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Integrated functional anatomy of the pectoralis minor. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, release techniques, and stretches for the pectoralis minor.

Pectoralis Minor

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I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

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Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



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We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

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This course describes the anatomy and integrated function of the pectoralis minor (a.k.a. the pec minor, and is included in the term pecs, chest muscles, and pectoral muscles). This muscle originates on ribs 3-5 and inserts into the coracoid process of the scapula (shoulder blade), lies deep to the pectoralis major; and unfortunately, research is not available on fiber type composition. The pectoralis minor muscle crosses the scapulothoracic joint (scapula), influencing motion of the sternoclavicular joint and acromioclavicular joint, and contributes to protraction, depression, and anterior tipping of the scapula. This course also describes the role of the pectoralis minor muscles in scapulothoracic arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the pectoralis minor for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. “tight pec minor”, pectoralis minor syndrome and the resulting weakness and pain during arm elevation, shoulder joint pain, shoulder impingement syndrome, thoracic outlet syndrome, scapular winging), the effect the pectoralis minor has on scapular kinematics (e.g. anterior tipping in synergy with the levator scapulae and upper trapezius muscles), and pectoralis minor exercises and techniques for enhancing sports performance (e.g. ensuring ideal pectoralis minor length for optimal shoulder stability, strength, power, hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the Pectoralis Minor (see videos below):

The pectoralis minor originating from the scapula to the ribcage

 Course Description: Pectoralis Minor

Introduction

 early 15c., “ornament worn on the breast,” from Middle French pectoral and directly from Latin pectorale “breastplate,” noun use of neuter of adjective pectoralis (see 

 (adj.)). – As a shortened form of pectoral muscle, attested from 1758. Slang shortening pec for this is first recorded in 1966. Related: Pectorals; pecs. (

 early 13c., menour “Franciscan” (see 

 (n.)), from Latin minor “less, lesser, smaller, junior,” figuratively “inferior, less important,” formed as a masculine/feminine form of minus on the mistaken assumption that minus was a neuter comparative, from PIE root *mei- (2) “small” (see 

“Smaller" of the muscles “worn” on the chest

The pectoralis minor with attachments on the scapula and ribcage

Attachment and Innervation

Attachment & Innervation: Pectoralis Minor

Relative Location

The attachments of the pectoralis minor, serratus anterior, teres major, latissimus dorsi, and subscapularis on the scapula

Where is the Pectoralis Minor Located?

Palpation

The location of the pectoralis minor 

Palpating the Pectoralis Minor

Introduction to the Pectoralis Minor

Action

Scapula: Protraction, downward rotation, depression, and anterior tipping (8, 10, 11, 17).

Respiration: With the arm and scapula fixed, the pectoralis minor can aid in forceful inspiration by elevating ribs 3, 4, and 5 (8, 10, 11).

The brachial plexus and the axillary artery coursing under the pectoralis minor

Note how the brachial plexus and the axillary artery course underneath the pectoralis minor - http://ajs.sagepub.com/content/29/6/729/F1.expansion

 Stabilization of the scapula (acromioclavicular and sternoclavicular joints respectively)

 Upward rotation, elevation, retraction, and posterior tilting of the scapula.

 work synergistically during downward rotation of the scapula.

 work synergistically during depression of the scapula

 in anterior tipping of the scapula (this synergy plays a major role in 

Acromioclavicular joint cross section identifying the AC joint, joint capsule, and cartilage

http://www.eorthopod.com/sites/default/files/images/shoulder_distal_clav_osteolysis_anatomy04.jpg

Arthrokinematics

The connective tissue surrounding the acromioclavicular and glenohumeral joint 

Pectoralis Minor Action

Fascial Integration

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

The fascial network between fascicles of a muscle - http://www.selfcare4rsi.com/images/fascia.jpg

Insertion: The tendinous insertion of the pectoralis minor has fascial continuity with the coracobrachialis and short head of the biceps brachii. This is noted by Tom Myers as the proximal portion of the Deep Front Arm Line (DFAL) (6). Functionally these muscles work synergistically during activities like a 

 or pull-over, where the arm starts in an elevated position and is pulled down toward the torso (shoulder extension and/or adduction). Over-activity and trigger point development is common in all three muscles, although the development of trigger points are far more common in the pectoralis minor with coinciding trigger points in the pectoralis major. It may be interesting to examine the activity, length, and synergy between these muscles relative to the scapular position.

Origin. The origin of this muscle invests in the periosteum and overlying fascia of the upper rib cage and corresponding intercostals. This may imply synergy between these structures (along with the subclavius and potentially the serratus anterior), with changes in length and tension of the fascial sheath stimulating forced inspiration through the upper rib-cage and activation of the pectoralis minor and other inspiratory synergists.

