I thought I would share my recent experience with everyone here because it could help you. I just spent 5 months away from the gym, losing tons of mass and strength and degenerating into a normal person. The problem I suffered from is incredibly complex and not very well-understood, even by physicians, orthopedists, chiropractors or sports therapists.
Do a google search for "serratus posterior superior." You'll get a few definitions and a couple of pictures. It takes some real digging to find the trigger point article on it. And there's only one I know of. If the internet doesn't have a lot of info on it, you can bet your average backwater sports therapist has no idea.
The serratus posterior superior is a DEEP muscle attached to several of your top ribs and responsible for lifting the ribcage during breathing. It is covered by your shoulder blade, but that means it has three big layers of muscle and one layer of bone sitting on top of it. It's not all that difficult to get to if you move the shoulder blade out of position, though.
For those of you who haven't heard of trigger point therapy or foam rolling/tennis ball, I suggest you stop reading this now and immediately read some stuff on it. For those of you that have, you know that trigger points develop in muscles that are overused and must be manually destroyed in order to maintain proper function of the muscle. There are trigger point charts out there to show you where the most common locations for these buggers are, and you can use them to get an idea of where your latent ones might be. If you're actively tight and feeling pain, you already have one anyway and you should be able to locate it.
The point is, when trigger points develop in the serratus posterior superior (SPS), the symptoms are complicated and the condition is extremely difficult to diagnose. The principle pain felt is a deep ache seemingly behind the shoulder blade. However, the true pain may be masked by referred pain. Some side effects that trigger points here can cause include numbness or pain in the rear delt, elbow or fingers. It can also affect the triceps region and it can cause pain in your chest. Sounds a lot like, well, everything else that can go wrong, no? Symptoms of TOS are mimicked to some degree by trigger points in the SPS. For the longest time, I was sure I had TOS because any time I put my arm above my head, I ended up with numbess and tingling. I also found it 100% impossible to use my rear delt, and dermal sensation through the back of my shoulder was minimal (for example, I was hooked up to a tens unit and they put enough juice through me to cause my whole arm to move, but I still felt nothing).
You could go see a therapist who could diagnose you with some kind of elbow problem. The numbness in your hands might be interpreted as carpal tunnel or TOS. There are a multitude of other maladies and misdiagnoses that could happen too. I went through almost every one of them myself, poured thousands into therapy, herbs, massage and chiropractic care and spent a ton of money on equipment I didn't need to buy. The more I searched on the net, the more conditions I found and I kept eliminating them one by one, either by symptom lists or by negative treatment.
Finally, I found this site: http://www.pressurepointer.com/pain_reference_chart.htm
This site is the only site I know of that mentions the SPS or talks about trigger points that develop there (it is also extremely handy for other muscles so check it out). It tells you you need a special cane to get at the SPS, but I can tell you that simply laying on a tennis ball works just as well and doesn't require a mail order that takes weeks to get to you.
So what's the point of this post? If you're having chronic shoulder problems that seem difficult or impossible to fix, give this a shot. Try running some sprints and see if your shoulder bothers you then. If it does, I'll bet you have trigger points on your SPS. Odd that your shoulder should hurt when you run no?
And the treatment: get your tennis ball ready. Find a good place to lay down on the ground, shut the doors and windows and warn everyone within earshot that they may hear you crying from pain. You put the tennis ball somewhere around your shoulder blade area. But, just before you put your weight on the ball, pull the affected side's arm over the front of your body. Your objective is to move the shoulder blade out of position to the side, exposing the SPS (look for a few pictures if you haven't already). It's pretty obvious how to get at it once you see how it's located. Now, put your weight down on the ball right where your shoulder blade used to be. Ease onto it, if you're tight this is going to hurt just as bad (if not worse) than the ITB on the foam roller. Once your entire weight is down (this may take a few minutes of grinding pain and eyes tearing up), roll around a bit to start really taking out those trigger points. My SPS has been tight forever, so it hurt like the end of the world for me, but your pain is still going to be pretty bad with any degree of tightness.
