This article shares my research into the Push Up Plus, a calisthenic exercise used to improve shoulder function.
I overheard a physical therapist recommending it to someone experiencing rotator cuff issues, so I decided to learn about it and post what I found here on heydayDo.
What Is A Push Up Plus?
The Push Up Plus is a variation of the standard push up that activates your serratus anterior muscles at the top of the motion, when your arms are fully extended.
The Push Up Plus strengthens your serratus muscles and is used in physical therapy to improve shoulder health & flexibility.
What’s next
Later on we’ll learn how to perform a Push Up Plus, so we can gain the most benefit by properly activating our serratus anterior muscles.
The tutorial videos are led by a sports physical therapist & an award-winning strength trainer, and both pass along several great tips.
Next, let’s look at what the serratus anterior muscles are, and why we should care about strengthening them via the Push Up Plus in the first place.
Science resources included
As is my custom here on heydayDo, I will provide links to all of the relevant medical and sports science resources, clinical studies, & nutritional data used in this article.
Push Up Plus = Serratus Anterior Push Up
Most of us have a pretty good idea of what a push up is.
So when I first heard the term Push Up Plus, I wondered what the plus part meant.
Q: Is it something that’s added onto a regular push up?
A: That depends on who you ask, as you’ll read about in a bit.
But for now, let’s focus on what that plus thing is.
* The plus is an exercise move that is done while in the standard push up’s finished “plank” position, when our arms are locked out & fully extended.
* The plus stands for using our serratus anterior muscles to cause an outward rotation of our scapulas (shoulder blades), away from our spine and out towards our sides.
Here’s a look at where our serratus anterior muscles are located:
*The plus movement is accomplished by simply pressing down through your locked arms, and the plus part of the movement is also known as the serratus anterior push up.
Your chest rises and your back stays parallel to the floor, as your serratus muscles tighten and “reach” around your sides towards your ribcage.
(My description makes it sound more complicated than it is…sorry ‘bout that, my bad. Thankfully, the videos show how easy (& natural) of a motion it really is to perform.)
How to perform the Push Up Plus
Here’s a detailed instructional video from professional bodybuilder John Meadows’ channel. His guest is orthopedic sports therapist Dr. Mario Novo, who in addition to explaining how to properly perform the serratus anterior push up, also explains
- where the serratus muscle is
- what the serratus muscle does
- why we need to exercise it with the Push Up Plus
(The therapist begins his how-to-do-it part of the video at the 2:01 mark.)
Key points to consider
Position 1: Hands & Knees
*These can be done from your knees and still be very effective. This is helpful if you’re not strong enough to hold a push up plank position for very long
*In this position you can increase intensity by using only one arm at a time
*From there you can progress to a push up position
Position 2: Push up position with feet spread wide
*Feet spread wide
*Neck and upper back kept in long straight line
*If you’re strong you can graduate up to trying them on one arm (but they’re tough)
Why do the Push Up Plus
There are great benefits to be had from doing a few sets of the Push Up Plus/Serratus Anterior Push Up every week.
Improved shoulder health
One area of benefit that strengthened serratus muscles provide is improved overall shoulder health for everyone.
And the other set of benefits applies more so to fitness buffs, weightlifters, & athletes – or anyone who repeatedly activates their chest & shoulders’ pectoral & deltoid muscles, respectively.
Avoid or heal repetitive shoulder injuries
It’s a common tool used by physical therapists when treating an assortment of shoulder & upper back issues, often from repetitive motion overuse or muscle imbalances. (1)
How we can get muscle imbalances
One example of muscle imbalance occurs with those of us who do a lot of lifting, specifically with our push exercises:
- bench press
- overhead press
- dips
The serratus anterior muscle is not activated by these exercises (or by any of our other typical weight training movements, for that matter).
So as our chest & shoulder muscles get bigger & stronger but our serratus doesn’t, this imbalance can cause a shoulder blade (scapula) to “wing” out of position.
This often results in what is known as shoulder impingement, a chronic condition which can be painful, let alone one that severely hinders athletic performance. (2)
Weak serratus muscles cause problems
Muscle tears, bursitis, & rotator cuff damage are often a result of repetitive athletic activities involving our pecs & shoulders. (3)
Weak serratus anterior muscles are linked to these chronic conditions because they can’t keep the scapulas (shoulder blades) in the right places.
