Introduction

Optimising Motion

Research Corner

Techniques and Progressions

Sample Mobility Program and Progressions

Shoulder Internal Rotator and Posterior Deltoid: Release and Lengthening 

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Shoulder Internal Rotator and Posterior Deltoid: Release and Lengthening

Shoulder Internal Rotator and Posterior Deltoid: Release and Lengthening (Pectoralis Major, Latissimus Dorsi, Teres Major and Subscapularis)

Shoulder Internal Rotator and Posterior Deltoid:  Release and Lengthening

<p>This course describes shoulder internal rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening (commonly referred to as shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>, shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> exercises, overhead <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>, shoulder internal rotator foam rolling, shoulder internal rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> with ball, and/or shoulder stretching). Although terms like tight <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, shoulder <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> tightness, rotator cuff tightness, tight lats, and tight pecs are commonly used, it may be more accurate to label these muscles as <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to over-activity (e.g. <a id="hypertonic" data-tip="1672" target="_blank" href="/glossary-term/hypertonic" class="glossary">hypertonic</a>, phasic), which may result in poor shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>. Performing shoulder internal rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening techniques to increase <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> prior to activation, <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>, and strengthening techniques may significantly enhance rehabilitation and performance programs.</p>
<p>In practice, the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> of the latissimus dorsi (lats), pectoralis major (pecs), subscapularis (subscap), teres major (t. major), and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid (post delt), mobilizing the shoulder joint, and integrating a wall stretch (chest stretch), child pose stretch (lat stretch), crucifixion stretch (internal rotator stretch), and/or sleeper stretch (<a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid), is likely to&#xA0;improve shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> and the effectiveness of exercises like shoulder external rotator activation, and exercises intended to target upper back musculature, including ITY&#x2019;s, wall <a id="glide" data-tip="1599" target="_blank" href="/glossary-term/glide" class="glossary">slides</a>, etc.</p>
<p>Shoulder internal rotator over-activity and a loss of shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> have been correlated with altered upper extremity alignment, rounded shoulder <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, shoulder <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> rotation syndrome, upper crossed syndrome, loss of shoulder internal rotator range of motion, loss of external rotator cuff strength and <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, shoulder injury, shoulder pain, neck pain, scapulothoracic pain, frozen shoulder, an increased risk of future injury, and a loss of sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) should add these exercises to their repertoire to improve the outcomes of their <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> exercise programs and therapeutic (rehabilitation) interventions.</p>
<h4><strong>Release Techniques</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/video/teres-major-and-latissimus-dorsi-sa-static-release">Latissimus Dorsi and Teres Major Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/video/subscapularis-sa-static-release">Subscapularis Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/supraspinatus-sa-static-release">Supraspinatus Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/video/posterior-shoulder-sa-static-release">Posterior Shoulder Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/latissimus-dorsi-self-administered-dynamic-release">Latissimus Dorsi Dynamic Release</a></li>
</ul>
<h4><strong>Joint Mobilization Techniques</strong></h4>
<p>Following <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques, but before lengthening techniques, it may be beneficial to perform <a href="https://brookbushinstitute.com/courses/joint-mobilizations-upper-body-self-administered">Self-administered Joint Mobilization Techniques: Upper Body</a></p>
<ul>
  <li><a href="https://brookbushinstitute.com/video/shoulder-mobilization">Shoulder Mobilization</a></li>
  <li><a href="https://brookbushinstitute.com/video/thoracic-spine-rotational-mobilization-stability-and-strengthening-exercise">Thoracic Spine Rotational Mobilization</a></li>
</ul>
<h4><strong>Lengthening Techniques</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-and-erector-spinae-static-stretch-childs-pose">Latissimus Dorsi and Erector Spinae (Childs Pose) Static Stretch</a></li>
  <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-active-stretch">Latissimus Dorsi and Erector Spinae (Childs Pose) Active Stretch</a></li>
  <li><a href="https://brookbushinstitute.com/video/pectoralis-major-and-minor-sa-static-stretch">Pectoralis Major and Minor Static Stretch</a></li>
  <li><a href="https://brookbushinstitute.com/video/crucifixion-stretch-static-pec-stretch-sub-occipital-release-gentle-thoracic-mobilization">Pec Major Crucifixion Stretch</a></li>
</ul>
<p><img title="Dr. Brent Brookbush demonstrating a latissimus dorsi release" src="https://www.datocms-assets.com/25800/1650568642-lat-dorsi-release.png" alt="A release technique used for an overactive latissimus dorsi muscle"></p>

Course Description: Shoulder Internal Rotator Release and Lengthening

<h3><a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a></h3>
<h4>Functional Anatomy</h4>
<p>For a complete review of origin, insertion, innervation, action, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> function, <a href="https://brookbushinstitute.com/glossary/arthrokinematics/" target="_blank" rel="noopener">arthrokinematics</a>, motor behavior, subsystem involvement, and <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, please check out the Functional Anatomy &amp; Human Movement Science of the:</p>
<ul>
  <li><a href="https://brookbushinstitute.com/courses/pectoralis-major" target="_blank" rel="noopener">Pectoralis Major</a></li>
  <li><a href="https://brookbushinstitute.com/courses/subscapularis" target="_blank" rel="noopener">Subscapularis</a></li>
  <li><a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a></li>
  <li><a href="https://brookbushinstitute.com/courses/teres-major" target="_blank" rel="noopener">Teres Major</a></li>
  <li><a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">Posterior Deltoid</a></li>
</ul>
<p>Note: Although the <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior deltoid</a> does not contribute to shoulder internal rotation, it often exhibits an increase in activity that may alter <a id="osteokinematic-motion" data-tip="1797" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">osteokinematics</a> and <a id="arthrokinematics" data-tip="1859" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematics</a>, contributing to commonly seen restrictions in shoulder motion. For this reason (and because it is not included in any of our other articles), <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening of the <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior deltoid</a> has been included in this article.</p>
<p><img title="The arms fall is a common sign of dysfunction during the overhead squat assessment in those with upper body dysfunction" src="https://www.datocms-assets.com/25800/1649258155-arms-fall-1.jpg" alt="An example of arms fall during the overhead squat assessment"></p>

