0:04 This is Brent of the Brookbush 0:06 Institute, and in this video we're going over 0:08 serratus anterior manual muscle testing 0:10 for an active population. Since we are 0:13 dealing with a more active population, 0:14 we're going to go ahead and take that 0:15 Kendall scale of the one through five 0:17 with pluses and minuses and set it aside. 0:19 We're going to replace it with a simpler 0:21 scale of strong, weak, with compensation, 0:23 or with pain. You're going to find that 0:26 we're going to make this test a little 0:27 bit more provocative, because with this 0:29 more active population who's putting a 0:31 lot more intensity through their human 0:33 movement system, I think what you'll find 0:34 is a little dysfunction can go a long 0:37 way towards creating some pain and 0:40 decreasing performance. I'm going to have 0:42 my friend, Melissa, come out. She's going 0:44 to help me demonstrate. Now, first let me 0:47 show you the serratus anterior manual 0:49 muscle test that I don't like. I'm going 0:52 to go ahead and have you lie down. You 0:55 guys probably already know that the 0:56 serratus anterior does protraction and 0:59 upward rotation. This has led to some 1:03 individuals trying to test the serratus 1:05 anterior through protraction. So, Melissa, 1:07 I'm going to have you take your 1:08 your arm to make a fist and punch it up 1:11 straight towards the ceiling. And then, 1:13 what I'm going to do is I'm going to 1:14 take my hands like this, and I'm going to 1:17 put a downward force straight through 1:18 the table and see if you can hold it. 1:21 Of course, Melissa is a beast and she can 1:24 hold it. The problem with this 1:27 test is it's testing protraction, but the 1:31 serratus anterior isn't you're 1:33 only protractor. The other two 1:35 muscles that are really good at 1:37 protraction are our pectoralis minor 1:40 and potentially our pectoralis major. a 1:42 little indirectly through the humorous, 1:45 but nonetheless aiding in that joint 1:47 action. They have a tendency to become 1:50 overactive. The pectoralis minor, in 1:53 particular, has a propensity to become 1:54 synergistically dominant for the 1:56 serratus anterior. So, the question 1:58 becomes, "In this position, can I 2:01 differentiate between pectoralis minor 2:02 and serratus anterior activity?" The 2:05 answer is, "No." Melissa could compensate, 2:08 which I know my athletes are really good 2:12 compensators. So, I need to find a new 2:14 test that will make it harder for Melissa to 2:17 compensate. 2:17 I'm going to have her sit up the. The other 2:22 test that we find in Kendall's manual 2:24 muscle testing is actually a far better 2:26 test and tests the serratus anterior as 2:28 an upward rotator, although this test 2:30 does take a little bit more skill and a 2:32 little bit more practice. I'm going to 2:34 have Melissa go ahead and raise her arm 2:35 to about 120 degrees of flexion, enough 2:40 that I'm getting a little bit of 2:41 upward rotation in the scapula, but I can 2:46 still create a nice downward force here. 2:48 Now, what you're going to do with this 2:49 hand is really important. You're going to 2:52 take two of your fingers, maybe your 2:54 index finger and middle finger, and put 2:56 them on the inferior angle of their 2:58 scapula. You're going to use your thumb 3:00 to palpate those those front fibers of 3:04 the serratus anterior that aren't 3:06 covered by the scapula. Now, what I'm 3:09 actually testing for when I press down 3:11 Melissa's arm is not whether she can 3:14 hold her arm up here. It's whether her 3:18 scapula collapses into these two fingers, 3:22 because her serratus anterior is 3:25 incapable of stabilizing and upwardly 3:28 rotating her scapula. I'm 3:31 going to start here, here, and apply some 3:35 force. and what I notice right away is 3:37 the harder I push down, the more 3:42 contraction I can feel of her serratus 3:44 anterior as her inferior angle is 3:48 maintained at the same position I 3:50 started. Alright, so let's show a 3:53 different angle. I'll have you turn this way. 3:55 Again, guys, just to show you a 3:57 different angle, and I'm going to have to use 3:59 like some tricky hand positioning here. 4:01 Go ahead and raise your arm up. I had 4:05 my fingers on her inferior angle. I'm 4:08 going to switch it around here and use 4:10 my thumb this time. And then, I 4:12 place my fingers right here, so that 4:14 I can get a nice broad palpation area 4:18 for those serratus anterior fibers. I'm 4:21 then going to push down her arm. Of course, we 4:24 don't see any tipping down of her 4:29 inferior angle, no 4:30 rotation, and I'm actually getting a 4:32 little bit of a- I can it feel an 4:35 increase in tissue density underneath 4:37 these two fingers. Then, again, we'll 4:40 do from the back, so face that way. You 4:43 guys can see this is her inferior angle, and 4:46 as she reaches up to 120 degrees, now 4:49 that's her inferior angle. We see a 4:51 little bit of upward rotation. I would 4:54 take these two fingers and then my thumb, 4:58 in this case, and I'm just going to use a 5:00 nice broad area to palpate. 