（Chi/Eng）肩胛前锯肌：你的核心与盆底之间的"缺失环节"

作为一名骨科及盆底物理治疗师，我经常被问：
“盆底物理治疗师也治疗肩颈痛啊？” 
“我的肩膀和盆底有什么关系？”

人体是一个完整的整体，评估、治疗时也应该从一个整体来看待问题。当身体出现不适，一切都有关联，尤其是在姿势支持、呼吸机制和核心稳定性方面。今天就想和大家分享一个常常被忽视、却在这个全身连接中扮演关键角色的肌肉——肩胛前锯肌（serratus anterior）。

As an orthopedic and pelvic floor physical therapist, I often get asked:

“Wait—do pelvic floor physios also treat shoulder and neck pain?”
“What does my shoulder have to do with my pelvic floor?”

The human body works as one integrated system. Assessment and treatment should always consider the whole picture. When something feels off, it’s rarely an isolated issue—especially when it comes to posture, breathing, and core stability. Today, I want to highlight one often-overlooked muscle that plays a key role in connecting your upper body to your core and pelvic floor—the serratus anterior.

什么是肩胛前锯肌？

肩胛前锯肌是一块扇形肌肉，它包裹着你的肋骨，并连接到肩胛骨（scapula）。肩胛前锯肌的主要工作是将肩胛骨固定在肋骨上，并帮助肩胛骨向前、向上移动——当我们在做高举过头、推的动作时，它能维持肩膀稳定，必不可缺。

你可能不知道的是：肩胛前锯肌与肋骨的位置、呼吸机制，以及最终你的核心与盆底的功能都有直接关系。

Photo:By Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=22208655

What Is the Serratus Anterior?

The serratus anterior is a fan-shaped muscle that wraps around your rib cage and attaches to your shoulder blade (scapula). Its main job is to anchor the scapula against the ribs and assist in moving it forward and upward.

Whenever you reach overhead or push something away, your serratus anterior is working hard behind the scenes to stabilize your shoulder.

What most people don’t realize is that this muscle also directly affects your rib position, breathing mechanics, and ultimately—your core and pelvic floor function.

肋骨、膈肌与盆底的三角关系

要理解肩胛前锯肌与盆底的联系，必须先理解身体的「压力系统」。

• 你的膈肌（diaphragm）位于肋骨下方，是呼吸的主要肌肉。

• 你的盆底肌群（pelvic floor）在核心底部，与膈肌形成呼应。

• 你的核心——尤其是腹横肌（transverse abdominis）和深层稳定肌群—连接以上两者。

当你吸气时，膈肌下降，腹内压增加，盆底会稍微延长。当你呼气时，膈肌上移，盆底回缩。为了这个系统能有效运作，你的肋骨必须处于能让膈肌正常运动的位置。

这时，肩胛前锯肌就派上用场了。

The Rib Cage, Diaphragm, and Pelvic Floor Connection

To understand how the serratus anterior relates to the pelvic floor, we need to look at the body’s pressure system.

• The diaphragm, located beneath the rib cage, is the main muscle for breathing.

• The pelvic floor forms the base of your core and mirrors the diaphragm’s movement.

• The deep core muscles, including the transverse abdominis, link these two structures together.

During inhalation, the diaphragm moves downward, increasing intra-abdominal pressure and allowing the pelvic floor to lengthen slightly. During exhalation, the diaphragm rises, and the pelvic floor recoils upward.

For this system to work efficiently, the rib cage must be in proper alignment—and that’s where the serratus anterior comes in.

肩胛前锯肌如何支持核心与盆底

一个运作良好的肩胛前锯肌，不仅仅在稳定你的肩膀——它还能够：

• 将肩胛骨锚固至肋骨：当肩胛骨稳定时，你的胸廓（上躯干）就成为呼吸与运动的坚实基础。

• 让肋骨保持在理想位置：强健的肩胛前锯肌让肋骨维持在中立位，膈肌才能有效运作。

• 协助完整呼气：肩胛前锯肌参与在控制呼气的过程中，这对核心激活至关重要。若不能完全呼气，核心（与盆底）无法完全激活或重置。

• 支持“功能性动作模式”：从推婴儿车到平板支撑，肩胛前锯肌让你的上半身在核心与盆底保持稳定的同时，依然能移动—尤其是在负重或动态运动中。

How the Serratus Anterior Supports the Core and Pelvic Floor

A well-functioning serratus anterior does far more than stabilize your shoulder. It also:

• Anchors the scapula to the rib cage: A stable scapula provides a solid foundation for breathing and movement.