Introduction to Shoulder Internal Rotator Release & Lengthening

<h3><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment"><strong>Overhead Squat Assessment:</strong></a></h3>
<ul>
  <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment"> </a><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener">Excessive Lordosis (</a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Pelvic Tilt): <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a>&#xA0;short and over-active</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arms Fall</a>: Shoulder internal rotators and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid short and over-active</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a>: <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a> short and over-active on the same side as the shift</li>
</ul>
<p style="padding-left: 120px;"><img title="Dr. Brent Brookbush demonstrating an asymmetrical weight shift during an overhead squat assessment" src="https://www.datocms-assets.com/25800/1649876308-asymmerical-2.jpg" width="331" height="462" alt="Example of an asymmetrical weight shift during a squat"></p>
<h3>Goniometric Assessment</h3>
<ul>
  <li><a href="https://brookbushinstitute.com/video/shoulder-external-rotation-goniometry" target="_blank" rel="noopener">Shoulder External Rotation</a> &lt; 100 - 110&#xB0; - Shoulder internal rotators short and over-active</li>
  <li><a href="https://brookbushinstitute.com/video/shoulder-internal-rotation-goniometry" target="_blank" rel="noopener">Shoulder Internal Rotation</a> &lt; 50 - 70&#xB0; - <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">Posterior deltoid</a> short and over-active</li>
  <li><a href="https://brookbushinstitute.com/video/shoulder-flexion-goniometry" target="_blank" rel="noopener">Shoulder Flexion</a>: &lt; 180&#xBA; = Shoulder internal rotators short and over-active</li>
</ul>
<h3>Muscle Length Tests</h3>
<ul>
  <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-length-test-muscle-length-test">Lat Length Test</a>&#xA0;- Indicative of short and over-active <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a><a href="https://brookbushinstitute.com/video/latissimus-dorsi-length-test-muscle-length-test" target="_blank" rel="noopener"> </a></li>
  <li><a href="https://brookbushinstitute.com/video/apleys-scratch-test" target="_blank" rel="noopener">Apley&apos;s Scratch Test</a> - Bottom arm restricted indicative of <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior deltoid</a> over-activity, top arm restricted indicative of shoulder internal rotator over-activity.</li>
</ul>

Signs of over-activity and adaptive Shortening

<p>Maintaining <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> length and activity of the shoulder internal rotators is likely dependent on not only <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> soft tissue <a href="https://brookbushinstitute.com/glossary/extensibility/" target="_blank" rel="noopener">extensibility</a>&#xA0;but <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motion</a> and activity of functional <a href="https://brookbushinstitute.com/glossary/antagonists/" target="_blank" rel="noopener">antagonists</a>. When addressing shoulder dysfunction, consideration of the quality of movement of the thoracic spine and scapula (at the very least) is also necessary.</p>
<ul>
  <li>Joint Mobilization:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/thoracic-spine-self-administered-mobilization" target="_blank" rel="noopener">Thoracic Spine Mobilization (</a><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Mobilization)</li>
      <li><a href="https://brookbushinstitute.com/video/thoracic-spine-rotational-mobilization-stability-and-strengthening-exercise" target="_blank" rel="noopener">Thoracic Spine Rotational Mobilization and Stabilization</a></li>
      <li><a href="https://brookbushinstitute.com/video/shoulder-mobilization" target="_blank" rel="noopener">Shoulder Mobilization</a></li>
      <li><a href="https://brookbushinstitute.com/video/sternocostal-joint-self-administered-mobilization" target="_blank" rel="noopener">Sternocostal Mobilization</a></li>
    </ul>
  </li>
  <li>Activation:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/shoulder-external-rotator-activation-progression" target="_blank" rel="noopener">Shoulder External Rotator Activation</a></li>
    </ul>
  </li>
  <li><a id="kinesiology" data-tip="1692" target="_blank" href="/glossary-term/kinesiology" class="glossary">Kinesiology</a> Taping:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/shoulder-external-rotator-activation-taping" target="_blank" rel="noopener">Shoulder External Rotator Facilitation Taping</a></li>
    </ul>
  </li>
</ul>

Optimizing Motion to Prevent Shoulder Pain

<p>Several texts have noted the propensity of the muscles addressed in this article to become over-active and short (1-10). Further, many of these texts recommend techniques similar to those described in this article (1-6). Recently, more research has been done to investigate the relative activity of muscles as it relates to upper body <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>. Although there are more studies examining maladaptive changes in scapular <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, there is a growing body of evidence correlating Upper Body Dysfunction (Upper Crossed Syndrome, Rounded Shoulder <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>) with an increased internal rotator and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid activity (8-10). For example, in a study by Scovazzo et al. (8), the <a href="https://brookbushinstitute.com/courses/subscapularis" target="_blank" rel="noopener">subscapularis</a> was more than twice as active in swimmers with shoulder pain than those without. Further in a study by Ibarra et al. (9), those with latent motor <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior deltoid</a> exhibited nearly 25% more activity in the <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior deltoid</a> during shoulder flexion. This may imply that despite an increase in length in those exhibiting excessive internal rotation during static and dynamic <a id="posture" data-tip="1661" target="_blank" href="/glossary-term/posture" class="glossary">postures</a>, this common site for <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development may be <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to over-activity (19).</p>
<p style="padding-left: 40px;"><img src="https://www.datocms-assets.com/25800/1642374166-forward-head-posture.png" title="Three examples of the transition from neutral head position to forward head position (a common sign of upper body dysfunction)" alt="Example of forward head position"></p>
<p>To date, research on self-administered <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques for the upper body has not been done; however, studies using these techniques on lower extremity muscles have shown promising results. This includes a perceived decrease in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> soreness and better performance and recovery in subsequent bouts of intense exercise when foam rolling was done immediately after training (11-13), an increase in range of motion (<a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> and calf) without a decrease in force production (14-15), and several studies have shown <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching (<a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">hamstring</a> and calf) is more effective for increasing ROM than either technique alone (16-18).</p>

Research Corner: Shoulder Internal Rotator Release

<ul>
  <li><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Techniques
    <ul>
      <li>Pectoralis Self-administered Release: Static Only</li>
      <li>Subscapularis Self-administered Release: Static Only</li>
      <li>Latissimus Dorsi and Teres Major Self administered Release: Static --&gt; Dynamic</li>
      <li>Posterior Deltoid Self-administered Release: Static Only</li>
    </ul>
  </li>
  <li>Lengthening Techniques:
    <ul>
      <li>Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch: Static --&gt; Active --&gt; Dynamic</li>
      <li>Latissimus Dorsi and Teres Major Stretch (Child&apos;s Pose with Modification): Static --&gt; Active --&gt; Dynamic</li>
      <li>Posterior Deltoid Stretch (Sleeper Stretch): Static</li>
    </ul>
  </li>
</ul>
<p><img src="https://www.datocms-assets.com/25800/1649110483-vibration-pectoralis.jpeg" title="Pectoralis major release (using a percussion tool)"></p>

