Is the Serratus Anterior Muscle causing your Shoulder and Neck Pain?

Shoulder and neck pain, we’ve all had it, and it can be incredibly frustrating, sometimes even scary. Most commonly, this pain arises from postural stressors, but that’s not always the whole story. It can often be just the tip of the iceberg when it comes to underlying dysfunctions contributing to your shoulder blade pain or serratus anterior muscle pain.

Today, we’re going to dive into the serratus anterior muscle, a key player in shoulder stability and shoulder movement. When it’s not functioning properly, it can contribute to muscle imbalance, tightness, and even nerve-related issues, leading to persistent serratus anterior pain.

But first, what are the symptoms of serratus anterior dysfunction, and how do you know if this article is for you?

1. Scapular winging of the shoulder blade (one or both shoulder blades stick out); this is most noticeable when sitting on a firm chair and feeling the shoulder blade bones pressing into it.

2. Pain in the shoulder or neck during upward rotation, like when reaching or holding your arm overhead.

3. Shakiness or muscle weakness during overhead pressing or bench pressing at the gym.

4. A clicky or clunky shoulder joint as you reach in front or overhead.

5. Numbness or pins and needles down the arm into the hand, most commonly affecting the fourth and fifth fingers, is potentially linked to nerve damage.

If you’ve experienced any of these symptoms, I’ll show you how to self-assess dysfunction and, more importantly, how to retrain the serratus anterior to restore healthy shoulder mechanics, reduce muscle tension, and support lasting pain relief.

But before we get into the nitty-gritty of fixing the issue, let’s first explore what this muscle does and why it’s essential for optimal shoulder health.

The serratus anterior attaches to the outside edge of the shoulder blade and then connects to the rib cage. Its purpose is to protract or pull around the shoulder blade as we reach forward. By protracting the shoulder blade, the bone is in a more supportive position to allow the rotator cuff to do its job. When this operates correctly, it means the scalenes and traps, which attach to the neck, don’t have to overcompensate, which is an incredibly common cause of neck and shoulder pain. The nerve that controls this muscle is the long thoracic nerve, which travels from the side of the neck and down to the muscle. One factor causing issues with this muscle is compression of the nerve on its path; however, the most common issue is shoulder internal rotation.

Internal shoulder rotation from either chronic postural stress or overuse of the internal rotators (pecs, lats, subscapula, teres major) is the major contributing factor in dysfunction of this muscle. With the shoulder pulled forward, the serratus anterior is in a chronically tight position with the shoulder blade slightly protracted around the body and lifted higher in the thorax. Over time, this becomes the new normal for its position, and the muscle stays partially contracted. Without the ability to fully lengthen and contract, movement is altered. When lifting the arm, it now no longer smoothly rotates along the thorax but can lift too high and pinch the rotator cuff. In pressing motions, it can’t be in its correct position, so the serratus anterior is functioning to its full potential, and excessive load is then placed on the cuff again. This gradually worsens over time, and this is what creates overload and stress on surrounding tissues and ultimately the pain you’re struggling with.

Now we know what the muscles' purpose is, let's check and see if yours is working correctly. The gold standard in assessing this muscle is the push-up test. Now, if you don’t have the upper body strength, don’t worry, you can drop to your knees for this one, but the more load put through the shoulders, the easier it is to identify. For this test, you’ll want to expose your back and get someone to film from over the top so you can see your shoulder blades. Move through three push-ups, then hold the last one for a moment. When you check the video, look for asymmetry between the two. The number one tell for a dysfunctional serratus anterior is winging or lifting of the shoulder blade, which is seen in this picture.

Now for the fun stuff, fixing the issue! The next three videos demonstrate exercises to reactivate and redevelop the muscle.

Now, unfortunately, if you’re one of those unlucky people with poor posture, you’re going to need to do a little extra work to make sure this doesn’t come back. Key to achieving better posture is firstly opening up the chest and deloading the shoulder internal rotators, and secondly mobilising the mid back to allow it to naturally stack into a more upright position called thoracic extension mobilisation.

My favourite stretch to open the chest is done in the corner of a room elbows and wrists touching the wall, and then leaning your chest toward the corner. Hold this for 3 sets of 30 seconds.

To mobilise the thoracic spine, the two easiest and most effective ways to quickly change spine posture are foam rolling and wall angels exercises against the wall. Foam rolling should be comfortable. Roll up and down the roller to start, then find the tight spots and lean back over these obilising each segment.

The second mobilisation is back in the wall angel position, placing the arms against the wall and then slowly sliding them up, keeping the elbows and wrists on the wall. If they come off the wall, that is the point where you go back to the start position. Work 3 sets of 10, and gradually the range of motion will increase.

It should take about three weeks of consistently doing these exercises to begin seeing a difference, but depending on the severity may require 8 weeks total. Limiting factors, however, may be if this injury has been present for a long time, a nerve entrapment of the long thoracic nerve, which supplies the serratus anterior, may have developed, or secondary issues with the rotator cuff.

Elite Health and Performance therapists treat this injury daily and would love to help with your injury.

Our state-of-the-art sport physiotherapy clinic is conveniently situated in Bowen Hills, a mere stone's throw away from New Farm, Newstead, Fortitude Valley, and Albion, with a new clinic now in Toowong. Pick up the phone or book online to get started on fixing your shoulder, stopping your pain, and performing at your best today.