0:04 This is Brent of the Brookbush 0:06 Institute, in this video we're going over 0:07 serratus anterior isolated activation, 0:09 a muscle that has a propensity to 0:10 become long and under active in those 0:13 with upper-body dysfunction. Those with 0:15 upper-body dysfunction have a propensity 0:17 towards anterior tipping and downward 0:20 rotation, or a lack of upward rotation of 0:22 the scapula during shoulder elevation; 0:24 and we know that my serratus anterior 0:26 does posterior tipping and upward 0:30 rotation. I'm going to have my friend 0:31 Melissa come out, she's going to help me 0:32 demonstrate. Now before we get started on 0:35 this exercise we do have to consider 0:37 what are my overactive synergists. My 0:40 overactive synergists are likely my 0:42 pectoralis minor trying to take over for 0:44 protraction and some scapular stability, and 0:47 potentially my subscapularis in some 0:49 weird maybe fascial continuity, or 0:53 humeral scapular mechanical problem. The 0:57 subscapularis does have a 0:59 tendency to get overactive in those with 1:01 serratus anterior inhibition. Now because 1:05 the pectoralis minor is overactive we 1:08 already have a couple exercises that I 1:11 see commonly used for serratus anterior 1:12 activation, that I'm going to go ahead 1:15 and nix. How many of you guys have seen 1:18 the serratus anterior press up, which is 1:21 where you have a patient or client do 1:23 this, maybe you put a dumbbell in their 1:25 hand, or maybe you use a little manual 1:26 resistance and they go ahead and 1:28 protract. I'm willing to bet if a 1:31 pectoralis minor was overactive before 1:33 we started this exercise, it's going to 1:36 be really really overactive by the time 1:38 we finish this exercise. The other 1:41 exercise which I know you guys have all 1:42 seen is the serratus anterior push up, or 1:45 the push up with a plus, which 1:46 essentially is a double press up. All 1:52 right so that exercise has this 1:55 tendency to maybe strengthen the 1:58 serratus anterior, but also reinforce 2:01 that synergistic dominance of the 2:04 pectoralis minor, we want to get that out. 2:05 So how do we get the pectoralis minor 2:07 out of this exercise. Well what we're 2:11 going to do is we're actually going to 2:12 use some posterior tipping and some 2:14 retraction, 2:16 and some upward rotation of course is 2:18 what we're going to work on, to try to 2:20 get my serratus anterior in gear. Now 2:22 you guys have already seen an exercise 2:24 that matches all of those qualities. How 2:30 many of you guys have seen floor angels 2:31 or wall angels which is where you kind 2:33 of do a shoulder press, but pressed into 2:35 the floor or pressed into a wall. Now the 2:39 only problem with this particular 2:41 exercise is it's hard, which normally 2:44 wouldn't be a problem. I like challenging 2:47 exercises, I like kind of beating up on 2:49 my patients and clients. I know it's a 2:50 little sadistic but that's that we are, 2:52 doctor of pain and torture right. So we 2:55 need to find a way to regress this 2:57 exercise because unfortunately with 2:58 these exercises, hard sometimes means 3:01 compensation is looming, they don't do 3:03 things with very good form. Now I still 3:06 want to get the upward rotation, I still 3:08 don't want to get any protraction, I 3:10 still need to focus on retraction. So 3:13 what I'm going to have her do is I'm 3:15 going to have her start with her hands 3:16 on her thighs. She's going to make fists 3:19 with her thumbs pointing out this way. 3:21 We're actually going to go just like this, 3:22 I'm going to have her start retracted 3:25 and depressed, that depression with 3:28 her back flat on the floor is going to 3:30 help me get into a little posterior 3:32 tipping right off the bat. Now if I keep 3:34 her depressed throughout the entirety of 3:37 this exercise in order to make room for 3:40 her humerus to elevate, she's going to 3:42 have to upwardly rotate which is going 3:44 to force her serratus anterior to fire. 3:46 So what this is going to look like is 3:49 her keeping her shoulders down while 3:53 doing scaption 3:54 all the way back to her thumbs. Keep 3:58 those elbows locked. For a lot of people 4:00 this is actually really challenging, what 4:03 they're working against is their 4:06 thoracic mobility. If they don't 4:08 have good thoracic extension posterior 4:10 tipping is very tough. They're also 4:12 working against their latissimus dorsi 4:14 extensibility. Now if this is no 4:18 problem I can increase the range of 4:20 motion by just having her tuck her thumbs 4:22 and trying to get all the way back 4:26 to the tops of her fists there. Now make 4:28 sure you keep the elbows locked. How's 4:33 that? Yeah Melissa's got pretty good 4:38 shoulder mobility. So I'm going to have 4:39 to up the challenge even further. Let's 4:42 have you try to get to the back of your 4:44 hands, keep those elbows locked, shoulders 4:48 down. Notice she's doing a really good 4:49 job here. I don't see a big rib flare, 4:53 Melissa is almost making this look too 4:56 easy. A lot of times we have to cue 4:58 people to keep drawn in, maybe even to 5:01 contract the rectus abdominus a 5:03 little bit so that they don't go into a 5:05 lumbar extension, thoracic extension. 