Techniques & Progressions for Shoulder Internal Rotator Release and Stretching

Shoulder Internal Rotator Release Techniques

Pectoralis Major

<p>Note: Although often attributed to &quot;pec tightness&quot; or &quot;pectoralis major tightness&quot;, the <a href="https://brookbushinstitute.com/courses/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a> is more often the site of <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development and adaptive shortening. The pectoralis major may develop <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, but this is fairly uncommon. Regardless, the technique below labeled &quot;Pectoralis MINOR Self-administered Static Release&quot; would work for both the pectoralis minor and major.</p>
<p><iframe src="//player.vimeo.com/video/82867097" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Pectoralis Major (Self-Administered) Static Release:</h4>
<ol>
  <li>Explain to your patient/client where they can find their pectoralis major (and minor), and if necessary palpate the portion of the pecs that you would like to target with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>Before asking your patient/client to lie face down, demonstrate the technique.</li>
  <li>Instruct your patient/client to assume a <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> position, with a ball or similar <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool under the side you wish to address.</li>
  <li>Have your patient/client reach their arm out to about 130&#xB0; of shoulder abduction on the target side.</li>
  <li>Your patient/client may place the opposite hand under their forehead to use as &quot;a pillow,&quot; keeping their face off the floor.</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>, using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>When the most tender point is located have your patient hold still on that point and attempt to relax.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; to occur (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Alternate Technique:
        <ul>
          <li>The pectoralis minor and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> portion of the pectoralis major can be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a> in a side-lying position. This is particularly effective for the pectoralis minor; in this position, a ball can be used to &quot;get behind&quot; the pectoralis major.</li>
        </ul>
      </li>
      <li>Common mistakes:
        <ul>
          <li>This technique does not work well when a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> or similar-sized <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool is used. Many of the <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> associated with this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> are located in the depression just <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to the deltopectoral groove.</li>
          <li>Not accommodating breast size with the appropriately sized tool, and/or rolling over breast tissue may lead to pain and embarrassment. Although a tennis ball may work for some smaller individuals with less breast tissue, a softball or <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> 5&quot; massage ball is likely a better choice for most. Note, the majority of <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> breast tissue is <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> associated with the pectoralis major and minor; there is no need to attempt to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> these muscles through breast tissue.</li>
        </ul>
      </li>
      <li>Caution:
        <ul>
          <li>Numbness is not a good thing! If tingling or numbness is felt in the shoulder, arm, or fingers, try to move a centimeter or two in any direction. These symptoms are likely caused by compressing the brachial plexus as it passes under the pectoralis minor, and as these nerves are fairly thin, moving a centimeter or two should allow your patient to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> without the risk of irritating a <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Pectoralis Major (Self-Administered) Static Release

Subscapularis

<p><iframe src="//player.vimeo.com/video/76724860" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Subscapularis (Self-Administered) Static Release:</h4>
<ol>
  <li>Explain to your patient/client where their subscapularis is, and if necessary palpate where you would like them to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>It may be helpful to demonstrate this technique before having your patient lie <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>.</li>
  <li>Instruct your patient/client to assume a <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> position, with a Back Nobber II in the hand opposite the side you wish to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
  <li>Have your patient/client flex the target side shoulder, resting there and on the table behind them and next to their head. If this is uncomfortable for your patient/client due to limited shoulder <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> they can place their hand under their head (assuming a position of about 130&#xB0; of shoulder abduction). The intent of placing the arm in this position is to protract and upwardly rotate the scapula as far as possible, and relax in that position so all contractile tissues are passive.</li>
  <li>With the curve of the &quot;S&quot; shaped Back Nobber II stabilized near, or on the sternum, have your patient/client place the ball-shaped end of the Back Nobber II into the axilla so that downward pressure can be exerted onto the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> face of the scapula (which has been exposed by raising the arm in step 4).</li>
  <li>Have your patient/client move the ball-shaped end of the Back Nobber II <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>, using the tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>When the most tender point is located have your patient hold still on that spot and attempt to relax.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; to occur (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Applying pressure in the wrong direction. Remember that the subscapularis lies on the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> face of the scapula (which is why we want to press down), pressing or pulling the tool into the rib cage may result in discomfort, bruising, or could result in a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> of the commonly under-active serratus <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>.</li>
        </ul>
      </li>
      <li>Caution:
        <ul>
          <li>Numbness, tingling, and/or burning are not a good thing! The <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fibers of the long thoracic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> are exposed in the position above; running along the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> face of the subscapularis. It is possible to <a id="compression" data-tip="1597" target="_blank" href="/glossary-term/compression" class="glossary">compress</a> and locally stretch or deform these nerves during this technique, resulting in some very immediate and fairly intense pain and discomfort. If you accidentally impinge or stretch one of these fairly small nerves try to move a centimeter or two in any direction and re-apply downward pressure.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Subscapularis (Self-Administered) Static Release

Latissimus Dorsi

<p><iframe src="https://player.vimeo.com/video/76727521" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Latissimus Dorsi and Teres Major SA Static Release:</h4>
<ol>
  <li>Have your patient/client assume a side-lying position, with the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> placed underneath the axillary (armpit) border of the scapula closest to the floor, and with the same arm extended and relaxed (full shoulder flexion).</li>
  <li>Explain to your patient/client where they should apply pressure with the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (<a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula).
    <ul>
      <li>A common <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> for the latissimus dorsi exists at the attachment of the latissimus dorsi to the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula; however, searching the entire axillary border of the scapula is likely to highlight <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the teres major, teres minor, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid.</li>
    </ul>
  </li>
  <li>Have the client search for &#x201C;tender points&#x201D; by gently rolling forward and back and up and down around the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula.</li>
  <li>Once a tender spot is located, have your patient/client try to hold and relax on that spot.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>An active lat - Your patient/client should not be using the target arm to stabilize the body and maintain the side-lying position. Make sure to position the knees and <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hand in such a way that the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> arm can relax completely.</li>
        </ul>
      </li>
      <li>Caution:
        <ul>
          <li>&#x201C;I feel a pinch&#x201D;: If the client feels a pinch or pain in their anterior/superior shoulder, experiment with different degrees of shoulder flexion and rotation until a pain-free position is found. Pain is likely to prohibit a patient from getting a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi and Teres Major SA Static Release

<p><iframe src="https://player.vimeo.com/video/181653768" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Latissimus Dorsi and Teres Major Dynamic Release Technique:</h4>
<ol>
  <li>Have your patient/client assume a side-lying position, with the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> placed underneath the axillary (armpit) border of the scapula closest to the floor, and with the same arm extended and relaxed (full shoulder flexion).</li>
  <li>Explain to your patient/client where they should apply pressure with the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (<a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula).
    <ul>
      <li>A common <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> for the latissimus dorsi exists at the attachment of the latissimus dorsi to the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula; however, searching the entire axillary border of the scapula is likely to highlight <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the teres major, teres minor, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid.</li>
    </ul>
  </li>
  <li>Have the client search for &#x201C;tender points&#x201D; by gently rolling forward and back and up and down around the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula.</li>
  <li>Once, the most tender point is located have your patient move the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> just <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> (<a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>) to that point, so it abuts the tender point on the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> (<a id="cephalad" data-tip="1559" target="_blank" href="/glossary-term/cephalad" class="glossary">cranial</a>) side.</li>
  <li>Instruct your patient to flex their shoulder in a sweeping motion, holding for 1 &#x2013; 2 seconds at end range. Perform 10 &#x2013; 15 repetitions.</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Only a roller will do: Because the latissimus dorsi is so broad, only a roller has the desired width to ensure restriction of the adhesive tissue. For example, a softball ball will not work.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi and Teres Major Dynamic Release Technique

