Serratus Anterior: 3 Exercises to Improve Overhead Mobility

The serratus anterior is a key muscle involved with the performance of many overhead movements such as throwing a baseball, serving in tennis, and pressing a barbell overhead.   The serratus anterior muscle spans from the upper 8 ribs along the side of the trunk up to the inner border of the shoulder blade.  This muscle assists with rotating the shoulder blade (scapula) upwards and tilting it backward in order to position the shoulder and arm for optimal overhead function.  Along with thoracic spine extension mobility, these scapular movements are often ignored as important components of overhead function.  The serratus anterior is also the primary muscle which protracts the scapula during upper extremity function.  This involves the scapula moving forward along the rib cage such as when punching in boxing.

The Serratus Anterior and Overhead Function in Athletes

Individuals with shoulder problems demonstrate decreased upward rotation of the scapula, decreased posterior tilt of the scapula, and increased activity of the upper trapezius muscle.  In particular, swimmers and baseball pitchers commonly present with a pattern of decreased serratus anterior activation and increased activation of the upper trapezius.  This alteration in muscle patterns leads to compensatory movements, decreased overhead range of motion, and increased stress to other structures such as the rotator cuff and elbow joint.

The serratus anterior functions to upwardly rotate and posteriorly tilt the scapula
Assessing strength of the serratus anterior

Exercises which combine scapular upward rotation, posterior tilt and protraction are ideal to activate the serratus anterior.  It is also advantageous to include closed chain exercises where the hand is fixed to a surface or weight bearing through the floor or a wall.  Finally, exercises performed with the arm elevated above the shoulder or eye level elicit greater activation of the serratus compared to exercises performed at or below shoulder level.  Wall slide and bear crawl variations fulfill these criteria which are optimal to train the serratus anterior in overhead function.

 Wall Slide with Foam Roll

Begin with your forearms resting on a foam roller against the wall placed just below shoulder height.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior.  Next, “roll” the forearms up the wall in a controlled manner to approximately eye level or slightly higher, making sure you don’t lose protraction.  Return back to the starting point in a controlled manner and repeat for the desired number of repetitions.

Serratus Anterior Wall Walks with Band

Begin by wrapping a resistance band around your wrists and pulling your wrists apart. Your forearms should remain parallel and take the form of the number “11” throughout the exercise.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior. Then, “walk” the forearms up the wall in a controlled manner to approximately eye level or slightly higher, making sure you don’t lose protraction.  Return back to starting point in a controlled manner and repeat for the desired number of repetitions.

Bear Crawl

Assume an all-4’s position with the hands in front, shoulder-width apart, feet behind the hips and up in the air.  The knees should remain elevated from the floor so you are stabilized by 4 points of contact.  Begin by pushing the back up towards the sky to protract the scapula and activate the serratus anterior.  Crawl forward starting with your right hand and your left foot following with the left hand and the right foot.  After each step, pause briefly to exhale. Take four steps or more depending on space, then turn around and bear crawl back.

Closing Thoughts

Building a foundation of strength targeting the scapular muscles is crucial for overhead athletes.  This foundation should include movements which facilitate activation of the serratus anterior through scapular upward rotation, posterior tilt, and protraction.  These exercises can be included as part of a strength training session warm-up or part of a regular arm care program.   Overhead athletes, such as baseball players and swimmers, should particularly include exercises targeting the serratus anterior as part of their year-round strength and conditioning program.

 

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5 Thoracic Mobilization Drills to Improve Overhead Mobility

The position and mobility of the thoracic spine directly affects the amount of overhead shoulder movement available.   A more erect and mobile thoracic spine and rib cage will result in greater overhead range of motion.  A slouched posture or stiffness in the thoracic spine and rib cage will result in a loss of range of motion reaching overhead.   Excessive thoracic kyphosis, or a slouched posture, may alter the position of the shoulder blade and impair muscle activation patterns both of which contribute to limited overhead function and shoulder pain.

Approximately 15 degrees of thoracic spine extension mobility is required for full overhead motion when lifting both arms such as when performing a barbell overhead press. Full 1-arm elevation requires approximately 9 degrees of thoracic extension.  Thoracic spine rotation is also crucial for rotational sports such as baseball where a large amount of power is transferred through the trunk.   A baseball pitcher who lacks thoracic spine rotation will compensate by increasing movement and stress through the shoulder and elbow joints.

Strength is foundational for optimal shoulder health but thoracic spine mobility is often a neglected area when athletes attempt to maximize their overhead shoulder function.  Therefore, exercises targeting thoracic spine extension and rotation mobility should be included in any rehabilitation or performance enhancement program seeking to optimize shoulder function.  Instead of jumping to restore shoulder mobility with bands and balls, try these thoracic spine mobility exercises first.

Bench T-Spine Mobilization

This is my favorite exercise for restoring thoracic spine extension.  It also provides a nice stretch to the lattisimus dorsi muscle which can also limit overhead mobility. The exercise begins by assuming a kneeling position facing a bench.  Place your elbows on the bench in front of you holding a PVC pipe or dowel with the palms facing up.  Sit back, pushing your buttocks towards your heels, keeping your spine relaxed, until you feel a stretch in your upper back.  For an added stretch you can bend your elbows further past your head.  Hold this position, and exhale fully.  Reverse the motion to return to the start and repeat the desired number of repetitions.

Thoracic Extension + Rotation (Reach Backs)

Begin this exercise by sitting back on your heels, face down, with one hand behind your head and the opposite forearm resting on the ground in front of you.  This position minimizes available movement in the low back and maximizes movement to the upper back.   From this position rotate your elbow up to the sky while exhaling.   The opposite forearm remains in contact with the ground.  Return to the starting position and repeat for the desired number of repetitions before switching to the opposite side.

