The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

PTA Global

International Sports Sciences Association

Athletics and Fitness Association of America

Provider #1315 Home Study and Credits: {{ncbtmbCredits}}

National Certification Board for Therapeutic Massage & Bodywork

American College of Sports Medicine

National Academy of Sports Medicine

Canadian Fitness Professionals

Providers of Approved Continuing Education

REPs Ireland

World Instructor Training Schools

Completion of this course will earn you {{credits}} non-contact hours of continuing education in "Anatomy and Physiology" with Yoga Alliance

Yoga Alliance

Australia Physiotherapists

CIMSPA course ID: {{cimspaId}} and Credits: {{cimspaCredits}}

Chartered Institute for Management in Sport and Physical Activity

ACE Course ID: {{aceId}} and Credits: {{aceCredits}}

American Council on Exercise

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2309052TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

Texas Physical Therapy Association

New York Physical Therapist just a disclaimer The Brookbush Institute (B2C Fitness) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.

New York State Education Department's State Board for Physical Therapy

The Brookbush Institute is an AOTA Approved Provider of professional development. PD activity approval ID# {{aotaCourseApprovalNumber}}. This distance learning-independent activity is offered at {{aotaCredits}} CEUs {{aotaLevel}} {{aotaCategory}}.  AOTA does not endorse specific course content, products, or clinical procedures.

American Occupational Therapy Association

Serratus Anterior exercises for improving movement dysfunction, posture, shoulder pain, neck pain, scapulothoracic pain, winged scapula, and sports performance. Great scaptions, wall angles, and wall slide activations for the serratus anterior.

Serratus Anterior Exercises (Activation)

Access to all courses with monthly membership

Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

Home

Courses

This course describes serratus anterior exercises, commonly referred to as serratus anterior activation. Performing upward rotation, posterior tipping, and depression of the scapula, with thoracic extension, may improve recruitment (isolation) of this important muscle. The serratus anterior acts as an upward rotator, depressor, and protractor of the scapulothoracic joint, and is likely the primary stabilizer of the shoulder girdle (scapula). It is common to include these exercises in a program designed to address 

; however, these exercises may also be recommended to address arms fall, thoracic kyphosis, and cervical dysfunction. Addressing these signs has been correlated with improving and reducing the risk of neck pain, shoulder pain, shoulder pathology, thoracic kyphosis, shoulder impingement syndrome, and improving sports performance. Movement professionals (personal trainers, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding these exercises to their repertoire with the intent of improving patient/client outcomes from their integrated exercise programs and therapeutic (rehabilitation) interventions.

Wall Slides with Resisted External Rotation

Last, it is important to integrate the increase in serratus anterior activity into functional exercise. The Brookbush Institute accomplishes this with intrinsic stabilization subsystem, anterior oblique subsystem, and posterior oblique subsystem integration. Some example movements for these purposes include:

Dr. Brent Brookbush demonstrating a serratus anterior activation exercise 

Course Description: Serratus Anterior Exercises (Activations)

Study guide introduction, serratus anterior exercises (activation)

Study Guide: Serratus Anterior Exercises (Activation)

Introduction

Serratus Anterior In Postural Dysfunction And Movement Impairment

 has a propensity to become inhibited and under-active (relatively weak during activity). This reduces our ability to eccentrically decelerate downward rotation and retraction, and scapulothoracic alignment during daily activity and sport. This impaired function may result in dyskinesis (movement dysfunction) of the scapula, thoracic spine, neck, and glenohumeral (shoulder) joint, and is often paired with over-activity of the 

. Serratus anterior inhibition may reduce performance, increase the risk of future injury and dysfunction, and is correlated with pain and dysfunction in the upper body and cervical spine.