<p><iframe src="https://player.vimeo.com/video/82861347" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Latissimus Dorsi (Self-Administered) Dynamic Release Technique 2:</h4>
<ol>
  <li>Have your patient/client assume a hook lying position (<a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> with legs bent and feet flat on the floor), with hands behind their head, and a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> perpendicular to their thoracic spine.</li>
  <li>Explain to your patient/client where they should apply pressure with the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (just below the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angles of the scapula).</li>
  <li>Have your patient/client search for &#x201C;tender points&#x201D; by gently rolling from the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula to a few inches below (Note: Try to keep from rolling the lumbar spine).</li>
  <li>Once, the most tender point is located have your patient move the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> just <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> (<a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>) to that point, so it abuts the tender point on the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> (<a id="cephalad" data-tip="1559" target="_blank" href="/glossary-term/cephalad" class="glossary">cranial</a>) side.</li>
  <li>Instruct your patient to reach up, as if performing a shoulder press, holding for 1 &#x2013; 2 seconds at end range. Perform 10 &#x2013; 15 repetitions.</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Only a roller will do: Because the latissimus dorsi is so broad, only a roller has the desired width to ensure restriction of the adhesive tissue. For example, a medicine ball will not work.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi (Self-Administered) Dynamic Release Technique 2

Posterior Shoulder

<p><iframe src="//player.vimeo.com/video/82867963" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Posterior Shoulder (Self-Administered) Release Technique:</h4>
<ol>
  <li>Explain to your patient/client where the common tender/trigger points are in the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid.</li>
  <li>You may wish to demonstrate the technique to your patient/client before asking them to attempt it themselves.</li>
  <li>Instruct your patient/client to assume a side-lying position with the shoulder flexed and reaching overhead, or horizontally abducted to approximately 90&#xB0;, with roughly 70 - 90&#xB0; of flexion, and the weight of their hand and flexed wrist pulling them into internal rotation (Sleeper Stretch Position).</li>
  <li>Place a small ball, <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> or <a href="https://www.serioussteel.com/collections/new-items-1/products/serious-steel-massage-ball?gclid=Cj0KCQjwrs2XBhDjARIsAHVymmTdPiGcFCi_WH3yyLzAzjf4EYN3HxUzo_gLBAJ__8Ktui_aZZLQYZUaAhDsEALw_wcB" target="_blank" rel="noopener">trigger point </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool under their <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> shoulder.</li>
  <li>Your patient/client should be using their opposite hand to prevent them from rolling over, allowing the arm being addressed to completely relax.</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a>, using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>When the most tender point is located have your patient hold still on that point and attempt to relax.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; to occur (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Pulling the arm into internal rotation in the sleeper stretch position. Remember, more is not better and this is not a lengthening technique. The structures of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> shoulder are delicate and do not require additional force to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> (or lengthen).</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Posterior Shoulder (Self-Administered) Release Technique

Stretching Techniques

Pectoralis Major, Pectoralis Minor and Subscapularis   

<p><iframe src="https://player.vimeo.com/video/101791984?title=0&amp;byline=0&amp;portrait=0" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Crucifixion/Cross Stretch (Brookbush Institute preferred method):</h4>
<ol>
  <li>Have your patient/client assume a hook lying position (<a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> with legs bent and feet flat on the floor), with a full round 3-foot foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> along their spine, extending from occiput to sacrum.</li>
  <li>Ensure that your patient/client feels stable and relaxed.</li>
  <li>Ask your patient/client to reach &quot;out and up&quot;, with a flexed elbow, until they reach roughly 110&#xB0; of shoulder abduction. Your patient/client may place their hands behind their head for comfort (although less force will be imparted on the target tissues).
    <ul>
      <li>Note: If the patient/client does not keep their elbows above their shoulders (greater than 90&#xB0; of abduction), it is unlikely that <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipping of the scapula will be promoted and the pectoralis minor will not be lengthened.</li>
    </ul>
  </li>
  <li>Ask your patient/client to allow their hands and forearms to sink to the floor, allowing gravity to provide the necessary force to lengthen the pectoralis major, pectoralis minor, and subscapularis.</li>
  <li>Hold for 30 to 120 seconds, or until a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, a reduction in discomfort, or change in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> is noted.</li>
  <li>Move on to the next stretch.
    <ul>
      <li>Modifications:
        <ul>
          <li>Half-round 3-foot foam rolls for the less stable and flexible: If a round foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> results in the client/patient feeling <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a>, or results in too much elevation so that the hands cannot touch the floor, switch to a half foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (half-circular, not 18&quot;).</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Crucifixion/Cross Stretch (Brookbush Institute preferred method)

<p><iframe src="https://player.vimeo.com/video/82866886" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Wall Stretch (for when you do not have a 3&apos; long foam roll handy):</h4>
<ol>
  <li>Have your patient/client assume a position standing perpendicular to a door jam, column, corner or solid object.</li>
  <li>Ask your patient/client to place their forearm on the solid object with the elbow bent and slightly higher than the shoulder.
    <ul>
      <li>Note: If the patient/client does not keep their elbows above their shoulders (greater than 90&#xB0; of abduction), it is unlikely that <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipping of the scapula will be imparted and the pectoralis minor will not be lengthened.</li>
    </ul>
  </li>
  <li>Check your patient/client&apos;s <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, ensuring that the feet are parallel and hip-width, neutral pelvis and spine are maintained, and the scapula is retracted and depressed.</li>
  <li>Ask your patient or client to &quot;turn-out&quot; or take a small step forward; gently pulling the arm into enough horizontal abduction to induce a mild stretch.
    <ul>
      <li>Note: if your patient/client had to dramatically change their <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> or take a large step forward to achieve a &quot;stretch&quot;, start over and re-position the patient/client so a small motion will impart a &quot;stretch&quot; and <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> can be maintained.</li>
    </ul>
  </li>
  <li>Hold for 30 to 120 seconds, or until a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, a reduction in discomfort, or change in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> is noted.</li>
  <li>Move on to the next stretch.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Locking the elbow and extending the wrist and fingers - The combination of elbow extension, wrist extension, and horizontal abduction can result in an intense ulnar and median <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> stretch. Nerves do not like to be stretched. Keep the fingers relaxed, the wrist neutral and the elbow bent.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Wall Stretch (for when you do not have a 3' long foam roll handy)

