00:04 - 00:06This is Brent of the Brookbush Institute
00:06 - 00:08and in this video we're going over static
00:08 - 00:09manual release of the pectoralis minor.
00:09 - 00:11Now, if you're watching this video, I'm
00:11 - 00:12assuming you're watching it for
00:12 - 00:14educational purposes and that you are a
00:14 - 00:16licensed manual therapist. That is, you
00:16 - 00:19are legally allowed to perform manual
00:19 - 00:21techniques based on your scope of
00:21 - 00:23practice. Generally, that includes
00:23 - 00:24physical therapists, athletic trainers,
00:24 - 00:26chiropractors, massage therapists, and
00:26 - 00:28osteopaths. I'm sure I'm forgetting a
00:28 - 00:31couple, but if you're unsure of whether
00:31 - 00:32you're allowed to do this technique,
00:32 - 00:35please look those laws up in your state
00:35 - 00:36or region. Personal trainers, this
00:36 - 00:39technique probably does not apply to
00:39 - 00:41your scope, but you could use the
00:41 - 00:43palpation portion of this video in an
00:43 - 00:46educational setting to help you learn
00:46 - 00:48your anatomy. I'm going to have my friend, Crystal,
00:48 - 00:49come out. She's going to help me
00:49 - 00:51demonstrate this technique. Now, as this
00:51 - 00:55technique is on the pectoralis minor
00:55 - 00:58which is in a fairly sensitive area,
00:58 - 01:00especially when working with females, we
01:00 - 01:03do want to be 80%, 90% sure
01:03 - 01:05that the release of the pectoralis minor
01:05 - 01:07is going to have an effect on our
01:07 - 01:10outcomes, whether those be rehab or
01:10 - 01:12performance related. The only way I'm
01:12 - 01:14going to get there is by starting with
01:14 - 01:16assessment. We'd never have Crystal
01:16 - 01:17just lay down and start releasing her
01:17 - 01:20pectoralis minor. I might do overhead
01:20 - 01:22squat assessment, goniometry, manual
01:22 - 01:25muscle testing, muscle length tests, or
01:25 - 01:28special tests. There have been
01:28 - 01:31assessments and tests done before trying this
01:31 - 01:33technique that give me an indication
01:33 - 01:36that this is going to help me towards
01:36 - 01:39Crystal's goals, whether those be
01:39 - 01:43performance or rehab related. All of
01:43 - 01:45our manual techniques follow a very
01:45 - 01:47similar protocol, which is basically
01:47 - 01:50palpate and compress. We do want to be
01:50 - 01:54able to palpate and differentiate, so in
01:54 - 01:57the case of the pectoralis minor, we do
01:57 - 01:59want to make sure that we know the
01:59 - 02:00difference between where the pectoralis
02:00 - 02:03minor is, which is underneath the pec
02:03 - 02:06major, and not just be
02:06 - 02:08compressing down on pectoralis major
02:08 - 02:10fibers. If we're trying to affect
02:10 - 02:13scapular mobility, working on
02:13 - 02:14pec major
02:14 - 02:17isn't going to help, but pec minor will. Alright,
02:17 - 02:19so we need to be a little bit more
02:19 - 02:23specific than that. We do get some bonus
02:23 - 02:24points for knowing where the trigger
02:24 - 02:26points are, which in this case is in the
02:26 - 02:28middle of the pectoralis minor fibers.
02:28 - 02:29But, I think you guys are going to find a
02:29 - 02:30little bit like when we did the
02:30 - 02:33subscapularis video, it's not so easy to
02:33 - 02:37just put an X on that particular point.
02:37 - 02:40Those trigger points
02:40 - 02:41are going to be right between the
02:41 - 02:43coracoid process and ribs three, four, and
02:43 - 02:45five. The one thing we do have to
02:45 - 02:47consider before I start digging
02:47 - 02:50underneath her pectoralis major is do we
02:50 - 02:54have other potential structures that
02:54 - 02:57could be insulted or injured by
02:57 - 03:00compression, and right underneath my
03:00 - 03:03pectoralis minor runs my brachial plexus,
03:03 - 03:05my axillary artery, and, of course, since
03:05 - 03:09I'm messing around in the axillary
03:09 - 03:10region, we do have to think about those
03:10 - 03:13lymph nodes as well. So, guys, if you're
03:13 - 03:17pressing through that tissue and
03:17 - 03:19your patient or client complains of
03:19 - 03:22numbness, tingling, pain, especially that
03:22 - 03:23searing burning pain that comes along
03:23 - 03:25with stretching a nerve, we're going to
03:25 - 03:28go ahead and back off a little bit. Try
03:28 - 03:31to move our thumbs or fingers around in
03:31 - 03:33such a way that we can get around that
03:33 - 03:36structure. Remember, nerves are very, very
03:36 - 03:38thin. We're talking like a millimeter, so
03:38 - 03:40it should be fairly easy to get around
03:40 - 03:43that tissue. And, of course, last, we want
03:43 - 03:45to think about patient comfort and our
03:45 - 03:48comfort, so we want to get body position
03:48 - 03:51where we are not going to wear ourselves
03:51 - 03:54out and our patient is still comfortable.
