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Eric Kerr
03-12-2008, 06:43 PM
Had some ART work done on my right shoulder due to some tingling running from my neck to posterior cap. The area always felt strong, but somewhat unstable when doing overhead lifts. Range of motion was also a little impaired. Long time injury that I'm finally trying to do something constructive about.

Chiro said that I needed to strengthen my serratus anterior and do some posterior cap stretches.

The stretches are no problem, its the push-up pluses that he wants me to do. I can barely feel those muscles to tell they are activated so I keep losing my arch when doing the push-up pluses. Also area seems to fatigue quickly when I do activate them correctly, so I'll probably have to start doing them on a wall before moving to actual knee, then regular push-ups.

Any tips for getting them right? Or other exercises for the serratus anterior?

Oh he recommended no pushing exercises other than the push-up pluses for two weeks.

Thanks,
Eric

Mike ODonnell
03-12-2008, 06:54 PM
I'll do some quick digging but look around T-nation as a while back I believe it was Eric Cressney that had some good shoulder articles. Might even find them referenced around here somewhere as well.

Sam Cannons
03-12-2008, 09:05 PM
This looks like them (http://www.t-nation.com/readTopic.do?id=1053531)

Allen Yeh
03-13-2008, 05:48 AM
Check out this link for Diesel Crew Shoulder Rehab program, it has a very comprehensive list of rehab exercises for the serratus anterior, internal/external rotators...etc

http://www.youtube.com/watch?v=A0ONHZmsFec

Another good link with a bit more explanation:

http://www.t-nation.com/readArticle.do?id=1426252

In the long run dropping all pressing movements won't really hurt you, I actually dropped all upper body movements for a month because of some impingement issues from too much overhead pressing. And only did a rehab type program for upper body. It kind of sucked but later on I was glad I did.

Derek Simonds
03-13-2008, 09:24 AM
Prior to this last mesocycle I did a whole bunch of prehab. I had some impingement at the AC joint and have worked really hard to clear that up.

I can second both the Cressey articles and the Diesel Crew Prehab. I totally changed the way I bench after reading Cressey's piece. The Diesel stuff I still incorporate into my warmups through out the week.

Eric Kerr
03-13-2008, 03:25 PM
Thanks for all the replies, gents. Plenty here for me to look through.

Mike Robertson's Inside Out also looks like it might have some good stuff in it, although a bit pricey at $80ish + shipping. Anyone famililar with it?

Back to the pushp-up plus, most videos show people retracting and protracting the scapulae.

Another source I found said simply hold a push-up position and then protract the scapulae, relax back into the push-up position, rinse+repeat.

Chiro told me to protract and hold the protraction and then bend at the eblows to do the movement. Going down 6-8" until I can work my way up to a full push-up plus while remaning protcated. My poor brain/body wants to bobble this badly.

Is one method more correct/effective than the others?

Thanks,

Garrett Smith
03-13-2008, 04:32 PM
Eric,
Honestly, I'd like to see the person who can do a push-up in full protraction! As far as I know, that's just not in the mechanics of the shoulder complex during a pressing movement. I just tried doing what your DC described and it felt totally unnatural and weak. I do a lot of serratus prehab with my joint mobility training, so I would guess this movement should come easily to someone like myself.

Strengthening the serratus, IMO, is most easily accomplished with locked arms. Heck, I just tried a bottom-of-a-pushup position with my arms while protracted here in my chair, it feels completely wrong to me in every way.

Allen Yeh
03-13-2008, 04:34 PM
Thanks for all the replies, gents. Plenty here for me to look through.

Mike Robertson's Inside Out also looks like it might have some good stuff in it, although a bit pricey at $80ish + shipping. Anyone famililar with it?

Back to the pushp-up plus, most videos show people retracting and protracting the scapulae.

Another source I found said simply hold a push-up position and then protract the scapulae, relax back into the push-up position, rinse+repeat.

Chiro told me to protract and hold the protraction and then bend at the eblows to do the movement. Going down 6-8" until I can work my way up to a full push-up plus while remaning protcated. My poor brain/body wants to bobble this badly.

Is one method more correct/effective than the others?

Thanks,

I've heard it's good but pricey, on your push-up plus question, I have also seen it done different ways so I'm not sure what the "best" solution would be, perhaps do as he tells you for the next 2 weeks or so and try other things later on.