<p><iframe src="https://player.vimeo.com/video/76702326" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Active Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch:</h4>
<p>As with many of the <a id="active-stretching" data-tip="1631" target="_blank" href="/glossary-term/active-stretching" class="glossary">active stretching</a> techniques, the position used is nearly identical to the static stretching technique (Crucifixion Stretch) for the same muscles.</p>
<ol>
  <li>Have your patient/client assume a hook lying position (<a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> with legs bent and feet flat on the floor), with a 3&apos; foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> along their spine, extending from occiput to sacrum.</li>
  <li>Ensure that your patient/client feels stable and relaxed.</li>
  <li>Ask your patient/client to reach out up with elbow bent until they reach roughly 110&#xB0; of shoulder abduction. Your patient/client may place their hands behind their head for comfort (although less force will be imparted on the target tissues).
    <ul>
      <li>Note: If the patient/client does not keep their elbows above their shoulders (greater than 90&#xB0; of abduction), it is unlikely that <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipping of the scapula will be imparted and the pectoralis minor will not be lengthened.</li>
    </ul>
  </li>
  <li>Ask your patient/client to allow their hands and forearms to sink back to the floor, allowing gravity to provide all the necessary force to lengthen the pectoralis major, pectoralis minor, and subscapularis.</li>
  <li>Cue your patient or client to try and press their elbows toward the floor, contracting their <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoids, trapezius muscles, and rhomboids.</li>
  <li>Hold this position for 2 &#x2013; 4 seconds and repeat 10 &#x2013; 15 times.
    <ul>
      <li>Modifications:
        <ul>
          <li>Half foam rolls for the less stable and flexible: Half foam rolls for the less stable and flexible: If a round foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> results in the client/patient feeling <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a>, or results in too much elevation so that the hands cannot touch the floor, switch to a half foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (half-circular, not 18&quot;).</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Active Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch

<p><iframe src="https://player.vimeo.com/video/76687820?title=0&amp;byline=0&amp;portrait=0" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Dynamic Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch:</h4>
<ol>
  <li>Have your patient/client assume a kneeling, half kneeling, or standing position and cue ideal <a href="https://brookbushinstitute.com/glossary/posture/" target="_blank" rel="noopener">posture</a> (feet hip-width, neutral pelvis, shoulders down, and back).</li>
  <li>Use a light dumbbell, small medicine ball, or sand bell to add a small amount of resistance.</li>
  <li>Ask your patient or client to perform a sweeping motion from the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hip to a position reaching out and up above their head. The motion could be described as a &quot;diagonal arc with external rotation&quot;, &quot;unsheathing a sword&quot;, or as it is commonly known to physical therapists as &quot;D2 Flexion&quot; from the <a href="https://www.amazon.com/PNF-Practice-Illustrated-Susan-Adler/dp/3540739017" target="_blank" rel="noopener">PNF in Practice</a> text.</li>
  <li>Have them return to the starting position and start again. It may be acceptable to allow a small amount of trunk rotation for the sake of fluidity of movement. However, this is not permission to sacrifice form; be careful to ensure a kyphosis is not adopted during the eccentric phase and that scapular elevation is not allowed during the concentric phase.</li>
  <li>Perform 10 &#x2013; 20 repetitions, gradually speeding up the tempo to near the speed of activity.</li>
  <li>Switch sides or move on to the next technique.
    <ul>
      <li>Comments:
        <ul>
          <li>Demonstration Necessary: This is a complicated movement pattern, that may initially appear strange to your client/patient.</li>
          <li>Be Patient: As this is a complex movement pattern, allow time for practice. If it is not perfect after the first session, try again&#x2026; and again. If it does not work in the 4th or 5th session, then it may be time to consider another technique.</li>
        </ul>
      </li>
      <li>Common Mistakes
        <ul>
          <li>Throwing the hand and weight into the finish position - Although we want to promote flexibility at higher tempos, we do not want patients/clients using initial momentum to throw their arm into the finish position (flailing), relying solely on passive tissue to halt the movement. Ensure they are maintaining an active contraction and control throughout the entire movement pattern.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Dynamic Pectoralis Major, Pectoralis Minor, and Subscapularis Stretch

Latissimus Dorsi, Erector Spinae and Quadratus Lumborum

<p><iframe src="https://player.vimeo.com/video/82860941" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Latissimus Dorsi, Erector Spinae Static Stretch (Child&apos;s Pose):</h4>
<ol>
  <li>Instruct your patient/client to assume a kneeling position.</li>
  <li>Have them sit, so their glutes rest on their heels.</li>
  <li>If this is uncomfortable, a rolled-up mat, yoga block, or foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> can be placed between the ankles and the glutes, reducing knee flexion.</li>
  <li>Have your patient/client bend forward, resting their belly on their thighs and forehead on the floor (or as close as is comfortable).</li>
  <li>Have your patient reach their arms out with elbows extended and hands in &#x201C;prayer position&#x201D; or back of hands on the floor (full shoulder flexion and external rotation).</li>
  <li>This should be sufficient to stretch the erector spinae and latissimus dorsi.</li>
  <li>Hold for 30 to 120 seconds, or until a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> or change in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> is noted.
    <ul>
      <li>Modifications:
        <ul>
          <li>Progression: Adding <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexion to this stretch (reaching to one side) will increase the lengthening of the latissimus dorsi stretch and lengthen the quadratus lumborum. The arms can be allowed to relax and adduct if the quadratus lumborum is the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> you wish to target.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi and Erector Spinae Static Stretch (Child's Pose)

<p><iframe src="https://player.vimeo.com/video/82861173" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Latissimus Dorsi Active Stretch (Child&#x2019;s Pose):</strong></h4>
<p>As with many of the <a href="https://brookbushinstitute.com/glossary/active-stretching/" target="_blank" rel="noopener">active stretching</a> techniques, the position used is nearly identical to the static stretching technique for the same muscles.</p>
<ol>
  <li>Instruct your patient/client to assume a kneeling position.</li>
  <li>Have them sit so their glutes rest on their heels.</li>
  <li>If this is uncomfortable, a rolled-up mat, yoga block, or foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> can be placed between the ankles and the glutes, reducing knee flexion.</li>
  <li>Have your patient/client bend forward, resting their belly on their thighs and forehead on the floor (or as close as is comfortable).</li>
  <li>Have your patient reach their arms out with elbows extended and hands in &#x201C;prayer position&#x201D; or back of hands on the floor (full shoulder flexion and external rotation).</li>
  <li>Cue your patient or client to reach out as far as they can (<a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>), contracting their deltoids&#xA0;as if doing a shoulder press.</li>
  <li>Hold this stretched position and the deltoid contraction for 2 &#x2013; 4 seconds and repeat 10 &#x2013; 15 times.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Reaching up (toward the ceiling; posteriorly), although it will lengthen the latissimus dorsi, tends to result in excessive activation of the erector spinae and lower trapezius muscles. This could result in fatigue becoming a factor before a successful set has been completed.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi Active Stretch (Child’s Pose)