Signs of Under-Activity and a Maladaptive Increase in Length

Dr. Brent Brookbush demonstrating an example of arms fall during an overhead squat assessment

Signs Of Under-Activity & Length In Weak Serratus Anterior

Introduction to Serratus Anterior Exercises

Overactive Synergists

Muscles that commonly become synergistically dominant when the trapezius muscles are inhibited. Release and stretch prior to activation and cue joint motion to reciprocally inhibit these muscles during activation exercise.

 (inhibit with posterior tipping, thoracic extension, and upward rotation)

 (inhibit with depression, thoracic extension, and upward rotation)


The levator scapulae, upper trapezius, and latissimus dorsi all act as overactive synergists when the serratus anterior is underactive

Optimizing Motion (Best Practice)

, serratus anterior activation should likely follow 

 (if assessment indicates a need) based on research showing that forward head posture and neck pain may reduce serratus anterior activity (4-5). Further, the exercises used for serratus anterior activation include external rotation, indicating 

 (when assessment indicates a need) should likely precede serratus anterior activation as well. The exercises used for 

 are less isolated, requiring significant contributions from the 

, and prone progressions require significant 

 strength indicating they should be performed last or used for "Integrated Stabilization" in the Brookbush Institute Corrective Exercise Template. That is "Isolated Activation" would include exercises for the 

 (in that order), and trapezius muscle activation would be used for "Integrated Stabilization."

Research Corner

The serratus anterior is most often long and under-active in those exhibiting signs and symptoms of 

. Research by Lawrence et al., demonstrated relative downward rotation and an increase in anterior tipping of the scapula in those with shoulder pain (2). Further, research by Scavozzo et al found that swimmers with symptoms of shoulder impingement exhibited less than half the normal activity of the 

 during the pull-through phase of stroke (3). An indirect relationship may also exist between excessive thoracic kyphosis and serratus anterior activity, as a thoracic kyphosis has been correlated with shoulder impingement syndrome (6). Helgadottir et. al found reduced serratus anterior activity in those with neck pain, Kwon et al. showed that forward head posture may also reduce 

 activity, and Thigpen et al. demonstrated changes in scapular mechanics where correlated with changes in head and neck posture (4, 5, 13).

Research indicates that the upper and lower portions of the serratus anterior may be preferentially recruited based on scapular action - the upper fibers playing a larger role in protraction and the lower fibers playing a larger role in upward rotation and posterior tilting (8-9). Considering the changes noted in scapular motion relative to shoulder dysfunction (2), focus should likely be placed on exercises that preferentially recruit the lower fibers of the serratus anterior (upward rotation).

In a study by Hardwick et. al, scaption and wall slide-type exercises (similar to the exercises discussed above), resulting in greater 

 activity when compared to push-ups with a plus or punch-up type exercises (11). Further, scaption-type exercises may be preferred during the initial phases of correcting dysfunction, as wall slide-type exercises had a propensity toward more 

 activity (a commonly over-active muscle) (12). Although push-ups may not be as effective as some of the other exercises described below for "activation" of the serratus anterior, push-ups, in general, resulted in favorable changes in the balance between serratus anterior activity (increase) and 

 activity (decrease) (10). Push-ups on an unstable surface were particularly effective for increasing the activity of the lower fibers of the serratus anterior (8).

Dr. Brent Brookbush demonstrating a serratus anterior and trapezius muscle activation technique

Research on Serratus Anterior Exercises

Floor Scaption (extended thumb --> flexed thumb --> fist --> back of forearm)

Wall Scaption (extended thumb --> flexed thumb --> fist --> back of forearm)

Facing Wall Slides with Resisted External Rotation

Note: The various hand positions (extended thumb, flexed thumb, fist, back of forearms) are range of motion progressions. It is important to give patients/clients a goal that is sufficiently challenging but can be achieved without compensation (i.e. low back arches, excessive scapular elevation, bent elbows, etc.).

Floor Scaptions and Floor/Wall Angels

Sahrman/Brookbush/Fluegel (SBF) Activation

Best Exercises for Serratus Anterior Isolated Activations

Single-leg Standing Cobra 

Single-leg Standing Cobra to Balance to Calf Raise 

Single-leg Alternating Abduction

Integrated Stabilization

Single-Leg Chest Pass

Reactive Activation

Sample Activation Circuit

Healthy, 25-year-old female complaining of upper back and neck tightness.

