Shoulder Pain? Get Pushy!

How come Arnold Schwarzenegger is so good at pushing people around? Well apart from his alarming size, he has excellent use of his Serratus Anterior – what I call the ‘Arnie Muscle’.

Yes Folks, it’s not just a muscle for bodybuilders and boxers, we all have these. One of the more unusual muscles of the body, we see it as it attaches to the ribs at the front – those ‘fingers’ of muscle coming around the sides under his armpit. But the Serratus Anterior starts on the surface of the shoulder blade – the interior surface that lies next to your ribs at the back.

Key functions are:

1) Protraction of the shoulder – i.e. pushing forward. This muscle takes your shoulder forward beyond your normal arm’s length. Great for keeping your opponent at bay!

Try this little exercise to ‘get’ the motion.

• Raise your arm up to horizontal in front of you. Keep your shoulder still. It might help to do this with your hand against a wall at shoulder height.
• Then, reach forward. Your arm stays horizontal, but your actual shoulder area (called the shoulder girdle) moves forward. If you are doing it against a wall, you will be pushing your body away from the wall.
• Relax your shoulder back to neutral again, making sure you don’t hunch your shoulder. Push your shoulder forward again. If you focus on that movement, you may become aware of your shoulder blade moving forwards around your rib cage as your shoulder moves forward. This is the Serratus Anterior in action.

2) Arguably the most important function of the Serratus Anterior is scapular stabilisation. If it is strong and functioning well, it holds the shoulder blade (the Scapula) flat to your back throughout its various movements, providing a stable base from which your hand can perform all the myriad tasks we want it to. Like nun-chucks for ninjas. Or getting chocolate off the ‘sin’ shelf without rustling when nobody’s looking. Like all shoulder muscles, it rarely acts alone, and is supposed to work in harmony with the rest of the shoulder movers.

I see so many patients with all sorts of shoulder pain and movement dysfunction, and many of their problems can be traced back to a weakness or deactivation of this muscle. Notably, this can still be the root cause, even though the pain is often felt elsewhere. This is because often the other muscles of the joint are in pain from overloading in compensation for the weak Serratus.

Classic signs include the shoulder blade popping out when pressing the palm against a wall (around waist height, fingers downwards), or even in more severe cases simply the bottom corner (‘inferior angle’) or middle edge (medial border) of the scapula sticking out when at rest in standing, sitting, or lying face down.

This is called ‘pseudo – winging’ (true winging is the result of a damaged nerve, not seen very often and something for another blog). One side is often worse than the other, though of course this depends on the case in question. Many people are non-symptomatic, i.e. have a weak serratus with no painful symptoms, and pseudo-winging is actually normal in young children as their body is still developing its stability and control mechanisms. Nevertheless, it can cause a lot of pain and problems, but isn’t identified perhaps as often as it should be.

How does it get this way?

Anatomically, the shoulder area is commonly termed the Shoulder Complex – and for good reason. Muscles at the back, front, sides and the ones winding through from one plane of movement to another are all designed to work in harmony, stabilising and moving the incredibly shallow ball-and-socket joint of the shoulder in all its ranges of movement. No other joint has such freedom, and it is all down to the coordination and cooperation of over 17 muscles on each side.

This harmony can easily, and commonly get disrupted. Slouch, tightening the muscles of your chest, and the back muscles quickly become long and weak. Your neck extensors (i.e. at the back of your neck and upper shoulders) start working overtime, leading to stiffness, aches, and even headaches. Some sources claim that this frequently seen posture can even restrict lymph flow in the armpits – key processors of metabolic and immune system waste.

The Serratus, though perhaps a key contributor to shoulder pain, is often a victim of our lifestyle habits and poor posture.

How can we be like Arnie?

So, what to do? As mentioned above, the Serratus is often the silent cause of a painful problem elsewhere. People often get aching and stiffness in their upper arm or neck rather than actually in the muscle in question. If you know that Serratus is the problem, the video below is a useful guide to one of the most common exercises. It’s a bit of a weird movement to do, and takes a bit of practice, because the Serratus has such a specific role. Give it a go, and ask a friend or partner to watch or even video you: they’ll be able to tell you whether your scapula is holding its posture well or winging out all over the place. Get them to watch you again after a couple of weeks and see how you have improved. Few people have a ripped Serratus as their fitness goal, or want to show it off in various shades of orange, but there’s no denying we can all benefit from a stable shoulder. And a little smugness.

Shoulder exercises

However, if you have shoulder pain, it really is best to get properly assessed, as the root cause needs tackling, not just soothing the painful area. It may well not be Serratus that is your problem, it could be any of the other muscles, or something else entirely, but for a full and lasting recovery, the question of the true cause needs to be answered.

I personally know of people who have actually had injections and even shoulder surgery for pain in the joint though their actual problem was poor muscular stability of the shoulder, which LEAD to joint pain.

I know which course of treatment I’d rather go for.

And I know I wouldn’t want to argue with Arnie. Would you?!