<p><iframe src="https://player.vimeo.com/video/76687107" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Latissimus Dorsi Dynamic Stretch:</strong></h4>
<ol>
  <li>Have your patient/client assume a standing position and cue ideal <a href="https://brookbushinstitute.com/glossary/posture/" target="_blank" rel="noopener">posture</a> (feet hip-width, neutral pelvis, shoulders down, and back).</li>
  <li>Attach a light resistance band to a low object, approximately 12&#x2033; <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and 12&#x2033; <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the foot of the side you are targeting.</li>
  <li>Have your patient or client grab the resistance band, and curl so that they are comfortably resting in cradle/rack position (elbow in full flexion, hand-over elbow near shoulder).</li>
  <li>To fully lengthen the latissimus dorsi, your patient/client is going to reach as high as they can (shoulder flexion) while supinating (palm faces face), and rotating away from the band (<a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> trunk rotation).</li>
  <li>Have them return to the starting position and start again. It is acceptable to dip into a quarter squat in-between reaches to enhance the fluidity of the movement pattern.</li>
  <li>Perform 10 &#x2013; 20 repetitions, gradually speeding up the tempo to near the speed of activity.</li>
  <li>Switch sides or move on to the next technique.
    <ul>
      <li>Comments:
        <ul>
          <li>Demonstration Necessary: This is a complicated movement pattern, that may initially appear strange to your client/patient (similar to a &#x201C;reverse lay-up&#x201D; in basketball). Demonstrating this movement for your client/patient will make your job much easier.</li>
          <li>Be Patient: As this is a complex movement pattern, allow time for practice. If it is not perfect after the first session, try again&#x2026; and again. If it does not work in the 4th or 5th session, then it may be time to consider another technique.</li>
        </ul>
      </li>
      <li>Common Mistakes:
        <ul>
          <li>Using a heavy resistance band: The band is intended to activate <a href="https://brookbushinstitute.com/glossary/antagonists/" target="_blank" rel="noopener">antagonists</a>, not provide resistance for strength and conditioning. This technique is generally used during warm-ups; a light resistance band is sufficient for even the largest athletes.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi Dynamic Stretch

<p>Note: Relative to <a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a> and shoulder pathology the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid is often <a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistically dominant</a> for inhibited external rotators (<a href="https://brookbushinstitute.com/courses/infraspinatus-and-teres-minor" target="_blank" rel="noopener">teres minor and infraspinatus</a>). As the humerus often adopts a position of excessive internal rotation this results in the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid adopting the maladaptive behavior of over-active and long. For this reason, the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid is most often <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>, and NOT stretched. It is suggested that before the techniques below are attempted, that shoulder internal rotation is re-assessed after <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and shoulder mobilization (when necessary). If internal rotation is still restricted then the techniques below may be useful.</p>

<p><iframe src="//player.vimeo.com/video/76704515" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Sleeper&apos;s Stretch:</h4>
<ol>
  <li>Have your patient/client assume a side-lying position with the target side down/against the table. You may use a yoga block, foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, or pillow to <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> the head.</li>
  <li>Ask your patient/client to bring the bottom arm to between 70 - 90&#xB0; of shoulder flexion with elbow bent to approximately 90&#xB0;.</li>
  <li>The key to this stretch is ensuring that the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> border of the scapula is stabilized by the table/floor. Adjust the client/patient&apos;s shoulder so the scapula is in the right position. You may need to practice getting into position several times before the client/patient can be expected to perform the stretch accurately without supervision.</li>
  <li>Have your patient/client &quot;stack&quot; their forearms, target side on the bottom, and allow the weight of the top arm to press the target arm into sufficient internal rotation for a stretch to be felt.</li>
  <li>Hold for 30 to 120 seconds, or until a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, a reduction in discomfort, or change in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> is noted.</li>
  <li>Move on to the next stretch.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>If the scapula is not stabilized by the floor or table, exerting an internal rotation force on the arm will likely result in upward rotation of the scapula and insufficient lengthening of the target tissues.</li>
          <li>The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> shoulder is delicate: Too often stretches are performed with an intensity of &quot;maximum tolerance&quot; versus &quot;mild discomfort&quot;. The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid, infraspinatus, and teres minor are not particularly large structures. Large amounts of force are not required to attain results.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Sleeper's Stretch

<p><iframe src="https://player.vimeo.com/video/82868157" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Modified Sleeper&apos;s Stretch (Brookbush Institute preferred method):</h4>
<ol>
  <li>Have your patient/client assume a standing position in the corner of a room, positioned so the target shoulder is in the corner with the head scapula and butt flat against the wall.</li>
  <li>Ask your patient/client to bring the target arm to between 70 - 90&#xB0; of shoulder flexion with elbow bent to approximately 90&#xB0;.</li>
  <li>The key to this stretch is ensuring that the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> border of the scapula is stabilized by the wall. Adjust the client/patient&apos;s shoulder so the scapula is in the right position.
    <ul>
      <li>The advantage of this variation over the popular &quot;Sleeper&apos;s Stretch&quot;, is the corner stabilizes the scapula both laterally and posteriorly, reducing the likelihood that poor scapular position is adopted by the client/patient.</li>
    </ul>
  </li>
  <li>Have your patient/client &quot;stack&quot; their forearms, target side on the bottom, and allow the weight of the top arm to press the target arm into sufficient internal rotation for a stretch to be felt.</li>
  <li>Hold for 30 to 120 seconds, or until a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, a reduction in discomfort, or change in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> is noted.</li>
  <li>Move on to the next stretch.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> shoulder is delicate: Too often stretches are performed with an intensity of &quot;maximum tolerance&quot; versus &quot;moderate discomfort&quot;. The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid, <a href="https://brookbushinstitute.com/courses/infraspinatus-and-teres-minor" target="_blank" rel="noopener">infraspinatus, and teres minor</a> are not particularly large structures. Large amounts of force are not required to attain results.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Modified Sleeper's Stretch (Brookbush Institute preferred method)

Manual Stretching

<p><iframe src="//player.vimeo.com/video/82865124" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Manual Pectoralis Major Stretch:</h4>
<ol>
  <li>Have your patient/client <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> to the side of the table so their shoulder is off the table and free to move, but the scapula is supported.</li>
  <li>Approach your client from the side, at about the level of their lower ribs</li>
  <li>Use the hand closest to them to stabilize the humeral head, by placing your palm over their deltoid.
    <ul>
      <li>Note: This force imparted during the stretch results in <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> translation of the humeral head. To prevent excessive stretching of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule (a commonly lax structure) a gentle <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> force should be applied throughout the duration of the stretch.</li>
    </ul>
  </li>
  <li>Now gently take the shoulder to end range by using the other hand to grasp the wrist - increasing the amount of flexion, abduction and external rotation until the first resistance barrier or mild discomfort. Unlike the latissimus dorsi stretch with relies primarily on flexion (below), this stretch relies primarily on horizontal abduction with the elbow just a bit higher than the shoulder (110&#xB0; of abduction)</li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>More is not better: A mild sensation of stretch is plenty. Increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> to a point of moderate discomfort or pain will only result in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> guarding, an increased risk of injury, and/or a less effective stretch.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Manual Pectoralis Major Stretch

