Is Your Serratus Anterior the Real Cause of Your Shoulder Pain?
Most people with shoulder pain are told one thing:
It’s probably your rotator cuff.
And sure — in many cases, that’s true. Rotator cuff dysfunction is common. But if you’ve been stretching, strengthening, or foam rolling without results, there may be a different culprit hiding in plain sight:
Your serratus anterior.
At Victory Performance and Physical Therapy, we often see shoulder pain patterns that don’t resolve with standard rotator cuff work. When that happens, the serratus anterior is one of the first muscles we evaluate — because when it’s not doing its job, the entire shoulder complex starts to break down.
Here’s why this often-overlooked muscle matters, how to know if it’s contributing to your symptoms, and what you can do to fix it.
What Is the Serratus Anterior?
The serratus anterior is a fan-shaped muscle that wraps around the side of your ribcage and attaches to the underside of your shoulder blade. Its job is to:
Anchor the scapula to the ribcage
Glide the scapula forward and around the torso (protraction)
Assist with upward rotation of the scapula during overhead motion
This muscle works in concert with your mid-back, rotator cuff, and trunk to keep your shoulder stable and efficient during movement.
But when the serratus anterior is weak, underactive, or dysfunctional?
Your scapula doesn’t stay flush against your ribs. It starts to “wing” — pulling away from the thoracic wall. And that changes everything about how your shoulder behaves under load.
How Serratus Dysfunction Leads to Shoulder Pain
A dysfunctional serratus anterior can disrupt the scapulohumeral rhythm — the coordinated dance between the shoulder blade and the upper arm. This leads to a cascade of compensation:
The upper trapezius and levator scapulae take over to lift the arm
The rotator cuff is forced to stabilize without proper scapular positioning
Subacromial space narrows, increasing risk for impingement
Shoulder joint mechanics become inefficient and painful
Studies confirm this. Research in the Journal of Orthopaedic & Sports Physical Therapy found that scapular dyskinesis — often tied to poor serratus anterior function — is linked to increased pain and reduced function in people with shoulder impingement and rotator cuff tendinopathy (Ratcliffe et al., 2014).
And in overhead athletes, diminished serratus activation has been shown to correlate with increased risk of injury, especially in baseball players and swimmers (Myers et al., 2005).
Signs Your Serratus Anterior Isn’t Doing Its Job
You don’t need to be an athlete to have this problem.
We regularly see underactive serratus anterior in:
Runners with shoulder fatigue and neck tension
Desk workers with rounded shoulders and postural collapse
Adults recovering from shoulder injuries who hit a plateau
Lifters who struggle with scapular control during pressing exercises
Here are a few common signs of serratus dysfunction:
Scapular winging (especially when pressing or pushing)
Pain during overhead or pushing movements
Inability to maintain shoulder blade control under fatigue
Overactive upper traps during light effort
Neck and upper back tightness that doesn’t resolve with stretching
It’s Not Just About Strength — It’s About Timing and Control
One of the most important things to understand about the serratus anterior is that weakness is rarely the only problem.
More often, the issue is motor control — your brain isn’t activating the muscle at the right time, in the right sequence, with the right intensity.
In fact, a 2016 study in Manual Therapy concluded that altered timing of serratus activation was more predictive of shoulder dysfunction than raw strength levels (Struyf et al., 2016).
That’s why doing endless wall slides or push-ups on your knees may not work. If the serratus anterior isn’t engaging at the right time, you’re just reinforcing the same faulty movement pattern.
How Victory Evaluates the Serratus Anterior in Shoulder Pain Cases
At Victory Performance and Physical Therapy, we don’t just guess.
We use a movement-based assessment to test how your serratus anterior contributes to your shoulder mechanics in real-world positions. That includes:
Closed-chain activation tests (like quadruped plus or wall pushes)
Scapular control evaluations during reach, press, and overhead motion
Thoracic mobility screening to ensure your spine can support scapular motion
Overhead strength sequencing to see what muscles are compensating
This helps us determine if the serratus anterior is inactive, delayed, or simply undertrained — and then build a targeted plan around it.
Effective Exercises to Activate and Train the Serratus Anterior
Once we’ve identified the problem, we use progressive movement strategies to rewire activation and restore proper control. Here are a few key phases in that process:
1. Activation and Motor Control
Scapular push-ups
Wall slides with foam roller
Quadruped protraction drills
These movements help your brain find the serratus anterior and reconnect it to the shoulder system.
2. Integration and Control Under Load
Landmine presses with upward rotation cue
Bear crawls with scapular stability emphasis
Cable punches with slow tempo
These teach your serratus to work in real movement patterns.
3. Advanced Strengthening
Overhead carries with controlled scapular glide
Turkish get-ups with cueing for scapular depression
Plyometric push-up variations with deceleration control
And most importantly: we don’t isolate this muscle — we reintegrate it into full-body movement patterns that restore performance.
What the Research Says About Treating Serratus-Based Shoulder Pain
Here’s a brief summary of relevant studies backing this clinical approach:
A study in Sports Health emphasized that serratus anterior strengthening significantly improved shoulder function and reduced impingement symptoms in swimmers (Pink et al., 2004).
Br J Sports Med confirmed that restoring scapular control through serratus anterior activation helped resolve rotator cuff pathology and avoid surgery in many cases (Cook & Purdam, 2009).
The addition of manual therapy and targeted scapular exercise showed significantly greater improvement than generalized shoulder rehab alone (Desmeules et al., 2015).
Real Results from Real Clients in Culver City
One Victory client, a 38-year-old filmmaker, came to us after months of shoulder fatigue during workouts and worsening posture at the editing desk. Multiple trainers had focused on rotator cuff work — but it wasn’t helping.
We identified serratus anterior underactivation and implemented a combined strategy of scapular control drills, thoracic mobility work, and strength sequencing.
Three months later, he was lifting overhead again pain-free — and feeling stronger at work, not just in the gym.
Should You Get Your Serratus Anterior Checked?
If you’ve been dealing with shoulder pain that doesn’t respond to:
Traditional rotator cuff exercises
Basic stretching and foam rolling
Massage or posture drills
Time off or modified workouts
You may be missing a key piece of the puzzle. Especially if you notice shoulder blade movement issues, neck tightness, or pain with pushing and overhead movements — the serratus anterior is worth investigating.
And in California, you can start physical therapy without a referral.
Victory Performance and Physical Therapy Can Help
Our team specializes in uncovering the real reasons behind pain — not just chasing symptoms. Whether your shoulder pain is from training, remote work, or long-term postural stress, we’ll evaluate your serratus anterior (and more) to get you moving pain-free again.
🟡 [Request an appointment] today to get a custom evaluation and begin your recovery.
