Serratus Anterior and Scapular Control in Modern Postural Pain

My Dear Reader,

There is a muscle I meet almost every day in clinic — and yet most people have never heard of it until something goes wrong.

It’s the serratus anterior.

When it works, nobody notices.When it doesn’t, the shoulder blade behaves like a shopping trolley with a dodgy wheel — noisy, unstable, and impossible to ignore.

At JANMI Postural Pain Clinic in Marylebone, serratus anterior is one of our most consistent sleepers in modern postural pain.

What and where is serratus anterior?

Anatomically, serratus anterior is a broad, flat muscle that runs from the upper ribs to the inner border of the scapula (shoulder blade).

Its job is deceptively simple:

• hold the scapula flush against the rib cage

• guide it smoothly during arm movement

• help rotate the scapula upward when you lift the arm

In other words, it provides the stable-but-mobile base the entire arm depends on.

No serratus, no quality shoulder movement.

Why I call it a sleeper

Serratus anterior is designed to work quietly, continuously, and reflexively — especially during reaching, pushing, carrying, throwing, and crawling.

Modern life removes most of these demands.

We sit.We type.We scroll.We train shoulders in isolation, often lying down.

The scapula stops needing to move intelligently on the ribs.

So serratus goes quiet.

Then the JANMI pattern appears:sleeping stabiliser, overworking substitutes.

Upper trapezius lifts instead of rotates.Levator scapulae grips.Neck muscles stay switched on.The shoulder loses its base.

Where this shows up clinically

Inhibited serratus anterior often hides behind:

• rounded shoulders

• scapular winging

• neck and upper trapezius tension

• anterior shoulder pain (“impingement” patterns)

• elbow and wrist overload in desk workers and athletes

• arm fatigue that feels out of proportion

The shoulder is blamed.The neck is blamed.Sometimes the elbow is blamed.

The scapula — and the muscle that controls it — is quietly ignored.

A chain reaction worth understanding

The shoulder blade is not decorative.It is a moving platform.

If serratus anterior does not:

• keep the scapula anchored

• guide its rotation

• coordinate with the lower trapezius

then the arm moves on an unstable base.

And unstable bases send stress downstream:to the neck,to the shoulder joint,to the elbow,to the wrist.

This is why people arrive with “forearm pain” that improves when we fix the scapula.

The body is honest like that.

The JANMI focus

At JANMI, we don’t “strengthen serratus” in the gym sense.

We research and test:

• how serratus times its activation

• how it cooperates with breathing and rib movement

• how much effort is enough (usually far less than people think)

Most common serratus exercises fail because they:

• overload too early

• cue too aggressively

• recruit neck and traps instead

Our work focuses on precision, timing, and context — often using short, bodyweight-based drills that look unimpressive but change everything.

Not more reps.Better intelligence.

A note on exercises

Yes, serratus anterior can be reactivated effectively — but only if the neck is calm, ribs can move, and the scapula is allowed to glide.

At JANMI, we always release what’s overworking before asking the sleeper to wake.

A quiet closing thought

You don’t need stronger shoulders.You need a shoulder blade that knows where it lives.

When serratus anterior wakes up, the neck often sighs with relief.

Warmly,Paulius Jurasius

JANMI Postural Pain Clinic, Marylebone