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