5:04 Then I'm going to go ahead and apply 5:06 some pressure and see if I can feel 5:10 serratus anterior getting more dense, 5:13 increasing tissue density under my thumb, and 5:15 see if I can feel her inferior angle go 5:20 into downward rotation as I press. Now, of 5:23 course, in this position, Melissa is 5:25 really strong. The truth of the matter is that 5:28 we're not done yet. As I've mentioned in 5:31 other videos, it's not always these very 5:34 neutral positions that's where the 5:38 weakness is. If Melissa's an overhead 5:41 athlete- she's a baseball player who has 5:44 to throw, she's a volleyball player who 5:47 has to spike a volleyball, she's a tennis 5:49 player who has to serve, she's a 5:51 basketball player who has to keep her 5:52 arms up- we're as concerned about 5:55 serratus anterior strength here, 5:58 maintaining optimal shoulder alignment, 6:00 as we are here. So, now what we're going to 6:04 do, again, is see if she has optimal 6:08 mobility. If she doesn't have optimal 6:10 mobility and can't get herself to 180 6:12 degrees, that might be a real good place 6:13 to start with our interventions. We also 6:16 want to make sure that she has strength 6:20 up here. Whether that's before we've done 6:23 our mobility techniques, if she already 6:25 has that hundred and eighty degrees, or 6:27 let's say she came in and she was 165 6:30 degrees, and then I did my mobility 6:32 techniques got her to 180, now we need to 6:35 test to make sure that she can control 6:36 this range. So, I'm going to do the exact 6:39 same test, exact same 6:41 palpations. I'm going to have her come 6:43 up this way. I'm going to grab the 6:46 inferior angle here now, put my thumb 6:49 over her serratus anterior- I don't know 6:54 if you guys could see that, but that was 6:57 almost instantaneous. As soon as I 7:00 started putting pressure, her inferior 7:03 angle just slid right under my fingers. 7:05 Alright, so I grab here. I hope you 7:09 guys can see that. I put my hand here, and 7:11 then you'll see- and she starts to 7:15 fall. So, we know that she is strong in 7:23 120 degrees of flexion, but she's not 7:25 strong at 180 degrees of flexion. If she 7:27 had come in with shoulder pain, that 7:30 gives me a lot different information. I 7:32 need to continue to work on her serratus 7:34 anterior activation, and maybe towards 7:37 that end range. Maybe it's going to be 7:39 something like wall angels that I need 7:41 to do, or that very end range of that 7:45 Sahrmann progression for serratus anterior 7:48 activation that we we did in a previous 7:50 video. Things like punch-ups are not going to 7:54 be adequate. Getting her to do 7:56 a dumbbell press with a plus is not 7:59 going to be adequate. We need to work 8:01 serratus anterior activation at end 8:04 range of upward rotation of the scapula. 8:06 Now, the last thing I want to show you 8:08 guys, which Melissa doesn't do, but she's 8:10 going to help me demonstrate is the 8:12 other result we could get besides strong, 8:14 weak, weak at end range in Melissa's case 8:18 is compensation. It's very, very common. 8:22 So, what would happen is here- is as 8:25 I hold here, hold here, and go to press, we 8:29 probably see Melissa go into anterior 8:32 tipping and elevation of the scapula, 8:35 like this. So, I'd go to press down, and 8:37 she'd do all this weird compensating 8:39 to really try to lock down her 8:42 scapula. That's her pec minor and maybe 8:44 levator scapula, and maybe even 8:47 rhomboids start to take over. Of course, 8:49 then you would write down "compensation" 8:51 and maybe note what joint action she 8:54 compensated into to give you an 8:56 indication of what muscles are 8:57 synergistically dominant for her 8:59 inhibited serratus anterior. I hope you 9:02 guys enjoyed this video. I hope these 9:05 manual muscle tests give you some new 9:08 information on what activation 9:11 techniques are appropriate for your 9:12 clients and patients, and maybe even how 9:16 some of those activation techniques 9:17 should be applied, through what 9:19 range of motion. I look forward to 9:21 hearing how you guys increase 9:24 performance, how you reduce pain and 9:26 dysfunction, and how you guys get better 9:28 outcomes. Please leave me comments. I love 9:31 to hear from you. I also love your 9:32 questions, so feel free to add your 9:34 questions to the bottom of this video. 9:44
