasions, that they love where we live. They are so happy to have been raised here. This is a beautiful thing and, although I am deeply appreciative that this is their experience, I would never have predicted it. I never saw it coming.

The thing that surprises me the most, though, is that, as I find myself driving through the streets where my kids grew up, I can see why they love it here. It has taken me two decades and a lifetime of parenting. But I look at where I live now through the eyes of my kids, and I can see what they see. The point of this story is not to tell you that I went through something difficult and now I have found peace. It is about the notion that we can be convinced about something, like totally believe it so deeply that there is zero ability to see otherwise, and then, most unexpectedly, it can change.

I see this with clients a lot. They become convinced of a thing - that their hip pain is sciatica, or that their neck pain will never go away. Working with them can be like punching a brick wall. No matter what I do, they seem stubbornly attached to their pain. Getting them to see what I see - how amazing their tissues are and how capable they are of change - this is what becomes the hurdle

For me, this experience can be most exemplified by one particular muscle in our body: The Serratus Anterior. It is a muscle located in an area that teeters on the edge of being either very cool or very troublesome, depending on how you look at it. Its complicated location and attachment sites make for a confused understanding of its position in time and space. And its list of actions make for an even more confusing ability to make it fire. It can lock up, become weak, adhere to neighboring tissues, and take control of the largest floating bone in our body. Or, on the flip side, it can dance and perform tricks right up there with the best of them. And I would argue that seeing it from the latter perspective might just be a critical element in easing it out of dysfunction.

Try this: With your client supine and draped well, access the right Serratus Anterior by standing on your client’s left side and reaching across her body. Have her hold her own breast drape to ensure the feeling of safety and bring her left arm up off the table and across her chest so that she is at 90 degrees of shoulder flexion, 90 degrees of internal rotation and 90 degrees of elbow flexion - so a little bit like a Brittany Spears pose in pretty much any of her videos.

Have her hold her own arm up in this pop star position while you palpate the lateral scapula. Grabbing the tissues here will offer you a clear navigation of the varying layers. From most superficial in the palm of your hand, you will first feel the Latissimus Dorsi, then slightly deeper at the inferior lateral scapula lies the Teres Major, and at the superior lateral scapula lives the Teres Minor. With these muscles in your palm, use your thumbs to sink around them and down towards the table into the anterior scapula where you will feel the Subscapularis. Then, shifting your intention towards the ribcage, this is where you will find the Serrtatus Anterior.

With your right thumb into the serratus, use your left hand to offer a resistance. Have your client make a fist and push into your flat palm. You can ask them to pretend they are throwing a punch. But in the effort to show your client what is good about this muscle as opposed to how it can act aggressively, my preference is to ask them to imagine that they are hugging someone they love. This creates the desired protraction of the scapula which calls upon the Serratus to do what it does best.

From here, the focus is on 2 things: 1. Your ability to isolate the Serratus Anterior so that you can give it the proper work (or love) it needs. And 2. Your client’s ability to recognize how awesome this muscle truly is. Because if they are convinced that it is wreaking havoc on their shoulder, that perspective isn’t going to help anyone. But if they understand it for its unique capabilities, perhaps they will begin to see what has been invisible yet in front of them the whole time. The relationship your client develops with their own Serratus Anterior rests in your hands. And although they may have been convinced that it is good for nothing, perhaps a glimpse through your eyes will help them see that it is actually good for so many things.

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