Wall Press with a Plus

Serratus anterior retraining exercise:

• Have the patient standing approximately three feet from a wall with their hands on the wall at shoulder height.
• Instruct the patient to drop their head down and straighten their elbows by pushing their arms against the wall and rounding their upper, but not their lower back. Make sure that the apex for spinal flexion is in the upper thoracic spine and not lower down the spine.
• The patient should feel a stretch between the shoulder blades.
• When their arms are extended fully the patient can rotate their head to the R to place an emphasis on the L serratus or rotate their head to the L to place an emphasis on engaging their R serratus.
• Have them hold the stretch for 5-10 seconds.
• Then ask the patient to stand up straight and lean into the wall maintaining a neutral low back. Have them try to touch the wall with their forehead.
• The shoulder blades should draw close together as they move towards the wall.
• They hold this position for 5-10 seconds then repeat the whole sequence 3 -5 times.
• The patient needs to relearn that the spine normally moves into flexion and that the scapulae abduct during shoulder protraction and the spine moves towards extension and the scapulae adduct with shoulder retraction.

Ludewig et al., 2004 found that the standard push-up is an optimal exercise to recruit the serratus anterior while keeping the activation of the upper trapezius low. However, for patient’s early in their rehabilitation the wall push-up with a plus is an ideal exercise to begin with before progressing to kneeling push-ups and eventually prone push-ups.