From Boxing to Breathing: The Many Functions of the Serratus Anterior Muscle

The serratus anterior is commonly referred to as the Boxer’s Muscle. It is a fan-shaped muscle that originates on the superolateral surfaces of ribs 1 to 8 (or even 9 in some people) at the lateral wall of the thorax, and inserts along the superior angle, medial border, and inferior angle of the scapula.

Given its anatomical location, origin and insertion, and extensive documentation, we know that the serratus anterior muscle is critical in healthy shoulder function. Specifically, it helps stabilize and move your arm forward and overhead when reaching. It also helps with upward rotation and protraction of the shoulder blade.

What is not so well known in mainstream literature is its role in back pain, neck pain, and respiration. When a muscle as broad as the serratus anterior becomes dysfunctional, many symptoms can arise. The neck may become stiff and painful. The mid-back may have difficulty going into backward bending (extension). The low back may have restrictions going into forward bending (flexion). However, its main culprit may be that the person is simply not breathing optimally. Allow me to explain…

In recent years, humans have become dependent on technology. We are constantly looking down at a computer, tablet, smartphone, and most likely sitting when doing so. This puts our spines into an exaggerated forward head posture with thoracic kyphosis (flexion) and increased lumbar lordosis (extension). Our shoulders shift forward too much. Our pecs and upper trap muscles become overactive. Our neck flexors (front of neck) and lower traps become underactive. This is all documented thoroughly in Janda’s Upper Cross Syndrome. These musculoskeletal changes can alter the position of the rib cage, which alters the position of the serratus anterior and diaphragm. 

The change in position of these muscles also affects the way we take in and expel air. We tend to breathe more with our neck and chest, and have a more difficult time getting air out. If air is not fully exhaled, how can you expect to get in new, cleaner, oxygenated air? It’s extremely difficult.  

It all starts with limiting how much you’re in certain positions. Too much sitting is no good. Too much time on a computer or smartphone looking down is no good. But chances are, if you are reading this post, you have been subject to these postures for a long time. Well, at least since the start of the Pandemic. 

The good news is that you can work on changing this. In addition to opening the chest, stretching the hip flexors, and strengthening the front of your neck, improving all functions of your serratus anterior will help, especially your breathing function. Learning to “breathe into your back” will go a long way in alleviating all of the above mentioned symptoms of shoulder pain, neck pain, and mid back pain. Check out these videos to learn how to do this!

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

Dr. Bryan Carestia

Physical Therapist | Doctor of Physical Therapy | Owner (Newtown)
Bryan Carestia is a Doctor of Physical Therapy (DPT) and Certified Strength & Conditioning Specialist (CSCS) with nearly a decade of experience in outpatient orthopedics. He works at Activcore in Newtown, PA and services Bucks County, Pennsylvania and Mercer County, New Jersey. With an extensive clinical background and education, Bryan is uniquely qualified to handle more complex pain conditions that other practitioners could not resolve.
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