Repeat this three times, twenty minutes apart or so for 3-5 minutes at a time. Then go to bed and prepare to be extremely sore tomorrow. With this simple treatment, along with my routine tennis ball treatment and foam rolling, my shoulder pain was gone literally overnight. I am back to putting my arm above my head with no bad biomechanics and I feel much lighter and more flexible.
Like I said before, this muscle has barely been given consideration by most therapists and diagnosing problems in the SPS is extremely difficult to do. For those of you who are suffering from anything in the following list, give this a try (this list is the progression of diagnoses I went through to finally realize relief):
Shoulder impingement due to...drum roll...kyphosis (normally that's a safe bet but not this time) -> recommended: rotator cuff work (I know dumb)
Scapular winging due to serratus anterior atrophy -> recommended: serratus anterior strengthening
Thoracic outlet syndrome due to poor posture (forward head) and misaligned cervical vertebrae -> recommended: 12 sessions of intense (and costly) chiropractic adjustment
At this point, I was 4 months out of the gym and absolutely fighting tooth and nail for anything that could make me feel better. I looked up everything on the net about thoracic outlet syndrome, including forums here and on tnation. What I found is that some guys end up getting bad TOS from having a leg too tight or something. I foam rolled the begeesus out of my right leg as I knew it was tight, but I had no idea how bad it was. The fascia was so tight it was impossible to stretch the muscle and my pelvic tilt was, for all practical purposes, intensely incorrect. However, after foam rolling all of the tightness out, stretching out the muscles and realigning the hips, still no relief in the shoulder area (of course I rolled/tennis balled the shoulder area too - everything I could think of).
FINALLY I found the SPS and its trigger points. In less than an hour I was completely and utterly relieved of almost all of my pain. Trigger point therapy has been called "not quite a miracle, but damn close." The only reason it isn't a miracle is because it takes at least a few days to relieve the worst of symptoms. But come on, a few days? Relative to 5 months of average American sedentary lifestyle completely against my will, I'll take three days of treatment to fix permanently a problem I've been living with since I started lifting years and years ago.
So take my advice: If you have a chronic problem that seems impossible to fix, give this a shot. At the very least, if you aren't already foam rolling or tennis balling, you ought to be. Maybe your problem can be solved by rolling a different area out, who knows. Even if you have NO apparent problems whatsoever, I guarantee foam rolling and tennis ball therapy can make you feel better.
Thanks all, and I am happy to bring you info on this obscure, incredibly-difficult-to-diagnose problem. I hope you can get something from it.
06-10-2009, 11:17 AM #1
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Serratus Posterior Superior - Quiet Shoulder Destroyer
06-10-2009, 11:46 AM #2
03-16-2010, 03:54 PM #3
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03-17-2010, 09:11 AM #4
03-18-2010, 11:44 AM #5
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Quick question - With trigger points when you use the tennis ball and roll it along the back muscles is it for certain that any pain or sore spots you feel are trigger points or is it possible that it could just be normal nerves that you're pressing on?
I have tender spots in my upper back but i just dont wonna be pressing the hell out of them if theres a chance i could be damaging anything lol.
03-20-2010, 06:09 PM #6
I just realized today i had the same issue...
to make a long story short i too suffered from different symptoms...the restriction in this muscle had caused other muscles around my body to compensate over year and years to where i was really out of whack....so i was able to roll out various trigger points and finally seemed to be in proper alignment, but my shoulder/scapula area still felt awkward...
So i realized i had scapular winging...had even experienced a shooting pain through my thoracic nerve before, which is a classic winging symptom, so i was sure it was my serratus anterior. I started doing strengthening exercises for it. One was basically holding an extended push up position and taking turns just using one arm, then the other. Well after several reps i went for a run and midway through felt this pain under my shoulder blade...i knew immediately it was a knew trigger point that popped up. I worked it out, and voila, my torso straightened out significantly and i felt my spine extend some as well. It made a HUGE difference. It did make me realize that my opposite hip is still a bit tight, but that seems to be the final step for me.
i also checked my scapular winging and it was practically gone. It still kicks in slightly if i move my shoulder too quickly or forcefully, but i'm sure that''ll go away on it's own with the new memory the muscle should collect through workouts.
