Wednesday Rehab – Integrating Serratus Part 1

Serratus needs very careful integration into functional movements once the client is ready (their biomechanics and pain levels are improved sufficiently) – and this is tricky business!

Hence why we include in many courses and teach you how to use a “Rehab Dowel”, much like a conductor uses a small stick to conduct the orchestra. Nothing fancy, but it does look and feel a little more professional with the branding on it ;))

 

 

 

 

 

 

 

So, as you step up your Athletes shoulder movement into functional positions like in the video today, remember you are training their brain to automatically include Serratus in their movement. That’s the goal. Train the BRAIN. A few more tricks that really help for Conducting Serratus:

  • Use the Rehab Dowel for tapping, stroking, and odd friendly prod 😉
  • Start with lower loads to begin, rehearsing the movement prior to adding loads
  • Cue heavily – the “armpit” cue on elevating or overhead positions, and the “elbow directly behind or underneath the hand” during pushing movements.
  • High reps and frequency through their workout and daily lives
  • Increase the complexity of what you are asking them to do – this has tremendous scope for imagination and that is what our video today is about!

Watch the video

http://www.rehabtrainer.com.au/cafe/serratus-conductor

Wednesday Rehab – SERRATUS SEATBELT WORK: A PEEK FROM PRACTITIONER

SERRATUS SEATBELT WORK: A PEEK FROM PRACTITIONER Course

using  a Belt, Therabands etc.. how to help the scapula during elevation.

 

 

Wednesday Rehab – Serratus Taping: a peek from Masterclass

So, Today’s Video shows in detail how you can use three different taping products for the best result…we have combined products to create the best effect as not loyal to any one brand (except the “Client” as a brand 😉 )

Wednesday Rehab – SERRATUS Question Mark DRILL

The Serratus Q-mark Drill


I can’t help but wonder what learning material we will create as a team of Rehab Trainer Educators for you this year… in any case, we’re not quite finished yet with our massive Serratus Anterior Library of Techniques.

Today – the famous “Q-mark Drill” from Chris (it’s an upside-down Q-mark !). Use a towel or a swiss ball for this cute drill, teach your clients and make sure if they have any shoulder niggles they are doing 30-40 reps / day. NO compromise! 😉

Wednesday Rehab – Serratus Weakness or Muscle Imbalance?

Cerritos Assessment by Experiment 

“Experimenting helps you Assess and see what works”. If a trigger point release helped the pain, or if a new cue helps, or a different set-up for an exercise looked better, then “Why?”. Of course you would continue on with doing what works and build upon that in your corrective exercise and rehab.

So in our Assessment, we might be asking the question:
“If my client is winging at their Scapula during push-up or plank, can we know if that is due to Pec Minor dominance, or due to Serratus weakness? In other words is it a classic muscle imbalance between the two, or just a weak Serratus?”

How can we Assess this by Experimenting? To help explain the point, permit me to use what Chris Mallac wrote recently about Serratus and Pec Minor:

From Chris

Trainers/therapists often claim they see a “winging” scapula (the medial borders of the scapula will stick outward and create a large valley between the shoulder blades – see photos below) and conclude that the client has a weak Serratus Anterior. And no doubt, if you were to grab 10 subjects and ask them to do a push up, or to hold a plank position, most likely 9 out of the 10 will show scapula winging especially as they fatigue.

But is this due to genuine weakness in the serratus anterior, or due to a dominance of another protraction muscle, the pectoralis minor? The easiest way to assess this is to ask them to do a “plus” movement (the experiment). This is an active protraction of the scapula. If the scapula corrects and closes down onto the ribcage then there is a strong argument that the main fault is pec minor dominance (a muscle imbalance rather than classic weakness, as they are able to correct it actively).

To fix this they may need lots of triggering and releasing of pec minor.

If, however, the scapula stays up high and proud even when asked to do the extra “push”, then chances are it is more to do with serratus anterior weakness. To fix this they will need lots of direct serratus anterior activation exercises. I have included some good examples of these two variations in the photos below.

 

 

 

 

 

 

 

 

Client #1 demonstrating Scapular winging on push up bilaterally

 

 

 

 

 

Winging corrects on execution of a “plus” – 

classic example of mild muscle imbalance causing winging

 

 

 

 

 

 

 

Client #2: Scapular winging on push up bilaterally
(his Right greater than Left)

 

 

 

 

 

 

 

 

Left scapula corrects with “plus” however note the his Right is still winged – truly weak and disengaged Serratus that will need a ton of activation and strength work.

