Most people will recognize the serratus anterior as the really cool looking muscle that sits just over top of the ribs and is visible only on someone who is very lean.

As sexy as it is though, this muscle has a function that is more important than just grabbing attention at the beach.  If you have a shoulder blade that sticks out (otherwise known as a winging scapula) you probably need to strengthen this muscle.  The push up plus is a great exercise for this purpose.

However, this article isn’t about how to strengthen the serratus anterior.  Instead, I want to talk about what to do when you’ve tried all the standard exercises and you’ve still got dreadfully winging scapula.

If this sounds like you, then you could have a problem with the nerve that supplies your serratus called the long thoracic nerve.  This nerve comes out from the cervical vertebrae in your neck and winds its way down to the serratus anterior.  When this nerve becomes compressed at any point along its path the serratus won’t fire properly no matter how much activation work you do.

Fortunately, the most common restriction with this nerve happens in the neck as it passes through and around the middle scalene.  When this muscle becomes tight the nerve can be compressed and it won’t function properly.  Tests such as an EMG or a Nerve Conduction Test from your doctor can confirm this.

If this proves to be the case, this can usually be rectified with a couple visits to your local ART practitioner.  Often they can manually release the restriction and allow the nerve signals to travel to the muscle allowing it to contract properly.  If this fails (and it sometimes does), surgery is an option, but I’d suggest going the manual route first.

Usually, once the nerve is released a few weeks of doing some activation exercises for your serratus is all you should need and you’ll be as good as new.

However, I should note that once you’ve taken care of the initial problem, make sure not to carry bags of any sort on that shoulder (ladies, this means no purses) or you can cause the issue to come back.