03-20-2010, 06:15 PM #7
what i do is wait until i'm not sore from any type of physical activity. If you're sore from working out then you're likely to get confused between actual trigger points and sore spots.
usually the trigger points have a very distinct feeling...somewhat painful, but once you're on it it's kind of addicting, you can't get off of it even though it hurts because there's something soothing about it within the pain. Some release within seconds, generally no more than 30 seconds or so is needed. If you end up on a nerve you should be able to tell right away, it would feel like hitting your funny bone, but the feeling should be more localized.
And I think you should consider buying some foam massage balls that are made specifically for this, you can buy a set of different sizes and softness for maybe 20-30 bucks. It really helps to have different sizes since muscles come in different shapes and sizes and your body isn't flat all over. the varying degress of softness come in handy with deeper trigger points or really painful ones.
Last edited by sixthman6; 03-20-2010 at 06:20 PM. Reason: adding info
03-25-2010, 04:15 AM #8
05-12-2010, 10:10 AM #9
Great thread, the Serratus poestrior inferior which is attached to your lower ribs from the lower vertebrae can cause havoc too. Apparently it used to aid a twisting motion, and also assists in expelling air from your lungs. Lower back pain, breathing problems, anxiety, can have a vairety of symptoms. Some overzealous ab work with twisting created trigger points in mine.
I also agree about the various therapists, very hard to find someone who knows where the root cause is. I used a book called Trigger Point Therapy by Claire Davies, what a fantastic book. Goes through self-massage techniques for the various trigger points, mainly using a tennis ball or theracane.
07-21-2010, 07:32 PM #10
08-22-2010, 01:12 AM #11
Good post. I hav i very similar problem that no one can diagnose. My right scapula has been winging out 4 almost a year now even after leaving gym all together. But i do not get pins and needles in my arm at all. My serratus posterior is extremely tender in spots under the scapula which leads me to believe i could hav the same problem. And my right pec cannot function properly ie: contract compared to the left pec. Does anyone else have this problem with their pec not being able to contract properly and wasting away. Ive had x rays, mri's and seen dozens of chiros massuers and osteos which have lead to no answers. If someone could shed some light that would be a great help
08-22-2010, 05:43 AM #12
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01-13-2011, 01:04 PM #13
This thread is getting old, but thought I would reply. In my research I came across this muscle as a possible problem area, but after reading these posts I'm 99% sure now so thanks for posting. Shoulder blade winging (when I make it do so), hurts when I run, shoulder blade popping, tingling down arm, and 'yes' to one of the posts about the pec on that side being smaller - same here.
07-02-2011, 06:49 AM #14
11-08-2011, 06:30 PM #15
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This was a HUGE relief finding this!! I haven't been on here in a while but after paying therapy bill after therapy bill I had to do something. I have scapular winging and any pressing movement I do, I can feel my right shoulder blade immediately start to wing. I really hope after I try this I can get back to lifting because I haven't been able to lift for real for a long time! Nice find and thank you to all who have contributed to this!!!
11-23-2011, 09:54 PM #16
11-27-2011, 02:58 AM #17
12-03-2011, 07:54 AM #18
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02-25-2012, 12:28 PM #19
Not sure how you tell if you have scapular winging. I mean I can make them wing if try to but I think anybody can. Does winging mean that they "wing" whenever your arms are forward? I have some shoulder pain and I also have a long existing muscle pain that's located about 1 inch to the right of the spine in line with the lower portion of the shoulder blade. It's not quite behind the shoulder blade but it's close. This muscle pain mainly triggers when I'm doing the eccentric portion of any overhead pressing movement.
03-01-2012, 08:29 AM #20
I have a trigger point in my serratus posterior as well. I have them all over my back. Ruined my life for the past 2 years and took a year to even get a diagnosis on them. I also had the thoracic outlet syndrome style neuralgia in my left arm and hand which went away after trigger points in my trapezius and levator scapulae muscle were removed.