<p><iframe src="https://player.vimeo.com/video/82864654" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Latissimus Dorsi Manual Stretch:</h4>
<ol>
  <li>Have your client/patient assume a <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> position on the table.</li>
  <li>Have them <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> to the side of the table so their shoulder is off the table and free to move, but the scapula is supported.</li>
  <li>Approach your client from the side, at about the level of their axilla.</li>
  <li>Use the hand closest to their head to grasp the arm at the elbow (or wrist) with a lumbrical grip, and move the arm into flexion short of end range.</li>
  <li>Use your other hand to stabilize the scapula by placing your palm on the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula. Note: This is easiest with your hand supinated so that your fingers <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> slightly under your patient/client&apos;s torso.</li>
  <li>Now gently take the shoulder to end range by increasing the amount of flexion, abduction, and external rotation, while keeping their <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle of the scapula stabilized. Unlike the pectoralis major stretch above, this stretch will be primarily flexion and abduction (towards the ear).</li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Modification:
        <ul>
          <li>For those patients/clients who exhibit a significant amount of range of motion loss, you can reduce the amount of work you have to do. Stabilize the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle, have your patient or client place their hand behind their head, and gently press the elbow toward the table.</li>
        </ul>
      </li>
      <li>Common Mistakes:
        <ul>
          <li>More is not better: A mild sensation of stretch is plenty. Increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> to a point of moderate discomfort or pain will only result in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> guarding, an increased risk of injury, and/or a less effective stretch.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Latissimus Dorsi Manual Stretch

<p>Perform each technique with <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> (ex. hold until <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> for static techniques, 10-15 repetitions for active techniques at a 2:2:2 count, etc.). Progress the flexibility routine as <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are reduced, techniques are mastered, and <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> flexibility is attained (generally over the course of weeks). This can be accomplished by adding additional <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques, and/or replacing static stretches with active and eventually dynamic stretches.</p>
<ol>
  <li><a href="https://brookbushinstitute.com/video/pectoralis-minor-sa-static-release" target="_blank" rel="noopener">Pectoralis Major/Minor Release</a></li>
  <li><a href="https://brookbushinstitute.com/video/teres-major-and-latissimus-dorsi-sa-static-release" target="_blank" rel="noopener">Latissimus Dorsi Release</a> - Progress to <a href="https://brookbushinstitute.com/video/lats-sa-active-release-technique" target="_blank" rel="noopener">Dynamic Release</a></li>
  <li><a href="https://brookbushinstitute.com/video/posterior-shoulder-sa-static-release" target="_blank" rel="noopener">Posterior Deltoid Release</a></li>
  <li><a href="https://brookbushinstitute.com/video/sternocostal-joint-self-administered-mobilization" target="_blank" rel="noopener">Sternocostal Mobilization</a></li>
  <li><a href="https://brookbushinstitute.com/video/thoracic-spine-self-administered-mobilization" target="_blank" rel="noopener">Thoracic Spine Mobilization</a></li>
  <li><a href="https://brookbushinstitute.com/video/crucifixion-stretch-static-pec-stretch-sub-occipital-release-gentle-thoracic-mobilization" target="_blank" rel="noopener">Crucifixion Stretch (Pectoralis major and minor, and subscapularis)</a> - progress to <a href="https://brookbushinstitute.com/video/pectoralis-major-and-minor-sa-active-stretch" target="_blank" rel="noopener">Active</a> and <a href="https://brookbushinstitute.com/video/dynamic-pec-pectoralis-major-and-minor-subscapularis-stretch" target="_blank" rel="noopener">Dynamic</a></li>
  <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-and-erector-spinae-static-stretch-childs-pose" target="_blank" rel="noopener">Child&#x2019;s Pose (Latissimus Dorsi, Teres Minor)</a> - progress to <a href="https://brookbushinstitute.com/video/latissimus-dorsi-active-stretch" target="_blank" rel="noopener">Active</a> and <a href="https://brookbushinstitute.com/video/dynamic-latissimus-dorsi-stretch" target="_blank" rel="noopener">Dynamic</a>
    <ul>
      <li>Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a> under-active structures specifically &#x2013; <a href="https://brookbushinstitute.com/courses/corrective-exercise-articles/activation/external-rotators/" target="_blank" rel="noopener">Shoulder External Rotator Activation</a></li>
    </ul>
  </li>
</ol>
<p><img title="Dr. Brent Brookbush demonstrating a latissimus dorsi release" src="https://www.datocms-assets.com/25800/1650568642-lat-dorsi-release.png"></p>

Sample Shoulder Mobility Program and Progressions

<ol>
  <li>Phillip Page, Clare Frank, Robert Lardner, <em>Assessment and Treatment of Muscle Imbalance: The Janda Approach</em> &copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
  <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;<em>NASM Essentials of Corrective Exercise Training</em>&rdquo; &copy; 2011 Lippincott Williams &amp; Wilkins</li>
  <li>Leon Chaitow, <em>Muscle Energy Techniques: Third Edition</em>, &copy; Pearson Professional Limited 2007</li>
  <li>Shirley A Sahrmann, <em>Diagnoses and Treatment of Movement Impairment Syndromes,</em> &copy; 2002 Mosby Inc.</li>
  <li>Stuart McGill, Low Back Disorders: Second Edition &copy; 2007 Stuart M. McGill</li>
  <li>Andrew Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelivic Pain: Integration of Research and Therapy (c) 2007, Elsevier Limited</li>
  <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry &ndash; Third Edition. &copy; 2003 by F.A. Davis Company</li>
  <li>Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. <em>The American Journal of Sports Medicine.</em> 19(6). 577-582</li>
  <li>Jos&eacute; Miota Ibarra, Hong-You Ge, Chao Wang, Vicente Mart&iacute;nez Vizca&iacute;no, Thomas Graven-Nielsen, Lars Arendt-Nielsen -Latent Myofascial Trigger Points are Associated With an Increased Antagonistic Muscle Activity During Agonist Muscle Contraction&ndash; The Journal of Pain, Volume 12, Issue 12, December 2011, Pages 1282&ndash;1288</li>
  <li>Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. <em>Journal of Bodywork &amp; Movement Therapies</em>. 14: 326-333</li>
  <li>Healey, K.C., Hatfield, D.L., Blanpied, P., Dorfman, L.R., and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research. 28(1). 61&ndash;68</li>
  <li>Pearcy, G.E.P., Bradbury-Squires, D.J., Kawamoto, J., Drinkwater, E.J., Behm, D.G., Button, D.C. (2015) Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training. 50(1): 5-13</li>
  <li>Macdonald, G.Z., Button, D.C., Drinkwater, E.J., Behm, D.G. (2014) Foam rolling as a recovery tool after an intense bout of physical activity. <em>Medicine &amp; Science in Sports &amp; Exercise</em> 46(1): 131-142</li>
  <li>Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. <em>International Journal of Sports Physical Therapy</em> 8(3) 228-236.</li>
  <li>Halperin, I., Aboodarda, S.J., Button, D.C., Andersen, L.L., Behm, D.G. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. <em>The International Journal of Sports Physical Therapy. 9(1):</em> 92 -102</li>
  <li>Mohr, A. R., Long, B. C., &amp; Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. <em>Journal of sport rehabilitation</em>. Currently in press.</li>
  <li>Skarabot, J., Beardsley, B., Stim, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range of motion in adolescent athletes. <em>International Journal of Sports Phyiscal Therapy.</em> 10(2): 203-212</li>
  <li>Renan-Ordine, R., Alburquerque-Sedin, F., De Souza, E.P.R., Cleland, J.A., Fernandez-De-La-Penas, C. (2011) Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: A randomized controlled trial. Journal of Orthopaedic &amp; Sports Medicine</li>
  <li>David G. Simons, Janet Travell, Lois S. Simons, <em>Travell &amp; Simons&rsquo; Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition</em>,&copy; 1999 Williams and Wilkens</li>
</ol>

