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Sports Performance Strength & Conditioning

Is Your Upper Back or Neck Pain Really Your Back/Neck?

By Sean Conner

Recently, physical therapists and chiropractors are seeing more neck, back and shoulder pain in younger individuals than ever before. This can mainly be attributed to poor posture. In an attempt to fix these problems, many people resort to chiropractors or physical therapists, stretching, and massaging to release the tight muscles. These strategies can help at first, but they do not solve the underlying issue. The human body is very complex and has many systems reliant on the next. Without improving stability to the shoulder, and strengthening muscles that have become lazy and weak, the tight muscles will tighten up again within a few days after stretching/therapy. To restore function to the shoulder, a new approach is necessary. This approach is strengthening the Serratus Anterior. 


The Serratus Anterior is a very important and underappreciated muscle deep in our torso. It wraps around the body on either side (under scapula/pecs), originating on the ribs and inserting on the upper/medial/lower angle of the scapula (shoulder blade). This muscle is crucial in stabilizing the shoulder joint during movement (whether that be sports, exercise, or activities of daily living). The Serratus Anterior is used when drawing the scapula forward (protraction) or rotating the scapula upwards. This muscle helps the scapula sit more downward and upward facing which helps the shoulder joint move back into the right position, and without pinching. This muscle aids in the deceleration of the shoulder, as well as movements with arms above shoulders/head, crucial in baseball. It also is an important muscle involved in breathing.

The Serratus Anterior is generally prone to weakness or inhibition (inactive). When there is a muscular imbalance or faulty movement at work, the muscles surrounding the Serratus Anterior take over and the Serratus Anterior basically shuts down due to inhibition by the Levator Scapulae, Upper Trapezius, Rhomboids, and Pec Minor. This can be due to tight inhibitor muscles which cause the scapula to sit rotated forward, causing the shoulder to roll over and the neck to be hunched forward. These can all lead to more serious imbalances and posture problems. The Serratus Anterior is often neglected in workouts, and can be a major source of pain/restricted movement if strained or injured. 

There are a number of problems arising from a weak/inhibited Serratus Anterior. The most commonly seen is shoulder, neck or back pain. Rotator Cuff problems can appear when the Serratus Anterior is forgotten (weak) or injured, and is often seen in baseball players. There is an issue when your Serratus Anterior is tight. It causes antagonists like levator scapulae to have to work harder and develop trigger points (sometimes leading to bad headaches). It is common for people to diagnose a tightness in upper back/neck to tight muscles in the area when it really originates at the Serratus Anterior. A major problem that can be the result of a weak Serratus Anterior is S.I.C.K Scapula (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and disKinesis of scapular movement) more often known as Scapular Dyskinesis. Scapular Dyskinesis is when your shoulder blade is moving improperly which can cause major implications (impingement, rotator cuff tendonitis or rotator cuff tear). Weak/inhibited Serratus Anterior can explain why some athletes have thoracic outlet surgeries following elbow or shoulder surgeries.  It can also lead to arm numbness and poor circulation at the shoulder/armpit. Nerve/muscle damage can cause winging of the scapula (one or both shoulder blades stick out instead of lying flat) which when left untreated can cause the problems mentioned above. So take care of your back, neck and shoulder by taking care of your Serratus Anterior!



·      Serratus push-ups (10 reps, 5 second holds)

·      Banded Serratus Punch (standing, 10 reps, 5 second holds)

·      Kettle Bell supine shoulder punches 

·      Oblique punching (kneeling)

·      Planks

·      Stretching the tight muscles (inhibitors mentioned above) will enhance Serratus Anterior function

·      Foam roller wall slides (forearm on wall sliding up at an angle)


Serratus Anterior Activation: Reach, Round, and Rotate. (2018, March 20). Retrieved from https://ericcressey.com/serratus-anterior-activation-reach-round-and-rotate

S., & Duvall, S. E. (2017, October 10). The Serratus Anterior: A Secret Weapon for Great Posture. Retrieved from http://www.coreexercisesolutions.com/the-serratus-anterior-a-secret-weapon-for-great-posture/

Serratus Anterior. (n.d.). Retrieved from https://ericcressey.com/tag/serratus-anterior

Ryan, W. (2017, December 29). Getting to Know Your Serratus Anterior: Strengthen Your "Wings". Retrieved from https://breakingmuscle.com/fitness/getting-to-know-your-serratus-anterior-strengthen-your-wings

Ryan, W. (2017, December 29). Getting to Know Your Serratus Anterior: Strengthen Your "Wings". Retrieved from https://breakingmuscle.com/fitness/getting-to-know-your-serratus-anterior-strengthen-your-wings