Name: Serratus Anterior Manual Muscle Testing (MMT) for an Active Population
Uploaded: 2023-04-26T01:02:42.000Z
Duration: 9 min 47 s
Description: Learn how to effectively and safely use MMT to evaluate serratus anterior strength in a clinically active population. The video will guide you through the anatomy, procedure and significance of the manual muscle test.

English captions

https://stream.mux.com/vNJ9suk1Jmc2Ezj02jZsXd6DfiJq02PO702hPPp4n00jno4.m3u8

Learn how to effectively and safely use MMT to evaluate serratus anterior strength in a clinically active population. The video will guide you through the anatomy, procedure and significance of the manual muscle test.

Introduction to Serratus Anterior Testing

Limitations of Traditional Protraction Testing

Improved Test for Serratus Anterior Activation

Assessing Strength at Overhead Positions

Recognizing Compensation Patterns During Testing

Serratus Anterior Manual Muscle Testing (MMT) for an Active Population

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

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