5:07 We don't want to see any of that. I 5:10 think you can do that with your elbows 5:12 locked, you keep bending that right elbow. 5:16 Now if she can get all the 5:20 way back to the back of her hands and I 5:22 see if her forearm lying down on the 5:24 floor, now I know she's ready for floor 5:27 angels. So now once again we 5:32 still have to keep this down. You guys 5:34 see a lot of elevation, levator scapulae, 5:37 upper trap are becoming really really 5:39 active and serratus anterior not so much. 5:43 In fact we can get a weird compensation 5:46 pattern where elevation is actually only 5:48 elevation of the superior angle of the 5:50 scapula, around relatively fixed glenoid 5:53 fossa, and you're actually getting 5:55 downward rotation which is going to 5:56 increase compensation, it's going to 5:59 reinforce our compensation pattern. How 6:01 does that feel? Does that feel tough? Now this 6:04 whole progression right here that I just 6:06 showed you is on the floor, and the 6:09 reason we start on the floor is because 6:10 it makes it easy to easier to stabilize 6:13 the lumbar spine, being that they have to 6:16 work against that thoracic extension. 6:18 You'll see, go ahead and bow up for me, 6:20 this is a very common compensation 6:23 pattern for this exercise, and we don't 6:25 want this. The floor gives us a little 6:27 bit of tactile cueing, makes it a little 6:30 easier to cue here as well, as the floor 6:34 helps us stabilize 6:36 the scapula. Right if the floors there 6:39 pushing her into posterior tipping with 6:41 the majority of her body weight, this 6:43 exercise is not quite as challenging. 6:46 From here we're going to do all those 6:48 same progressions but we're going to 6:51 move to the wall and we're going to go 6:54 ahead and stand up continuing our 6:56 serratus anterior isolated activation 6:58 progression, bringing Melissa out here 7:01 we're going to have her right up against 7:03 this wall. Now the wall still remains a 7:05 great posture check for this exercise. So 7:08 I'm going to have her step her feet out 7:10 which I know you guys can't see, but you 7:11 don't need your heels back against the 7:13 wall, that makes this pretty awkward. 7:15 You end up just having to arch your 7:17 lower back to get around your butt, when we 7:20 don't need that. We want to walk 7:22 the heels out a little bit, soft knees, 7:24 get them into a neutral spine so they're 7:28 drawn in, head back chin tucked and then 7:32 all of the progressions are exactly the 7:34 same. o I can have her start with her 7:37 hands on her thighs, thumbs up, make your 7:39 fists right, keep your shoulder blades 7:42 down and back, let's see if you can get 7:45 all the way to the wall, stay drawn in, no 7:49 excessive lordosis. That looked pretty 7:52 good. Let's go here, keep those elbows 7:55 locked, good drawn in, keep those shoulder 7:58 blades down. All right good, let's 8:03 try back of your hands. 8:06 All right so that's 8:12 actually Melissa's progression right 8:13 there. That was tough for her, she had 8:15 that that last couple of inches she was 8:18 really having to strain to maintain her 8:22 scapula depressed, so she keeps posterior 8:25 tipping, keeps that pectoralis minor out 8:27 of it. You know she was really having to 8:29 engage her core to keep her latissimus 8:32 dorsi from pulling her into an anterior 8:34 pelvic tilt. But just so they can see 8:37 let's see those wall slides a little bit. 8:38 So she'd be trying to keep her entire 8:41 forearm and back of hand against the 8:44 wall, really externally rotate into that 8:47 wall, help inhibit the subscapularis. 8:51 This is not easy, doing wall slides well 8:56 super difficult, doing wall slides crappy 8:59 totally easy, totally easy. If you don't 9:01 watch your form, you let your elbows come 9:02 off, you just try to touch your 9:04 fingertips to the back, and you just kind 9:05 of go up and down not worrying about all 9:07 these form cues, not great serratus 9:09 anterior the activation. Not something 9:13 you're going to convince your clients 9:14 they need or is even hard. You get your 9:17 clients or patients to do this exercise, 9:19 half the time I can sneak it into a 9:22 resistance training workout because they 9:23 think they're getting so much work for 9:25 their shoulders and serratus anterior. 9:26 They swear it's a weight training 9:27 exercise, which is a good thing. It's a 9:30 good thing to help get some extra 9:32 corrective exercise in where maybe we 9:35 have certain clients who are a little 9:38 less compliant. Of course this exercise 9:40 is also great for home exercise programs 9:42 because it takes absolutely no equipment. 9:44 I hope you guys enjoyed this progression. 9:47 I hope to see a lot of serratus anterior 9:50 activation in your routines. Just about 9:52 everybody with any sort of upper body 9:55 dysfunction can definitely benefit from 9:58 this exercise. There's even some research 9:59 to show that those with cervical 10:01 dysfunction could benefit from serratus 10:04 anterior activation. I look forward to 10:06 talking to you guys soon.
