This is Brent of the Brookbush
Institute, in this video we're going over
serratus anterior isolated activation,
a muscle that has a propensity to
become long and under active in those
with upper-body dysfunction. Those with
upper-body dysfunction have a propensity
towards anterior tipping and downward
rotation, or a lack of upward rotation of
the scapula during shoulder elevation;
and we know that my serratus anterior
does posterior tipping and upward
rotation. I'm going to have my friend
Melissa come out, she's going to help me
demonstrate. Now before we get started on
this exercise we do have to consider
what are my overactive synergists. My
overactive synergists are likely my
pectoralis minor trying to take over for
protraction and some scapular stability, and
potentially my subscapularis in some
weird maybe fascial continuity, or
humeral scapular mechanical problem. The
subscapularis does have a
tendency to get overactive in those with
serratus anterior inhibition. Now because
the pectoralis minor is overactive we
already have a couple exercises that I
see commonly used for serratus anterior
activation, that I'm going to go ahead
and nix. How many of you guys have seen
the serratus anterior press up, which is
where you have a patient or client do
this, maybe you put a dumbbell in their
hand, or maybe you use a little manual
resistance and they go ahead and
protract. I'm willing to bet if a
pectoralis minor was overactive before
we started this exercise, it's going to
be really really overactive by the time
we finish this exercise. The other
exercise which I know you guys have all
seen is the serratus anterior push up, or
the push up with a plus, which
essentially is a double press up. All
right so that exercise has this
tendency to maybe strengthen the
serratus anterior, but also reinforce
that synergistic dominance of the
pectoralis minor, we want to get that out.
So how do we get the pectoralis minor
out of this exercise. Well what we're
going to do is we're actually going to
use some posterior tipping and some
retraction,
and some upward rotation of course is
what we're going to work on, to try to
get my serratus anterior in gear. Now
you guys have already seen an exercise
that matches all of those qualities. How
many of you guys have seen floor angels
or wall angels which is where you kind
of do a shoulder press, but pressed into
the floor or pressed into a wall. Now the
only problem with this particular
exercise is it's hard, which normally
wouldn't be a problem. I like challenging
exercises, I like kind of beating up on
my patients and clients. I know it's a
little sadistic but that's that we are,
doctor of pain and torture right. So we
need to find a way to regress this
exercise because unfortunately with
these exercises, hard sometimes means
compensation is looming, they don't do
things with very good form. Now I still
want to get the upward rotation, I still
don't want to get any protraction, I
still need to focus on retraction. So
what I'm going to have her do is I'm
going to have her start with her hands
on her thighs. She's going to make fists
with her thumbs pointing out this way.
We're actually going to go just like this,
I'm going to have her start retracted
and depressed, that depression with
her back flat on the floor is going to
help me get into a little posterior
tipping right off the bat. Now if I keep
her depressed throughout the entirety of
this exercise in order to make room for
her humerus to elevate, she's going to
have to upwardly rotate which is going
to force her serratus anterior to fire.
So what this is going to look like is
her keeping her shoulders down while
doing scaption
all the way back to her thumbs. Keep
those elbows locked. For a lot of people
this is actually really challenging, what
they're working against is their
thoracic mobility. If they don't
have good thoracic extension posterior
tipping is very tough. They're also
working against their latissimus dorsi
extensibility. Now if this is no
problem I can increase the range of
motion by just having her tuck her thumbs
and trying to get all the way back
to the tops of her fists there. Now make
sure you keep the elbows locked. How's
that? Yeah Melissa's got pretty good
shoulder mobility. So I'm going to have
to up the challenge even further. Let's
have you try to get to the back of your
hands, keep those elbows locked, shoulders
down. Notice she's doing a really good
job here. I don't see a big rib flare,
Melissa is almost making this look too
easy. A lot of times we have to cue
people to keep drawn in, maybe even to
contract the rectus abdominus a
little bit so that they don't go into a
lumbar extension, thoracic extension.
We don't want to see any of that. I
think you can do that with your elbows
locked, you keep bending that right elbow.
Now if she can get all the
way back to the back of her hands and I
see if her forearm lying down on the
floor, now I know she's ready for floor
angels. So now once again we
still have to keep this down. You guys
see a lot of elevation, levator scapulae,
upper trap are becoming really really
active and serratus anterior not so much.
In fact we can get a weird compensation
pattern where elevation is actually only
elevation of the superior angle of the
scapula, around relatively fixed glenoid
fossa, and you're actually getting
downward rotation which is going to
increase compensation, it's going to
reinforce our compensation pattern. How
does that feel? Does that feel tough? Now this
whole progression right here that I just
showed you is on the floor, and the
reason we start on the floor is because
it makes it easy to easier to stabilize
the lumbar spine, being that they have to
work against that thoracic extension.
You'll see, go ahead and bow up for me,
this is a very common compensation
pattern for this exercise, and we don't
want this. The floor gives us a little
bit of tactile cueing, makes it a little
easier to cue here as well, as the floor
helps us stabilize
the scapula. Right if the floors there
pushing her into posterior tipping with
the majority of her body weight, this
exercise is not quite as challenging.
From here we're going to do all those
same progressions but we're going to
move to the wall and we're going to go
ahead and stand up continuing our
serratus anterior isolated activation
progression, bringing Melissa out here
we're going to have her right up against
this wall. Now the wall still remains a
great posture check for this exercise. So
I'm going to have her step her feet out
which I know you guys can't see, but you
don't need your heels back against the
wall, that makes this pretty awkward.
You end up just having to arch your
lower back to get around your butt, when we
don't need that. We want to walk
the heels out a little bit, soft knees,
get them into a neutral spine so they're
drawn in, head back chin tucked and then
all of the progressions are exactly the
same. o I can have her start with her
hands on her thighs, thumbs up, make your
fists right, keep your shoulder blades
down and back, let's see if you can get
all the way to the wall, stay drawn in, no
excessive lordosis. That looked pretty
good. Let's go here, keep those elbows
locked, good drawn in, keep those shoulder
blades down. All right good, let's
try back of your hands.
All right so that's
actually Melissa's progression right
there. That was tough for her, she had
that that last couple of inches she was
really having to strain to maintain her
scapula depressed, so she keeps posterior
tipping, keeps that pectoralis minor out
of it. You know she was really having to
engage her core to keep her latissimus
dorsi from pulling her into an anterior
pelvic tilt. But just so they can see
let's see those wall slides a little bit.
So she'd be trying to keep her entire
forearm and back of hand against the
wall, really externally rotate into that
wall, help inhibit the subscapularis.
This is not easy, doing wall slides well
super difficult, doing wall slides crappy
totally easy, totally easy. If you don't
watch your form, you let your elbows come
off, you just try to touch your
fingertips to the back, and you just kind
of go up and down not worrying about all
these form cues, not great serratus
anterior the activation. Not something
you're going to convince your clients
they need or is even hard. You get your
clients or patients to do this exercise,
half the time I can sneak it into a
resistance training workout because they
think they're getting so much work for
their shoulders and serratus anterior.
They swear it's a weight training
exercise, which is a good thing. It's a
good thing to help get some extra
corrective exercise in where maybe we
have certain clients who are a little
less compliant. Of course this exercise
is also great for home exercise programs
because it takes absolutely no equipment.
I hope you guys enjoyed this progression.
I hope to see a lot of serratus anterior
activation in your routines. Just about
everybody with any sort of upper body
dysfunction can definitely benefit from
this exercise. There's even some research
to show that those with cervical
dysfunction could benefit from serratus
anterior activation. I look forward to
talking to you guys soon.