This is all because the serratus anterior muscles aren’t able to provide a balanced stabilizing force vs. the stronger chest & deltoid muscles.
Enter the Push Up Plus to the rescue.
Benefits of the Push Up Plus
Fortunately, the Push Up Plus strengthens our serratus anterior muscles, and they will in turn help keep us flexible & pain-free (4). Strong serratus anterior muscles:
- Prevent or reduce scapular winging
- Reduce shoulder impingement & its associated pain
- Increase our strength by keeping scapulas in position
- Improve arm & shoulder range of motion
- Improve posture
Research studies have demonstrated that the push up plus is a great exercise for activating & strengthening the serratus anterior muscles. (5)
Next we’ll get into how to correctly perform the push up plus so that we can gain the maximum benefit from it.
Various Push Up Plus versions online
Poking around the internet I found several different variations of the Push Up Plus being taught by fitness trainers, strength coaches, & orthopedic sports rehab therapists.
The common element amongst all of them was the activation of the serratus anterior muscles at the top of the ‘push’ position.
Var. 1: Activate serratus muscles after doing a push up
The five fitness trainers’ articles & videos I came across all used a full standard push up, and then engaged the serratus muscles at the end of the rep as a finishing move.
Var. 2: No regular push up, just activate serratus muscles
But none of the physical therapist and coach tutorials used the full range of the standard push up motion at all.
All of the focus in their versions was on activating the serratus muscles.
Thus the entire range of motion in their Push Up Plus (AKA the serratus anterior push up) occurs with the arms already locked & fully extended.
The tutorial videos I included here — one from a sports physical therapist and the other from a well-regarded strength training coach — both utilize this “serratus anterior-only” version of the Push Up Plus.
Variations on the serratus anterior push up
This next video is from award-winning strength trainer Nick Numinello’s channel.
It’s a short 2+ minute video where he offers up a couple of ways to increase the intensity of your serratus activation:
1) by bringing your hands in closer together
2) move your hands out ahead of your shoulder, and slightly internally rotate them
Key points
*You’re pushing your shoulder blades apart at the top, then letting gravity push them back together to the start position
*Don’t drop your head or your hips: move shoulder blades only
*In advanced move #2, get your hands under your eyes
How often to work the serratus anterior
In the first video above, physical therapist Dr. Mario Novo says that because the serratus muscles are stabilizers, they can be worked more often than we train our major muscle groups.
He suggests 3-4 times per week.
He also notes that since the serratus is a stabilizing muscle, it responds better to sets using isometric holds versus repping it out.
The hold would be done while in the fully engaged serratus position, with the chest raised and scapulas laying flat as the serratus muscles wrap onto the ribs.
Iso hold sets: For starters, 10-30 seconds of holding per set.
Push up reps: And if doing the reps, start with 25-40 reps per set.
# of sets: Work to fatigue. 1-3 sets to failure ought to do it, depending on your level of strength.
These serratus push ups won’t pre-exhaust muscles
A great thing about this serratus anterior-only version of the Push Up Plus is that it can be done at the start of your workout, before any of your regular heavy lifting.
The orthopedic sports therapist in the video suggests it because you’re not pre-exhausting any of your major muscle groups: this modified push up is only activating your serratus anterior muscles.
Vs. the regular push up with a PLUS at the end
Compare that to the other type of Push Up Plus exercise being taught online & in YouTube videos that I mentioned earlier.
Those were the ones where they had you complete a full push up first, then outwardly rotate your scapulas using your serratus anterior muscles.
Consistent lifters on training blocks: You’re likely not going to want to now add multiple sets of push ups 3-4 times a week just to work on your serratus muscles, especially if you’ve already dialed-in your strength training program.
That’s a good reason why the serratus anterior-only version of the Push Up Plus is better for us regular lifters.
Wrapping Up
Related articles here on heydayDo
I think the greatest serratus-building exercise I’ve ever done is the dumbbell pullover, and I recently wrote an article on it here on heydayDo — check it out if interested — here’s the link:
Dumbbell Pullover: Muscles Worked, Benefits, & How-To Videos
Do Resistance Bands Build Muscle As Well As Free Weights Do?
Do Ab Belts Work? Here’s What Sports Science Has Found
I hope that my article on the serratus anterior Push Up Plus is useful to you, and that the tutorial videos are helpful too.
– greg
