Serratus Anterior Muscle: The Missing Link Between Your Core and Pelvic Floor

As an orthopedic and pelvic health physical therapist, I often get asked: “Why does my shoulder have anything to do with my pelvic floor?” The short answer is that everything is connected, especially when it comes to postural support, breath mechanics, and core stability. And one often-overlooked muscle that plays a pivotal role in this full-body connection is the serratus anterior.

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So let’s talk about why this muscle matters so much.

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What Is the Serratus Anterior?

The serratus anterior is a fan-shaped muscle that wraps around your rib cage and attaches to the shoulder blade (scapula). Its main job is to hold the scapula against the rib cage and help move it forward and upward—key for overhead movement, pushing, and stabilizing the shoulder.

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But here's where things get interesting: the serratus anterior also has a direct relationship with your rib cage positioning, breath mechanics, and, ultimately, your core and pelvic floor function.

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The Rib Cage, Diaphragm, and Pelvic Floor Trio

To understand the serratus-pelvic floor connection, you have to understand the pressure system of the body.

Your diaphragm sits under your rib cage and is the primary muscle for breathing.
Your pelvic floor mirrors the diaphragm at the base of your core.
Your core—especially the transverse abdominis and deep stabilizers—connects the two.

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When you inhale, the diaphragm descends, intra-abdominal pressure increases, and the pelvic floor lengthens slightly. When you exhale, the diaphragm lifts and the pelvic floor recoils. For this system to work efficiently, your rib cage must be aligned in a way that allows the diaphragm to move properly.

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This is where the serratus anterior comes in.

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How the Serratus Supports the Core and Pelvic Floor

A well-functioning serratus anterior does more than stabilize your shoulder—it:

Anchors the Scapula to the Rib Cage: When the scapula is stable, your thorax (upper trunk) becomes a solid foundation for breath and movement.
Promotes Optimal Rib Cage Positioning: A strong serratus supports a neutral rib alignment, which allows the diaphragm to function properly.
Assists in Full Exhalation: The serratus plays a role in controlled exhalation, which is essential for core activation. Without full exhalation, the core (and pelvic floor) can’t fully engage or reset.
Supports Functional Movement Patterns: From pushing a stroller to holding a plank, the serratus allows your upper body to move while your core and pelvic floor stabilize—especially during loaded or dynamic tasks.

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Signs Your Serratus Anterior Might Need Attention

Shoulder blade “winging” off your back
Neck or upper trap tension
Shallow breathing patterns
Poor posture with flared ribs
Difficulty with overhead movement or core engagement

If you’re noticing these patterns—especially if you’re postpartum, have pelvic floor symptoms, or deal with chronic core instability—the serratus could be part of the puzzle.

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How I Integrate Serratus Training into PT

In both orthopedic and pelvic health rehab, I often include exercises like:

Low Pressure Fitness activates the serratus anterior and supports optimal rib cage positioning, as well as scapular stability. It also enhances breath mechanics and pelvic floor engagement without increasing intra-abdominal pressure.
Wall-supported breathing drills to reestablish rib alignment and diaphragmatic movement
Quadruped serratus push-ups to train scapular stability and breath coordination
Bear holds with controlled exhale to build pressure management and deep core engagement
Dynamic arm movements during Pilates-based core work to integrate upper body and pelvic floor

Final Thoughts

The body doesn’t operate in isolated systems. Your shoulder, rib cage, breath, core, and pelvic floor are part of a deeply connected kinetic chain. And in that chain, the serratus anterior is often the unsung hero.

If you’re dealing with lingering core weakness, pelvic floor dysfunction, or postural issues—don’t skip the serratus. It just might be the link you didn’t know you were missing.

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If you live in the Atlanta area, please contact us to schedule a consultation.

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‍Disclaimer: The views expressed in this post 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.

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