Foam Roll Thoracic Extension Mobilization

This exercise can be a challenge to perform correctly.  Most end up extending through the lumbar spine and not the thoracic spine.  Begin in a lying position over a foam roll.  Place the hands behind the neck supporting, but not pulling on, the neck.  Raise the buttocks off the ground and roll the upper back up and down the foam roll.  Identify a sensitive, stiff, or tender area and then drop the buttocks down to the ground.  From this position perform small extension movements by lifting the elbows up towards the ceiling.  Be careful not to overextend at the lower back.

Thoracic Spine Windmill

This is my “go to” exercise to restore thoracic spine rotation.  Begin on your side with both arms outstretched in front of you.  Place a foam roll under your top leg with the knee and hip bent to 90 degrees.  The bottom knee and hip remain extended throughout the exercise.   Reach forward with your top hand and then complete a large circular windmill motion as you rotate your entire upper body.  Keep reaching as if you were attempting to lengthen your entire arm.  Follow your hand with your eyes to ensure proper thoracic spine and rib cage movement.  The top knee and leg should remain in contact with the foam roll throughout the exercise.  Perform the desired number of repetitions and then repeat on the opposite side.

Standing Thoracic Rotation Mobilization

The standing rotation exercise is ideal to incorporate into a pre-workout dynamic warm-up.  From a standing semi-squat position place one arm between your thighs just above the knees.  This position will block unwanted hip and pelvic movement.  Next, rotate the body upwards towards the sky by following your open hand with your eyes.  At the top of the movement, exhale before returning to the starting position.  Perform the desired number of reps and then repeat on the opposite side.

Closing Thoughts

After performing these mobility drills it is important to work on strength and endurance of the thoracic muscles.  Also, manual therapy to the thoracic spine and rib cage has been shown to accelerate recovery and reduce shoulder pain immediately and for up to 1 year.  Maintaining or improving thoracic spine mobility is imperative for any active individual who regularly functions overhead.  Manual therapy, mobility drills, and strength/endurance exercise targeting the thoracic spine can lead to significant gains in overhead function for athletes and the general population.  These 5 mobility drills can be easily integrated into any pre-workout warm-up routine or as part of a home exercise program.

Youth Baseball Pitching Injuries on The Rise

Youth baseball pitching injuries are on the rise. The world-renowned Dr. James Andrews describes the increase in injury rates as an epidemic (ESPN interview).  His research shows 5% of youth pitchers will sustain at least one serious elbow or shoulder injury which will require surgery or end their career. Historically, throwing breaking pitches at a young age was cited as the major risk factor for these types of injuries. However, the latest research shows arm fatigue, not breaking pitches, is the primary reason for the sharp rise in youth pitching injuries.

Should Youth Pitchers Throw Curveballs?

Dr. Andrews and his team at the American Sports Medicine Institute (ASMI) in Birmingham, Alabama tracked 481 youth baseball pitchers (ages 9 to 14) for ten years. Pitchers were interviewed annually to determine the incidence of serious injury and to track pitching volume and pitch type. Serious injury was defined as those requiring surgery or ended an athlete’s career. Pitching more than 100 innings in a year significantly increased the risk of a serious elbow or shoulder injury by 3.5 times. Throwing curveballs before the age of 13 did not significantly increase the risk of injury.

Throwing with Arm Fatigue

Another 2006 study at ASMI identified the following risk factors for shoulder or elbow surgery in youth baseball pitchers:

  • Pitching 8 or more months per calendar year (5 times more likely to sustain a serious injury)
  • Throwing 80 or more pitches per appearance (3.8 times more likely)
  • Throwing velocities greater than 85 mph (2.5 times more likely)
  • Regularly pitching with arm fatigue (36 times more likely)

Research from the Journal of Strength and Conditioning Research found throwing accuracy and arm soreness to be closely associated with arm fatigue. Throwing velocity is more closely associated with generalized fatigue. Therefore, youth athletes should be closely monitored by coaches and training staff to gauge arm fatigue and throwing-induced injury risk. Throwing accuracy, and not velocity, is probably the more important variable to monitor in order to reduce injury risk. Also, regularly communicating with athletes about arm soreness is crucual  to reduce the risk of youth baseball pitching injuries.

Conclusion: Youth Baseball Pitching Injuries

Parents and coaches should closely monitor youth pitchers for signs of arm fatigue and soreness and discourage throwing year round. A minimum of 2-3 months without throwing is recommended (more from Dr. Andrews). During this active recovery period, athletes should work on other baseball skills along with aspects of strength and conditioning to improve their long-term athletic development. The off-season is the ideal time for an athlete to work with a strength coach to develop strength and power.  Contrary to popular belief, throwing breaking pitches is not associated with youth baseball injuries. The Stop Sports Injuries website has posted some other valuable youth baseball pitching injury prevention tips here.

References

  1. Fleisig, G. S., Andrews, J. R., Cutter, G. R., Weber, A., Loftice, J., Mcmichael, C., … Lyman, S. (2011). Risk of serious injury for young baseball pitchers: A 10-year prospective study. The American Journal of Sports Medicine, 39(2), 253–257. http://doi.org/10.1177/0363546510384224
  2. Olsen, S. J., Fleisig, G. S., Dun, S., Loftice, J., & Andrews, J. R. (2006). Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. The American Journal of Sports Medicine, 34(6), 905–12. http://doi.org/10.1177/0363546505284188
  3. Freeston, J., Adams, R., Ferdinands, R., & Rooney, K. (2014). Indicators of throwing arm fatigue in elite adolescent male baseball players: A randomized crossover trial. Journal of Strength & Conditioning Research, 28(8), 2115–2120.