 A client presenting with arms fall and shoulder elevation during the Overhead Squat Assessment, with normal shoulder flexion during goniometry, is likely exhibiting dysfunction of the scapula, upper thoracic spine, and/or lower cervical spine.

Thoracic Spine Mobilization: Posterior-to-Anterior and Transverse

Mobility Program: Self-administered Techniques

Pectoralis Minor Self-Administered Manual Static Release

Levator Scapulae Self-Administered Static Manual Release

Upper Trapezius Self-Administered Static Manual Release

Rhomboid Self-Administered Manual Static Release

Self-Administered Thoracic Spine Mobilization

Pectoralis Minor Self-Administered Static Stretch

Load: Light to Moderate (60 - 85% of 1-RM), focus on form and ROM

Rest between exercises: Circuit training, 1 min rest between exercises

Training Time: 5 - 15 minutes (excluding mobility interventions)

Serratus Anterior Isolated Activation Progressions

Dr. Brent Brookbush demonstrating wall slides with a foam roller as a progression for serratus anterior activation

Sample Activation Circuit: Serratus Anterior Exercises

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. 

journal of orthopaedic & sports physical therapy

Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. The American Journal of Sports Medicine. 19(6). 577-582

Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of electromyography and kinesiology,21(6), 947-953.

Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. 

Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. 

Ekstrom RA, Bifulco KM, Lopau CJ, et al. (2004). Comparing the function of the upper and lower parts of serratus anterior muscle using surface electromyography. 

Park, Se-yeon, and Won-gyu Yoo. "Differential activation of parts of the serratus anterior muscle during push-up variations on stable and unstable bases of support." 

Journal of Electromyography and Kinesiology

Decker, M. J., Hintermeister, R. A., Faber, K. J., & Hawkins, R. J. (1999). Serratus anterior muscle activity during selected rehabilitation exercises. 

(6), 784-791. (none of the exercises selected in this study used upward rotation to target the serratus anterior)

Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J. (2004). Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. 

Hardwick DH, Beebe JA, McDonnell MK, Lang CE. (2006). A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. Journal of Orthopaedic & Sports Physical Therapy. 36(12) 903-910

Ha, Sung-min., Kown, Oh-yum., Cynn, Heon-seock., Lee, Won-hwee., Park, Kyue-nam., Kim, Si-hyun., & Jun, Do-young. (2012) Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. 

Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. 

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Serratus Anterior Exercises (Activation)

Related Courses:

Course Description: Serratus Anterior Exercises (Activations)

Study Guide: Serratus Anterior Exercises (Activation)

Introduction to Serratus Anterior Exercises
1 Sub Section

Overactive Synergists

Optimizing Motion (Best Practice)

Research on Serratus Anterior Exercises

Best Exercises for Serratus Anterior Isolated Activations
2 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
1 Sub Section

Sample Activation Circuit: Serratus Anterior Exercises

Bibliography

Related Courses:

Comments

Guest

Serratus Anterior Exercises (Activation)

Related Courses:

Course Description: Serratus Anterior Exercises (Activations)

Study Guide: Serratus Anterior Exercises (Activation)

Introduction to Serratus Anterior Exercises1 Sub Section

Overactive Synergists

Optimizing Motion (Best Practice)

Research on Serratus Anterior Exercises

Best Exercises for Serratus Anterior Isolated Activations2 Sub Sections

Integrated Stabilization3 Sub Sections

Reactive Activation1 Sub Section

Sample Activation Circuit: Serratus Anterior Exercises

Bibliography

Related Courses:

Comments

Guest

Introduction to Serratus Anterior Exercises
1 Sub Section

Best Exercises for Serratus Anterior Isolated Activations
2 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
1 Sub Section