03-07-2012, 11:56 AM #21
To whom it may concern:
I've posted some issues I've had with LTN damage/Scapular winging since late last year. My issues began on October 21st, 2011. My symptoms were not being able to raise my arm over head and sustain it there without it falling to the side. It was due to my serratus anterior not functioning properly due to LTN misfiring. It began with serious pain shooting down my shoulder to my elbow area. That pain last for a couple days and went away. Since the date I mentioned I visted every time of doctor to determined exactly what it was and how long it would take to heal. None indicated surgery was needed. All I needed was time to recover. Also they couldn't determine cause of injury, its uncommon but it happens. Could be an immune system thing, muscle imbalance, injury from repetative lifting. I think the latter was my issue but I can't be sure. Today is March 7, I've started the recorvery process as off 2 weeks ago. Slowly I started to feel progress as my arm strenght came back and my range of motion returned. The progress was so little but I felt a difference enough to motivate me more to continue what I was doing in the gym. I will say to you that are going through this issue is to continue a physical therapy program to sustain the muscles that are working to prevent other injury and minimize the work you need to do when you start to recover. Thats what I did. I went to the chiropractor as others suggested however I don't feel that helped me. What did helped was stretching and pinpoint massage of the trigger point areas using a tennis ball or lacrosse ball (lacrosse ball hurts but it lossens up tight muscles- do it agains a wall). It became and obsessive compulsive thing that develop but it seems thats what it takes to get those knots or muscle spams out of the shoulder so the LTN can breathe and fire properly. I'm almost one hundred percent and I hope this help. When I was going through this I couldn't do anything and looked for answers but nobody was sure what helped. Well now, I've been through it and out almost reaching the light at the end of the tunnel. I continue to have a small know near my clavicle bone around my neck that I know is causing some tightness but I'm working that out with massage. I hope this read helps someone. If you don't experience pain just be patient and workout light. Do exercises, stretches, stretches, massage, and patience, oh, and more stretches. At one point I felt progress and regressed for a couple days because I was overdoing the exercises. Anyways, good luck.
Ronnie ( firstname.lastname@example.org ) if you would like to email me directly.
03-27-2012, 09:10 PM #22
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I had a similar experience but was fortunate enough to find someone who diagnosed it fairly quickly. For anyone dealing with sports injuries I highly recommend seeking out and going to a chiropractor who incorporates Applied Kinesiology. My regular chiropractor is very good but he totally missed the problem. The applied kinesiology practitioner figured it out with in five minutes and pretty much corrected the problem in one visit.
03-29-2012, 03:51 AM #23
Im having shoulder issues and have been out of the gym just like you for 4 months now , and the pain is only slighly better than it was 4months ago
I have gone to physio and it was diagnosed as long head bicep tendonopathy but yet it is taking an awful long time to recover when i havent done anything strenuous in 4 months
Do you recommend me tryning this treatment OP ?
03-30-2012, 09:18 PM #24
I have a winged left scapula, slight twinges of pain in my elbows(right predominantly), a numbness over my rotator cuffs, and a deep dull ache near the middle of my back usually the day following a chest day, also a tingling numbness shoots down my forearms on triceps pushdowns with overhand grip on straight bar as well as a burning sensation starting at rear Delts going down triceps during triceps kickbacks, I'm glad I read this post. Thanks, repped.
04-15-2012, 02:23 PM #25
I've been out of the gym for almost 1 year....
I've got my chest cat scanned. Numerous chiropractor visits. 6 Physical therapy visits. A few doctors appointments.
Nobody could help me. I've always wondered why I had problems with my left side.
I made a few posts awhile back on bodybuilding.com....Nobody had answers.
Ever since this problem started happening. I always would rub my back around the corner of the wall. I would put my left arm over my body, Put the corner of the wall in the crack of my scapula and take that bad boy to town. I didn't know what it was but I could never get enough of it.