The Clavipectoral Fascia: The clavipectoral fascia envelopes the pectoralis minor and is invested in the overlying pectoralis major. Although few would argue that the pectoralis major and minor muscles have synergistic functions, closer examination of the clavipectoral fascia will highlight its continuation into a fascial sheath that envelopes the serratus anterior and continuity into the dense axillary fascia. A pushing/protraction synergy may be related to the fascia overlying serratus anterior, but how does the axillary fascia affect the pectoralis minor and other investing structures? Clinically, I have found the clavipectoral, anterior axillary fascia, and deltopectoral fascia to be a source of restriction in those with limited shoulder elevation (flexion, scaption or abduction), and it is not hard to imagine a relationship between adaptive shortening and over-activity of the pectoralis minor resulting in changes in clavipectoral fascia length and extensibility. However, the effect this may have on muscular function is a bit perplexing. There are numerous synergies that may emanate from this fascial sheath (clavipectoral to axillary to deltopectoral fascia) including, any combination of the pectoralis major and minor, subclavius, coracobrachialis, short head of the biceps brachii, and anterior deltoid - and if we continue this line, much of the arm and scapular muscles. More research into the role of fascia is desperately needed.

The pectoralis minor, pectoralis major, and fascia surrounding the scapula and shoulder

Behavior in Postural Dysfunction

 by many clinicians, texts, and studies (1, 2, 4, 7, 8, 11, 17).

The pectoralis minor is most often short and over-active contributing to excessive anterior tipping and downward rotation of the scapula in those with 

 (17). It is my hypothesis that the pectoralis minor becomes synergistically dominant for an inhibited 

 in an attempt to stabilize the scapula and maintain force output during scapular protraction. Further, the pectoralis minor is the functional antagonist of the 

, implying that a change in the length of one results in an opposing length change of the other (20). More research is needed to determine if altered reciprocal inhibition may play a role in pectoralis minor over-activity, 

 under-activity, or both. Clinically, I have also found that pectoralis minor activity, thoracic kyphosis, and stiffness in thoracic facets to be inter-twined. That is, thoracic mobilization will often make release of the pectoralis minor easier (quicker with less pressure), and visa-versa. Some evidence exists to support this relationship, a correlation between a thoracic kyphosis and shoulder impingement was found in a study by Otashi et al.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, the pectoralis minor plays no significant role.

 the pectoralis minor plays no significant role.

, the pectoralis minor has a propensity toward over-activity and adaptive shortening in 

. This implies that release and lengthening techniques for the pectoralis minor (and potentially self-administered thoracic mobilizations) should be part of a human movement professional's repertoire (20). Further, AC, SC, and thoracic mobilization techniques may aid in optimizing the length and activity of the pectoralis minor and should be part of the repertoire of any licensed professional (PT, ATC, DC, OT, DO).

Impingement of Brachial Plexus (Thoracic Outlet Syndrome?)

Impingement of Axillary Artery (Thoracic Outlet Syndrome?)

Cervical Radiculopathy (Brachial plexus impingement)

Signs of Altered Length/Tension and Tone:

Shoulder External Rotation - Less than 90 degrees

Although the pectoralis minor cannot directly restrict glenohumeral motion, posterior tipping of the scapula is required for optimal range in the above goniometric assessments. If release and lengthening of muscles that cross the glenohumeral joint do not return optimal range of motion (ROM), release and lengthening of the pectoralis minor may prove beneficial.

Apley's Scratch Test (Top arm unable to reach the superior angle of the opposite scapula

Sahrmann's Pectoralis Minor Length Test - With the patient in prone, inability to relax and retract the scapula so that the shoulders lie on the table (8, 11, 21).

Wright Full Abduction test for Thoracic Outlet Syndrome

Palpation results in tenderness and may result in radiating symptoms.

Postural Dysfunction and the Pectoralis Minor

Techniques and Ending Info

Pectoralis Minor (Self-Administered) Static Release

Pectoralis Major and Minor Wall Stretch

Crucifixion/Cross Stretch

Active Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch

Dynamic Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch

Pectoralis Minor Manual Stretch

Thoracic Spine (Self-Administered) Release and Mobilization

Exercises and Techniques for Pectoralis Minor

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. 

journal of orthopaedic & sports physical therapy

Lee, J, Cynn H, Yoon T, Ko C, Choi W, et al. (2015). The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. Journal of Electromyography and Kinesiology. 25:107-114.

Seitz AL, McClure PW, Finucane S, Boardman III ND, Michener LA. (2011). Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?. Clinical Biomechanics. 1-12

Sanders RJ, Annest SJ. (2014). Thoracic outlet and pectoralis minor syndromes. Seminars in Vascular Surgery. 27: 86-117.

Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. 

Weber C, Enzler M, Wieser K, Swanenburg J. (2015). Validation of the pectoralis minor length test: a novel approach. Manual Therapy. 1-6.

Bibliography

Questions, comments, and criticisms are welcome and encouraged.

Pectoralis Minor

Related Courses:

Course Description: Pectoralis Minor

Introduction to the Pectoralis Minor
3 Sub Sections

Pectoralis Minor Action
1 Sub Section

Fascial Integration

Postural Dysfunction and the Pectoralis Minor

Exercises and Techniques for Pectoralis Minor
7 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Pectoralis Minor

Related Courses:

Course Description: Pectoralis Minor

Introduction to the Pectoralis Minor3 Sub Sections

Pectoralis Minor Action1 Sub Section

Fascial Integration

Postural Dysfunction and the Pectoralis Minor

Exercises and Techniques for Pectoralis Minor7 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Pectoralis Minor
3 Sub Sections

Pectoralis Minor Action
1 Sub Section

Exercises and Techniques for Pectoralis Minor
7 Sub Sections