• Keeps the ribs in optimal alignment: Strong serratus anterior activation helps maintain a neutral rib position, allowing the diaphragm to move effectively.

• Assists in full exhalation: This muscle plays a role in controlled exhalation—essential for proper core and pelvic floor engagement. Incomplete exhalation can limit activation and reset of these deep stabilizers.

• Supports functional movement patterns: Whether pushing a stroller or holding a plank, the serratus anterior allows your upper body to move freely while keeping the core and pelvic floor stable—especially during dynamic or loaded activities.

出现这些，你的肩胛前锯肌可能在求救！

如果你有以下情况，特别是在产后、有盆底症状或长期核心不稳定的情形下，那么肩胛前锯肌可能是其中的关键：

• 肩胛骨在背部“翘起”（肩胛骨外翻）

• 颈部或上斜方肌（upper trap）紧张

• 浅表呼吸模式

• 不良姿势，肋骨外翻（ribs flared）

• 做高举过头动作感觉困难，或难以启动核心

Signs Your Serratus Anterior Might Need Attention

If you experience any of the following—especially postpartum, or when dealing with pelvic floor symptoms or chronic core instability—your serratus anterior might be the missing link:

• Shoulder blade “winging” or lifting off the back

• Tightness in the neck or upper trapezius

• Shallow breathing patterns

• Poor posture or rib flare

• Difficulty with overhead movements or engaging the core

如何在物理治疗中融入肩胛前锯肌训练

How do I Train the Serratus Anterior

在骨科与盆底健康的康复中，我常常带入呼吸及腹内压控制，再结合前锯肌的训练：

As a physical therapist, I often incorporate exercises that train the serratus anterior while respecting breathing mechanics and pressure control, such as:

• “低压健身”：激活肩胛前锯肌、让肋骨保持最佳位置与稳定肩胛；且在不增加腹内压的前提下，改善呼吸机制并让盆底更多参与。

  Low Pressure Fitness (LPF): Activates the serratus anterior, optimizes rib positioning, stabilizes the scapula, and enhances breathing without increasing intra-abdominal pressure—allowing greater pelvic floor involvement.

• 倚墙呼吸训练：重建肋骨对位和膈肌运动。

  Wall breathing drills: To restore rib alignment and diaphragm mobility.

• 四足位肩胛前锯俯卧撑：训练肩胛稳定与呼吸协同训练。

  Quadruped serratus push-ups: To train scapular stability and coordinate breathing.

• 熊爬支撑（bear holds）配合控制呼气：建立压力管理与深层核心激活。

  Bear holds with controlled exhalation: For deep core activation and pressure management.

• 在普拉提（Pilates）基础的核心训练中加入动态手臂运动，同时融合上半身与盆底的训练。Pilates-based core work with dynamic arm movement: Integrating upper body and pelvic floor coordination.

结语

健康的身体不是一个个孤立的系统组成。你的肩膀、肋骨、呼吸、核心和盆底是一个深度连接的动力链。在这个链条中，肩胛前锯肌常常是那个被忽视的英雄。

如果你正面临持续的核心无力、盆底功能障碍或姿势问题——不要忽视肩胛前锯肌。它可能正是你不知道自己缺失的那一块拼图！

Final Thoughts

A healthy body is never a collection of separate systems—it’s an interconnected chain. Your shoulders, ribs, breathing, core, and pelvic floor work together as one dynamic unit. Within that chain, the serratus anterior is often the unsung hero.

If you’re struggling with persistent core weakness, pelvic floor dysfunction, or postural issues, don’t overlook this powerful muscle—it might just be the missing puzzle piece you’ve been searching for.

免责声明：本文观点为作者个人意见，不应视作个人医疗建议。提供的信息旨在帮助读者做出自身健康的知情决策。

Disclaimer: This article reflects the author’s professional opinion and is not a substitute for personal medical advice. The information provided is intended to help readers make informed decisions about their health.