Garrett Smith
03-13-2008, 05:20 PM
Check this out:

Serratus anterior muscle activity during selected rehabilitation exercises. (http://www.mdconsult.com/das/citation/body/90173368-2/jorg=journal&source=&sp=11130136&sid=0/N/11130136/1.html?issn=0363-5465&issue_id=9834)
The purpose of this study was to document the electromyographic activity and applied resistance associated with eight scapulohumeral exercises performed below shoulder height. We used this information to design a continuum of serratus anterior muscle exercises for progressive rehabilitation or training. Five muscles in 20 healthy subjects were studied with surface electrodes for the following exercises: shoulder extension, forward punch, serratus anterior punch, dynamic hug, scaption (with external rotation), press-up, push-up plus, and knee push-up plus. Electromyographic data were collected from the middle serratus anterior, upper and middle trapezius, and anterior and posterior deltoid muscles. Each exercise was partitioned into phases of increasing and decreasing force and analyzed for average and peak electromyographic amplitude. Resistance was provided by body weight, an elastic cord, or dumbbells. The serratus anterior punch, scaption, dynamic hug, knee push-up plus, and push-up plus exercises consistently elicited serratus anterior muscle activity greater than 20% maximal voluntary contraction. The exercises that maintained an upwardly rotated scapula while accentuating scapular protraction, such as the push-up plus and the newly designed dynamic hug, elicited the greatest electromyographic activity from the serratus anterior muscle.

I found a description of the "dynamic hug" in this link:
Thera-Band Resistance Band & Tubing, Instruction Manual, Volume 4 (http://www.rainerrajala.fi/service.cntum?serviceType=document&documentName=122265/TBInstruction-012706__013106_130451.pdf), it's a PDF file.

OK, I thought about it a little more.

The serratus anterior originates on the ribs and inserts on the scapula. Note that the humerus plays no role in its attachments. So, assuming the ribs are fixed, movement of the scapula is how this muscle will be activated and strengthened.

Protracting the scapula absolutely changes the orientation of the glenohumeral joint, making it face more anteriorly. While this may be a good thing at the top of a push-up plus, it is definitely NOT a good thing at the bottom of a push-up. I believe the body would specifically fight this combination of movement in an effort to not impinge the shoulder joint.

I highly suggest you don't try to do a push-up with your scapula protracted. It won't work, and you may be worse for trying it.

Or you could just ask your DC to demo it, make sure you point out to him when his scapula aren't protracted anymore at the bottom of the movement.

Eric Kerr
03-14-2008, 10:21 AM
I had found the source you cited, Dr. G, but hadn't had time to look up the Dynamic Hug, yet, so thanks for the link to the .pdf.

I had a little quiet time last night to try a couple of different things and you nailed it, feels unnatural to do the push-up plus with the shoulders protracted the entire time, but having a better understanding of what muscles I was trying to activate, I got it to work.

Chiro can do them protracted, at least the 6-8" elbow bend variety.

As Allen suggested, I'll do them his way for 2 weeks and see how that works.

Many thanks for the additional input :)

Garrett Smith
03-15-2008, 06:02 AM
Eric,
Glad you agree.

I could also do the 6-8" elbow bend variation. I felt like a newbie who didn't know how to do a push-up. You know, using all sorts of muscles (the wrong ones) to try to do a movement.

You'll do great with your rehab. Make sure to keep some serratus exercises in your warm-up routine after you have this issue licked. When I was in high school and college, I had a winging scapula on the left side. Back then, I fixed it with a lot of conscious attention on retraction/depression during all the push-up-type movements in Ashtanga/power yoga class.

I was also thinking that clap push-ups would require some darn good activation of the serratus, especially during the lift-off (and the eccentric on the landing).

Steven Low
03-15-2008, 05:09 PM
Planche work is extremely good for serratus anterior strength.. if you wanted alternative exercises. :)

Eric Kerr
03-18-2008, 10:35 AM
[QUOTE=Garrett Smith;27937]Eric,
Glad you agree.

I felt like a newbie who didn't know how to do a push-up. You know, using all sorts of muscles (the wrong ones) to try to do a movement.

[QUOTE]


Exactly.

From doing outer cap stretches I can already tell that there is a slightly increase in mobility and the push-up pluses with the 6-8" elbow bend get are getting easier to manage with good protraction.

I will endeavor to include some pre-hab exercises in my warm-up.

Steven, I would love to manage a planche. I will put that on my list of things to work towards. And oh lookie, Beast Skills has a progession routine. Snice.

Thanks,
Eric

Garrett Smith
03-18-2008, 11:04 AM
Steven,
Great suggestion as usual. As my routine will now be including pushups plus with added resistance AND planche progressions, I think I'll be dropping the protraction work from my prehab (gotta cut something out sometime or the workouts become unmanageable time-wise).

Steven Low
03-24-2008, 07:51 PM
Come to think of it there's protraction in the front lever as well (although retraction in front lever pullups).

Interestingly enough I figured out planche was awesome for protraction when basically my weighted muscle ability went down after doing push heavy work with planches. Not enough retraction and long rhomboids significantly weakened them to the point where I was just less strong.

