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