Bibliography

<p>&copy; 2016 Brent Brookbush</p>
<p>Questions, comments, and criticisms are welcomed and encouraged</p>

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

<strong>Accuracy</strong> - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

<strong>Adenosine triphosphatase (ATPase):</strong> is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

<b>Adenosine triphosphate (ATP): </b>The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

<strong>Algometry</strong> - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter  wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

<span class="_Tgc"><b>All-or-none</b> <b>principle</b> - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.</span>

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the <em>anterior</em> aspect of the head

<strong>Appendicular Skeleton</strong> - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

<strong>Arthrokinematic Motion</strong> - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

<strong>Assessment</strong><em> -</em> is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li><strong>"Clear" the Patient/Client for Intervention</strong> - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A <em>Calf Squeeze (Thompson) Test</em> is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li><strong>Highlight Contraindications - </strong>Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li><strong>Refine Exercise/Intervention Selection</strong>: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to <em>Refine Exercise/Intervention Selection</em>, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and <em>Clearance</em> to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of <em>Contraindicated Activities</em> from the physician. - <em>"When in doubt, refer out!"</em>

<strong>Axial Skeleton</strong> - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin <span class="foreign">axis</span> "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

<strong>Balance</strong> - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

<strong>Base of support (BoS)</strong> - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

<strong>Case-control Study</strong> - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. <i>American journal of epidemiology</i>, <i>134</i>(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed<em> caudally</em>.

<strong>Center of mass (CoM)</strong> - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

<b>Center of gravity (CoG)</b> - point where <b>gravity</b> appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed <em>cephalad</em>.

<strong>Cohort Study</strong> - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

<strong>Comparable Sign:</strong> A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

<strong>Concave (Concavity)</strong> - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

<strong>Concordant Sign</strong> - The patient's specific pain, symptom or complaint.<span style="color: #ff0000;"> </span>
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

<strong>Conductivity</strong>: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

<strong>Contractility: </strong>The ability to shorten (1).
<ul>
 	<li><strong>Contractility</strong>: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

<strong>Convex (Convexity)</strong> - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

<strong>Correlational Research</strong> - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. <em>J. Phys. Ther. Sci. </em>26: 961-964</a></li>
</ol>

<strong>Counter-nutation</strong> - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

<strong>Crossover (Study) Design</strong> - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. <em>Journal of Human Kinetics, 58, 197-206.</em> </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) <em>Journal of Medical Science</em> 5(1). 52-54</a></li>
</ol>

<strong>Cytokine</strong> - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength. <em> Journal of Manual &amp; Manipulative Therapy</em>. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the <em>distal</em> end of the leg.

An arthrokinematic motion - a <span class="_Tgc">force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.</span>

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the <em>dorsal</em> surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>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</li>
</ol>

Faulty or abnormal movement; an<span class="_Tgc"> alteration of normal kinematics.</span>

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

<strong>Elasticity</strong>: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). <i>Anatomy &amp; physiology</i>. New York (NY): WCB/McGraw-Hill.</li>
</ol>

<strong>Equilibrium</strong> - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0"><strong>Evidence-based medicine (practice)</strong> is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. <i>Bmj</i>, <i>312</i>(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

<strong>Excitability:</strong> The ability of a cell to <span class="hvr">change</span> in <span class="hvr">membrane</span> <span class="hvr">conductance</span> as a <span class="hvr">response</span> to <span class="hvr">stimulation.
</span>
<ul>
 	<li><span class="hvr">For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</span></li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

<strong>Excitation threshold:</strong> The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

<strong>Exercise Progression</strong> - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

<strong>Exercise regression</strong> - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

<strong>Experimental Research</strong> - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. <em>Journal of Strength and Conditioning Research, 27</em>(11), 2997-3000.</a></li>
</ol>
&nbsp;

<strong>Extensibility</strong>: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

<strong>False Negative </strong>- the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

<strong>False Positive </strong>- the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

<strong>Fibromyalgia</strong> - A loosely defined diagnosis that is associated with a combination of widespread pain <i>in combination with</i> 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. <i>Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition</i>.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. <i>Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology</i>, <i>33</i>(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. <i>The Clinical journal of pain</i>, <i>27</i>(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. <i>PAIN®</i>, <i>145</i>(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. <i>Spine</i>, <i>20</i>(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. <i>Spine</i>, <i>20</i>(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

<strong>H-Band</strong> - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (<em>biological holism</em>) - (from Greek <i>holos</i> "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. <em class="EmphasisTypeItalic ">Holism and evolution</em>. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

<strong>Hormone: </strong>Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. <i>Scandinavian journal of clinical and laboratory investigation</i>, <i>60</i>(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

<strong>Hyperplasia</strong> is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

<strong>Muscular hypertrophy</strong> is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

<strong>I-Band</strong> - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. <em>International Journal of Health and Rehabilitation Sciences</em>. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is <em>inferior</em> to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

<strong>Intermuscular Coordination</strong> - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

<strong>Example: Role of Muscles during Hip Extension</strong>
<ul>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:</strong>  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: </strong><a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An <strong>isoform</strong>, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.<sup id="cite_ref-2" class="reference"></sup>
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior <em>kinetic chain</em>, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

<strong>Latent Trigger Point</strong> - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, <em>Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition</em>,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is <em>lateral</em> to the pectoralis major

<strong>Length/Tension Relationship</strong> - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. <i>The Journal of physiology</i>, <i>184</i>(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. <i>The Journal of Physiology</i>, <i>183</i>(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. <i>Journal of neurophysiology</i>, <i>71</i>(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). <i>Skeletal muscle structure, function, and plasticity</i>. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

<span class="_Tgc"><strong>Levels of Evidence</strong> - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.
</span>

The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. <i>Western Journal of Medicine</i>, <i>170</i>(6), 348.</li>
</ol>

<strong>Likelihood Ratios</strong> - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li><strong>Positive Likelihood Ratio (LR+)</strong> - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li><strong>Negative Likelihood Ratio (LR-)</strong> - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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