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myofascialpain.com
Atlas · Upper Back

Serratus Posterior Superior

Deep aching beneath the scapula that is difficult to localize or reach manually

Body region
Upper Back
Trigger points
1
documented in this muscle
Common symptoms
3
patterns cataloged
Common causes
4
contributory factors

Trigger points

TrP 1

Serratus Posterior Superior

Location. Upper back, near shoulder blades

Pain referral. Back of shoulder, upper arm

  • Back of shoulder
  • Posterior upper arm
  • Elbow
  • Fourth and fifth fingers

Symptoms patients report

Deep upper back pain. Deep aching beneath the scapula that is difficult to localize or reach manually

Shoulder pain. Posterior shoulder ache referred from deep upper thoracic trigger point activation

Arm pain. Referred pain down posterior arm toward elbow and ulnar hand distribution

Common causes

Poor posture. Sustained thoracic kyphosis stretches serratus posterior superior beyond its resting length

Shallow breathing. Restricted rib elevation demand overworks serratus posterior superior as inspiratory muscle

Stress. Emotional tension causes sustained upper thoracic guarding affecting deep back muscles

Overhead work. Prolonged arm elevation requires continuous upper rib stabilization by this muscle

Treatment & self-care

immediate

Tennis Ball Against Wall Under Scapula Edge

Stand with your back to a wall and place a tennis ball between the wall and the inner border of your shoulder blade. Lean into the ball with moderate pressure and slowly roll up and down along the scapula edge. When you find a particularly tender spot, hold steady pressure for 20-30 seconds until you feel the tension release.

Duration
3-5 minutes per side
Frequency
2-3 times daily
Expect
Temporary relief of deep subscapular aching and improved shoulder range of motion within the first few sessions
exercise

Thoracic Rotation Stretch

Sit on a chair with your feet flat on the floor. Cross your arms over your chest and slowly rotate your upper body to one side as far as comfortable, keeping your hips facing forward. Hold the end position for 15-20 seconds, breathing deeply. Return to center and repeat to the opposite side. Perform 5 repetitions per side.

Duration
3-5 minutes per session
Frequency
2-3 times daily
Expect
Improved thoracic mobility and reduced upper back stiffness within 1-2 weeks
exercise

Scapular Stability Exercises (Wall Slides)

Stand with your back flat against a wall, feet about 12 inches from the base. Press your arms against the wall with elbows bent at 90 degrees. Slowly slide your arms upward along the wall as high as you can while keeping your back, elbows, and wrists in contact with the wall. Hold at the top for 3 seconds, then slowly lower. Perform 3 sets of 10 repetitions.

Duration
5-7 minutes per session
Frequency
Once daily, 5 days per week
Expect
Improved scapular control and reduced compensatory muscle strain over 3-4 weeks
exercise

Deep Breathing with Rib Expansion

Sit or stand with good posture. Place your hands on the sides of your lower rib cage. Inhale slowly and deeply through your nose for 4 counts, focusing on expanding your ribs laterally into your hands. Hold for 2 counts, then exhale slowly through your mouth for 6 counts. Perform 10 breath cycles per session.

Duration
3-5 minutes per session
Frequency
3-4 times daily
Expect
Reduced pain with breathing and improved rib cage mobility within 1-2 weeks
lifestyle

Posture Correction for Forward Head

Set hourly reminders to check your posture during desk work. Perform chin tucks by gently drawing your chin straight back as if making a double chin, hold for 5 seconds, and release. Adjust your monitor to eye level and position your keyboard so your shoulders are relaxed. Avoid sustained forward head posture during reading or phone use.

Duration
Ongoing throughout the day
Frequency
Hourly posture checks with chin tucks
Expect
Reduced upper back and subscapular strain from improved head position over 2-4 weeks
professional

Professional Trigger Point Dry Needling

Consult a physical therapist or practitioner trained in dry needling for treatment of deep serratus posterior superior trigger points. Because this muscle lies beneath the rhomboids and trapezius, it can be very difficult to treat with manual pressure alone. Dry needling can access these deeper layers directly for more effective release.

Duration
20-30 minute treatment session
Frequency
Weekly for 3-6 sessions as recommended by the practitioner
Expect
Significant reduction in deep subscapular pain and improved shoulder function after 2-4 sessions
Key Takeaways
  1. Deep aching beneath the scapula that is difficult to localize or reach manually
  2. Posterior shoulder ache referred from deep upper thoracic trigger point activation
  3. Referred pain down posterior arm toward elbow and ulnar hand distribution