I have all these symptoms though. Insanely tight chest muscle (pec). Over time my shoulder slouched forward, pain in elbow, pinched Tricep feeling, little bump in between my shoulder blade that I love to rub but at the same time it hurts. I have some pain right up where my pec and my clavicle meet it is also really tight right there too.
I've been doing the tennis ball massage therapy though. I tried to really rub that thing out. I've been doing it for 3 days. It seems like the tennis ball trick is just temporary though. It just keeps coming back. I also have a really bad trigger point where my lat and armpit meet. Kinda where the rear delts are at but a tad bit lower.
Should I get a lacrosse ball and just really pound them out and make myself cry with pain and anguish? Do you think that will help? I don't want to try it and then really mess my body up. Also after I pound them out with the tennis ball do you think it would be a good idea to put a heat pad on them to increase blood flow? Should I massage them everyday? Or how often should I wait between massages?
But man.....Words cannot describe how happy I am that I found this thread. I finally feel like I am in the right direction. After 11 months away from the gym.
Last edited by elizzle; 04-15-2012 at 02:57 PM.
08-08-2012, 02:19 AM #26
Ultrasound / Fibromyalgia?
Trust me, I know this feeling. Desperately foamrolling, tennis balls, rubbing up against wall corners, hammers even, pain keeps coming back.
One thing that did work for somewhat more than short-term relief was physiotherapy with ultrasound. Those waves can penetrate deep into the body where no tennis ball has gone before. Hell, it's possible to shatter kidney stones with ultrasound, and with much lower intensity it can release trigger points beautifully.
If you're like me, you'll probably find that even THAT is no ultimate solution, My trigger points keep coming back within a few days no matter what. And I'm not even away from the gym. After visiting countless doctors, physios, chiros, ayurvedic massage, accupressure yada yada, I've come to the conclusion that I suffer from FIBROMYALGIA, which is basically muscle pain and stiffness caused by a combination of too many subtle factors to even diagnose properly.
The treatment for this (barring depression meds and muscle relaxants) is leading a stress free life, plenty of deep breathing and meditation (yup), extremely clean diet, regularizing sleep patterns (10pm to 6am), and avoiding stimulants like caffeine nicotine altogether (alcohol too, but in moderation it can help you relax and actually reduce pain). Foamrolling and tennis balls work for temporary release.
I find that when I lead this extremely disciplined and healthy lifestyle, I develop trigger points less often and I'm relatively pain-free. However, living like this is not feasible all the time - with college and work and requiring to stay up late.... in which case we're destined to suffer this constant nagging pain.
08-09-2012, 04:59 AM #27
In the same boat as most of you guys.
Found this thread about 4 months ago because I was desperately searching for solutions to get rid of the ache I had around/under my shoulderblades.
In 4 months I aggrevated it alot by training and competitions. Now I'm at a point where I have constant pain and discomfort.
I no longer feel comfortable working out nor do I want to run the risk of tearing something.
Just had a new prescription for 9 sessions of physio, after the first sessions he felt around the area and there must've been 6-10 big knots in there: Traps, infraspinatus, lats, lower back. The once under my traps feel like golfballs, everytime he puts pressure on them I feel them shoot away.
I'm glad that he's working on them but it's gonna take some time to get rid of it.Ases's MAX-OT styled keto bulk:
09-21-2012, 06:38 AM #28
Ive been suffering for nearly a year. Your right when you say not much is known about sps. Ive spent so much money and time trying to fix this.
Ive been to doctors, phisios, & chiropractors. Ive had xrays & mri's & tests to try to identify the problem.
All these have failed until i spent (a lot) of time on the internet trying to pinpoint this pain.
I came across your post two weeks ago and i gave it a go.
I am a completely different person. It is not completely gone yet, but the relief i have gotten already can only be described heaven!!
This has to be a very common and i cannot believe so little is known about this??!!
Well done on the great post & thanks again
10-24-2012, 07:54 PM #29
10-26-2012, 11:03 AM #30Arnoldís 6 Rules
Break the rules
Donít be afraid to fail
Donít listen to the naysayers
Work your butt off
Give something back
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