Kelly White
01-21-2010, 08:38 AM
Trying to fix my cronic muscle spasms in my upper back, (seperated left shoulder and winging scapula right) and as I was reviewing this thread I found a full link to the study Dr G posted with pictures and explanations of all the exercises.

http://scottsevinsky.com/pt/reference/shoulder/ajsm_serratus_anterior_rehab_exercises.pdf

Mark Fenner
01-26-2010, 11:53 AM
Hi folks, long time, no post ... but this is an issue near and dear to me.

In about June of 2008, I developed some severe shoulder pain that, of all things, completely destroyed me while squatting. I got bad enough that I did some squatting and then attempted to bench press and ..... presto, I had to limp home holding my arm as if it were in a sling. Not good. One note, my downhill slide with the shoulder issue was accelerated by a transition from hi-bar to low-bar squatting. That is neither here nor there for this discussion. One other note, I was a "overhead athlete" for sometime: LOTS of volleyball in my history and some of my soccer career was spent as a goalie. My shoulders have also been dinged up from judo.

My pain was primarily on the posterior side of the left deltoid: sometimes coming at the top left of the scapular triangle, sometimes at the delt-tricep intersection. For the summer of 2008 I did a bit of this, that, and the other thing to rehab it. Mostly, I rested it. It healed up enough to let me do two rounds of Sheiko in the Fall of 2008. In spring 2009, I followed Cressey's Maximum Strength programs, partially b/c of the lack of direct back squatting. I really enjoyed it (great program! my wife is doing for her second time now), but at the end my back squat was in sorry shape and my shoulder pain while back squatting was substantially worse. Now to the point.

In May, 2009, I was fed up with my back squat being interferred with by a "stupid" shoulder problem. So, I found a great PT (Joe Grant, Warren, VT) and we went to work. His main comment on assessing me went something like this: "Holy Crap! I've (almost) never seen someone that trap dominant". In other words, thanks to lots of heavy pulling (especially rack pulls), my traps were doing all the raising (literal lifting) of my scapular shelf and I wasn't getting any raise out of upward rotation of the scaps. Now, you can get height at the shoulder in two ways: either shrug (duh) or rotate your scaps so they "face the heavens". I was doing all of the former.

So, my PT prescribed some exercises. Here are the two "raises" that were most useful:

(1) DB in right hand, standing tall, shoulders pushed away from my ears, palm facing forward (supine position): do a "front raise" but move from the hip across in front of your LEFT eye/ear and continue up ... as long as you don't get into a shrug. Lower and repeat. Eventually, I did this in a staggered stance (right leg slightly back) which emphasized the cross-body movement a bit.

(2) DB in right hand, slightly bent forward and rotated right shoulder towards left hip, palm to the back: basically do the cocking motion for a volleyball spike but keep it in slightly tilted plane ... when you get to the top, reach back but also allow your body to open up (don't isolate). As you get the feel for your serratus anterior, make sure it is locking your scap to the ribs as you reach back.

A comment on raise (1). Thing about the action of the SA: it anchors the scaps to the ribs. If you reach across your body (particularly with your palm like a mirror coming up to your face), you almost have to staple the scaps to the ribs to make it happen. Bingo! Hello, Mr. SA, pleased to meet you! Raise (2) is more of a "make the whole body open up so you don't overstress your rear delts and friends" when you reach behind you.

I consider raise (1) my money exercise to wake up my SA. I do it almost every workout. When I "forget" it ... I pay. My setup for my squat now includes actively raising my chest (includes upward scap rotation), shrugging my shoulders DOWN, and then reinforcing the upward rotation. All of a sudden, I have tons of room for my arms AND I'm not hyperextending in the rear delt compartment.

3 other exercises that were surprisingly helpful:
(1) Full body version of raise (2) progressing to one foot. Right hand starts near your left foot. Open up and reach back behind you to your right-rear corner. Make sure everything contributes to opening-closing. If you do it very forcefully, you might want to review your judo forward rolls.

(2) Full body reach up. While standing, dip low and then reach up as if you are trying to do a layup. Focus on the shoulder mechanics in raise (1) and using all your muscle to extend up and absorb the force of coming back down.

(3) Kung fu power punch (sorry folks, this are my mental images :) ). Standing in about a 45 degree stance: coil back on your right leg with your right hand chambered at your hip. Twist your feet, rotate your hips, shoulders, and extend your right arm forward (a knife hand or cupping hand works well, palm facing your left) ... and keep extending and extending and extending. Possibly try to take the base of your hand (the side under the pinkie) and show it to a person in front of you [that last bit I found helpful to get more SA involved].

In all three of these "stupid human tricks" as my PT names them for some of his clients, the goal is to look like an athlete. When I was learning them, an older lady on a bike in the office said: "He looks like a Greek statue". Let me assure you, it was not b/c of my physique!!! It was b/c of the full extension/movement of my whole body.

