+Donna Martin
Dec 262012

What pain and symptoms are associated with the serratus anterior?

Areas of pain contributed to the serratus anterior.

Pain in the side of the chest, arm, fingers and middle back can indicate serratus anterior dysfunction. People with asthma, emphysema, and chronic bronchitis often experience problems with this muscle.

  • Pain on the side of the chest toward the middle of the ribcage
  • Pain down the arm to the fourth and fifth fingers
  • Pain below the shoulder blade
  • Difficulty breathing
  • Sharp pain in the side (side stitch)

Where is the serratus anterior muscle?

The serratus anterior attaches ribs 1-8 to the shoulder blade.

What movements does the serratus anterior control?

  • Raises the arm
  • Aids in inhalation by raising the ribs

Activities that cause serratus anterior pain and symptoms:

  • Throwing a ball
  • Tennis
  • Running
  • Cycling for extended periods of time
  • Chin ups, Push ups
  • Weight lifting
  • Gymnastics
  • Hyperventilation
  • Severe coughing

Interesting facts about the serratus anterior:

The serratus anterior muscle can be found on the side of the ribs.

You use the serratus anterior muscle to raise your arm and to inhale during breathing.

The serratus anterior is easily taxed by hard or heavy breathing. People with asthma and emphysema often suffer from symptoms of this muscle. Tightness and trigger points in the  serratus anterior can cause headaches, jaw pain, dizziness,  and numb hands for those who have difficulty breathing.

Clinical diagnoses to which this muscle symptoms may contribute:

Thoracic outlet syndrome, Rib subluxation/dislocation (Slipping rib syndrome), Fractured rib syndrome, Intercostal muscle tear, Osteoporosis, Osteoarthritis

Other muscles that should be considered and examined in conjunction with the serratus anterior:

Help with Serratus Anterior Muscle Pain and Symptoms

Sombra Warm Therapy Gel provides pain relief.
Warm Therapy Gel for Serratus Anterior Muscle Pain

Sombra Warm Therapy Pain Relieving Gel is a pain relieving gel that I use both personally and in my massage therapy practice. Unlike other over the counter heating creams, it provides warmth without burning heat.  Applying Sombra to the serratus anterior muscle as well as to the upper back, chest and arm area can help relax muscle spasms caused by the serratus anterior. I recommend Sombra for chronic pain and chronically sore tight muscles.

Cold Gel Therapy for Serratus Anterior Rib Injury and Pain

Biofreeze is recommended for recent muscle injury

Biofreeze Pain Relieving Gel is an excellent pain relieving gel that I use on clients who have sudden onset muscle pain or recent injuries.  Biofreeze Cold Therapy gel works  like ice  and does not promote swelling. A recent study showed that Biofreeze decreased pain 2 times more than ice and the pain relief lasts 9 – 10 longer. If  your pain is from a recent injury such as strained serratus muscle from coughing or recent high rib injury that affects the serratus anterior,  I would recommend Biofreeze.

Hot Cold Packs For Serratus Anterior Muscle Pain


SofTouch Large Hot Cold Pack is a large pack that can be used for hot or cold treatment. The pack is large enough to cover the serratus anterior muscle and drape down over the back. To treat the serratus anterior lay your unaffected side and drape the pack over the side of your ribs starting  just under the arm covering the side of the rib cage.

The inside of the pack contains a clay like substance that remains soft and pliable so you can mold the pack to your body. The outside of the pack is wrapped with soft suede like material that does not shock the skin when touched. My clients love this pack and it is now the only hot and cold pack that I use in my massage therapy practice.

Breathing Correctly Can Help With Muscle Pain


Improper or irregular breathing is one of the main contributors to serratus anterior muscle dysfunction.  Learn To Breathe is a DVD by internationally renowned yoga instructor Max Strom that walks you through several breathing exercises that will help you improve your quality of breathing. The exercises are especially beneficial for people who suffer with breathing problems such as asthma  emphysema  COPD and allergies.  I often recommend this dvd to friends and clients who have breathing problems. Yoga experience is not necessary.

Braces and Support To Help With Serratus Anterior Muscle Dysfunction


Rounded shoulders and slumping upper body posture are can contribute to serratus anterior pain and breathing difficulty.

ShouldersBack Posture Support gently pulls your shoulders back helping you maintain straight correct posture while stretching and elongating the chest muscles.

I use this brace myself when I begin to feel twinges of pain in my shoulders and upper back. I have recommended it to family, friends and clients who have pain due to slumping upper body and rounded shoulder posture. If you have rounded shoulders, begin using the brace slowly for short periods of time. As your body adjusts, you can tighten the support and use it for longer time periods. This brace is not a rigid support, you can still move comfortably and freely, it does not forcibly hold your shoulders down and back.

Treatment For Your Serratus Anterior Pain

The Trigger Point Workbook can help you resolve muscle pain throughout your body.

Injury to the serratus anterior muscle can cause a multitude of symptoms. If you are suffering with pain on the side of the rib cage, pain just under the shoulder blade, pain and numbness in the arm going down into the ring and little fingers, and often have sharp pains in your side (side stitches), then your pain is likely trigger points in the muscle. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief will help you locate and treat these trigger points, relax the muscle, and relieve and possibly eliminate your symptoms.  Not only will this book help with your serratus anterior muscle pain, but it will also help with other muscle pain that you may be experiencing!

Anatomy Study: Origin, Insertion, Action and Innervation of the Serratus Anterior Muscle

Origin: Fleshy slips from the lateral aspect of the superior eight ribs and anterior intercostal membranes from the midclavicular line, the lower four slips interdigitating with external abdominal oblique
Insertion: Volar surface of the axillary border of the scapula, spanning the superior and inferior angles
Action: Protracts and stabilizes scapula, assists in upward rotation.
Innervation: Long thoracic nerve (C5, 6, 7)


Primary Actions:

1. Upward rotation of the scapula

  • Agonists: Trapezius
  • Antagonists: Levator Scapulae, Serratus Anterior (upper fibers) Rhomboid Major and Minor, Pectoralis Minor

Stabilizer: Trapezius

2. Downward rotation of the scapula

  • Agonists: Levator Scapulae, Rhomboid Major and Minor, Pectoralis Minor, Trapezius (middle fibers
  • Antagonists: Trapezius (upper and lower fibers), Serratus Anterior (lower fibers)

Stabilizer: Trapezius

3. Protraction of the scapula

  • Agonists: Pectoralis Minor
  • Antagonists: Trapezius (middle fibers),  Rhomboids Major and Minor

4. Depression of the scapula

  • Agonists: Pectoralis Minor, Trapezius (lower fibers)
  • Antagonists:Trapezius (upper part), Levator Scapulae

5. Stabilizes the medial border of the scapula to the chest wall during movement of the arm at the shoulder

Satellite Trigger Points: Latissimus Dorsi, Scalenes, Sternocleidomastoid

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