 

 

Wednesday Rehab – ISO-INTEGRATING SERRATUS II

This week it’s a much shorter and simpler concept – It’s designed to help fire-up Serratus during elevation in the forward plane. It’s a “selfie” (a drill you do yourself) …so get out some tubing, set it up like in the video, and start elevating. I would get you to do 3-4 sets of 10 or so, slowly and without any pain at any stage.

 

Wednesday Rehab – Iso-integrating Serratus in Scaption

Our challenge as we progress with Serratus Anterior work is to engage it towards upward rotation (which seems harder than protraction for most people). Working from horizontal arm protraction like the Serratus Plank last week, to raising it overhead can be very tricky for those with Impingement Syndromes of many varieties.

“Iso-Integration” initially involves trialing whether using theratubing pulling backwards as a static tension removes their pain they otherwise would have with shoulder press. Why could adding tubing work? Due to its ability to activate “Subscapularis” (the magic shoulder stability muscle), which in turn works with Serratus to help improve upward rotation.

STEP BY STEP GUIDE

  • Position arm in “Scaption” (see bottom of page) to begin with, as that gives us the best chance of success with the sore shoulder.
  • Keep the elbow bent to 90 degrees with forearms vertical;
  • Test the movement without any tubing first to see client’s pain level;
  • Then add the tubing or use the swiss ball (see the video), and assess if their pain is gone or near it. It happens regularly for people!

 

If the pain is gone from the Shoulder Press movement with the Iso-Integration added, then this functional movement becomes a “Rehab Movement” for improved activation of Serratus Anterior and Subscapularis. Do 30-40 Reps twice a day for 2 weeks, aiming for new neural pathways to be laid down. Keep testing if pain is reduced without the theratubing.

 

Rehab Trainer has developed a multitude of signature Iso-Integration drills for use all around the body to try and reduce pain – this one remains our most tricky to perform, so you have to do it carefully to get best results.

Alright hope the video helps to make all of this complexity a little less confusing or muddy.

 

What is Scaption anyway? Also, called “Scapular Plane”, it’s the commonly ascribed angle of 30 degrees forward of the body’s Frontal Plane, where the Scapula sits most naturally for the average person.

 

 

 

 

How to Feel it? Put your arms out to the side in line with your trunk like you are going to do a lateral shoulder press. Then bring your elbows forward so your forearms just come into view, and you will be pretty close.

 

 

 

Wednesday Rehab – How to use the Plank to help fix Shoulder Impingement

Serratus drill that turns the simple plank (which I normally think is a pretty poor exercise in itself, personally because it is so static) into an “Iso-Integration” drill for excellent rotator cuff and Serratus activation. We discussed doing scapular work in the forward plane for safety last week, and this shows another way to progress this in the midst of normal training you might be doing with athletes.

“Iso-Integration” is taught extensively with Rehab Specialists means that Theraband tension is used during the functional movement to super-activate smaller stability muscles. It turns a Functional Movement into a Rehab Movement, basically. As long as you have no shoulder pain at all during the drill of course

 

 

 

 

 

This weeks video below:

A Serratus Blaster

Last Wednesdays article was simply  Scapular Packing utilises the opposite movement to Serratus Anterior so you need to be very selective in when you use it.

  • Use it with arms closer to the body, and

Use it on the pull movement NOT the push movement.

Serratus Anterior and Overhead Shoulder Rehabilitation

Ok so let’s take our Serratus Anterior work into new territory to deal with some of the more tricky and resistant types of athletic shoulder complaints: overhead impingement due to poor scapular positioning and control. 

In rehabilitating overhead movement, the last thing we would ever do is simply start doing overhead press as an exercise! Boy, oh boy will that shoulder get angry as you force all the inflamed soft tissues to friction against each other. 

 

Rather, here are a few safety strategies we will introduce, in order to decrease our chances of aggravating the shoulder (discounting all the myriad of critical loosening techniques of course):

  • work in the forward (sagittal) plane – elbows where you can see them – before the lateral (coronal) plane
  • warm- up with emphasis on the protraction element (easier to activate and cue) before you attempt to train the more subtle upward rotation element
  • train beginning and end positions of overhead press statically, before progressing to the full movement through
  • use iso-integration (tubing tension in various directions) to reduce pain and help maintain good scapular position and rotator cuff activation.

Today’s video (below) and the next few weeks’ worth of videos will explain it all…