A few other notes that I learned on my journey:

(1) If you are compensating for lack of scapular mobility with overuse of your posterior delts and friends, then doing more posterior delt/upper back work may make your shoulder worse! Seriously! I look at it like this: my humerus should be in line with my scap. If the humerus goes back significantly further than my scap, there is going to be a "pinch" in the area of the delt.

(2) Pushup-pluses are good ... if you know how to work your SA. If you don't, you are just grooving the wrong pattern. If you are in the position of re-educating your SA, then make sure you have a mind-body connection to your SA and make sure you can feel it before going pushup-plus crazy. Don't be ashamed to do pushup-pluses from your knees.

(3) Raised feet pushups can activate the SA more (if you are using the right movements ... if you pike up and shrug your shoulders, guess what ... you lose).

(4) I found that pushups with either my hands (fingers) pointing to 10 and 2 o'clock (or even 6 o'clock on both like a reverse grip bench press) made feeling my SA easier. Using a medicine ball with the fingers at 9 and 3 o'clock has the benefits of being unstable (more muscle activation with less weight) AND the great benefit of requiring some compression (i.e., pulling the arms to the chest ... and the scaps to the ribs).

I didn't pursue it alot, but raised feet, medicine ball pushups definitely bring out the SA.

(5) Be careful of pull ups and friends. If you do a "chest heavy" pull up (i.e., at the top squeeze, you pull your shoulders together with your pecs to get the last inch), you might be making things worse. If so, make sure that your are opening your chest at the top (i.e., pulling your shoulder blades together for the top squeeze).

My PT also recommended DB presses from seated and incline. He wanted me using the "reverse bench press" grip orientation and taking them in front of the opposite eye. These were low weights. Again the cross-body action forces the SA to get in on the act.

Hope your find one or two useful pieces of advice in here.

Best,
Mark

Steven Low
01-26-2010, 05:56 PM
Interesting stuff mark. I'll keep it in mind

Allen Yeh
01-27-2010, 04:31 AM
Nice post Mark.

Garrett Smith
01-27-2010, 05:39 AM
Please post that in the Prehab/Rehab sticky thread.

Mark Fenner
01-27-2010, 07:35 AM
Done.

Garrett Smith
01-27-2010, 10:04 AM
I can't remember which side it was on, but I used to have a winging scapula on one side. I rehabbed it mainly through really concentrating on pinning the scaps to my back in the yoga classes I was doing at the time.

This may be why Ido Portal's scapular exercise routine (http://www.youtube.com/watch?v=y4Wo095zPnc) intuitively feels so beneficial to me these days.

I think I'll add a set of the cross-body SA front raise too...how high are you able to go on these? The natural end for me seems to be somewhere between the chin and the top of my head...

Mark Fenner
01-27-2010, 07:43 PM
I think I'll add a set of the cross-body SA front raise too...how high are you able to go on these? The natural end for me seems to be somewhere between the chin and the top of my head...

That sounds about right. I go to about nose or top of head level. Also, I use a moderately bent elbow (maybe 20 degrees flexion). Two reasons here: (1) shorter lever arm means more control over the weight and (2) letting the tricep relax a bit seems to let the SA flow a bit more.

These are easily doable without weight: just imagine you are looking at your hand as a mirror. While not a manly description, you should also feel "elegant" as you raise your arm. Part of that fluidity of movement that makes dancers look graceful is what makes it "right". The clunky-ness of segmented movement contrasts very strongly.

Best,
Mark

Garrett Smith
01-27-2010, 08:27 PM
I did them tonight with 10# DBs (just what I had in my hands after some other shoulder prehab exercises).

The elbow definitely wanted to bend, and there was definitely a soft endpoint around shoulder level when I kept my arm as straight as possible (will try the bent elbow next time).

Mark Fenner
01-30-2010, 08:39 AM
That sounds about right. I go to about nose or top of head level.

Turns out, I actually go a bit above head level (4-6"?). Also, at the top, my shoulder raises a hint, but I actively try to keep the trap down. When I was in more "rehab" mode, I was using (up to) 20 lb. DBs for higher reps. Now that it is more warmup, I typically just grab a 10 lb. plate off the rack.

I checked out the video you posted. The demonstrator has nice scap movement. For someone with scap problems, trying that right off might (MIGHT!) leave the scaps fixed and the shoulder over compensating. However, if someone is to the point that they can recognize good scap movement (in themselves) then hop to it!

One other thought for this thread: one of the antagonists of the serratus is the pec minor. Pec minor tends to get super tight. Tight pec minor -> overworked serratus -> serratus use problems. Stretch/mobilize/roll that pec minor!

Best,
Mark