03:54 - 03:58Now, I'm going to throw my comfort out
03:58 - 03:59the window for you guys for just a
03:59 - 04:01second here, so that I can show you where
04:01 - 04:03you're going to be placing your hands
04:03 - 04:08Notice that I very casually, but very
04:08 - 04:11meaningfully, took this hand and put it
04:11 - 04:15behind Crystal's head. It's actually a
04:15 - 04:18really convenient position to do
04:18 - 04:20pectoralis minor release in, because
04:20 - 04:23that will posteriorly tip and
04:23 - 04:27upwardly rotate my scapula, which then
04:27 - 04:28lengthens out my
04:28 - 04:31pectoralis minor, and it gets her arm out of
04:31 - 04:35the way of her axilla. So, all of that-
04:35 - 04:37nice easy position, this is a nice
04:37 - 04:39comfortable position for her, and now
04:39 - 04:42it's easy for me to get in there with my
04:42 - 04:44hands. Your pectoralis minor is
04:44 - 04:47underneath your pectoralis major. The way
04:47 - 04:49I would go about identifying this, guys,
04:49 - 04:51is you see this tissue here is her
04:51 - 04:55anterior delt, which then kind of folds
04:55 - 05:00into her pec major. So, I just follow
05:00 - 05:03that anterior delt down and reach just
05:03 - 05:07underneath pec major here, and I very
05:07 - 05:11gently start trying to coerce my fingers
05:11 - 05:12deeper and deeper underneath that pec
05:12 - 05:16major. What I will run into is while my
05:16 - 05:20pec major fibers run this way, my pec
05:20 - 05:23minor fibers run this way, so instead of
05:23 - 05:25having all of these horizontally
05:25 - 05:27oriented fibers that I'm kind of pushing
05:27 - 05:30into, all of a sudden I'll run into this
05:30 - 05:32very distinct lateral border on the
05:32 - 05:35upper lateral portion of her pectoral
05:35 - 05:40region. Once I find those tissues, I can
05:40 - 05:43press in just a little bit deeper, so
05:43 - 05:46that I know I am affecting the fibers of
05:46 - 05:49pectoralis minor, inserting into ribs
05:49 - 05:52three, four, and five. The fibers inserting
05:52 - 05:54into ribs three just being a little bit
05:54 - 05:56more medial, four a little lateral to that, and
05:56 - 05:58five lateral to that. I push a little
05:58 - 06:03deeper. I can definitely affect all
06:03 - 06:06of those tissues, and then I can come in
06:06 - 06:12here and find the most tender point,
06:12 - 06:14superior to inferior, inferior or
06:14 - 06:17superior within those
06:17 - 06:21vertically oriented fibers. Now, of course,
06:21 - 06:23I wouldn't do that reaching cross body
06:23 - 06:26this way. That's actually a fairly
06:26 - 06:29inconvenient way to do this technique. It's
06:29 - 06:31not easy for me. Obviously I don't get
06:31 - 06:33much of a visual reference here. I'm
06:33 - 06:34having to kind of
06:34 - 06:38feel around with my hands. The way I
06:38 - 06:39would actually do this from my body
06:39 - 06:42position is, once again, have Crystal's
06:42 - 06:44hand up this way. I'm going to take this
06:44 - 06:47hand, the one closest to her head, and I'm
06:47 - 06:48going to put my hand over the top of her
06:48 - 06:51anterior delt. I'm just going to use
06:51 - 06:54this thumb to slide right underneath
06:54 - 06:59her pec major, and then once I get deep
06:59 - 07:04enough, I'll find that vertical border. I can
07:04 - 07:06go superior to inferior, inferior to
07:06 - 07:09superior. Make sure with these fibers
07:09 - 07:11you're taking short strokes. I
07:11 - 07:14wouldn't start at her anterior delt and then
07:14 - 07:16keep dragging skin with me all the way
07:16 - 07:20to rib five. If I start up high, I want to
07:20 - 07:23lift up my finger and then try a spot a
07:23 - 07:25little lower, lift up my finger and try a
07:25 - 07:26spot a little lower, and lift up my finger and
07:26 - 07:29try a spot a little lower until I find
07:29 - 07:32that most tender point, or that point of
07:32 - 07:36highest tissue density. Once I'm there,
07:36 - 07:39and I found it, I can then use my other
07:39 - 07:42thumb if I need to, to add a little
07:42 - 07:45bit more pressure. So this is one
07:45 - 07:47position. The other position that also
07:47 - 07:50gets used is I can have Crystal lay on her
07:50 - 07:54side, facing away from me. I can lower the
07:54 - 07:57table a little bit.
07:58 - 08:00I can go ahead and place her arm up
08:00 - 08:05like this, and now I can go
08:05 - 08:08down towards the table to affect these
08:08 - 08:09tissues. Once again, I'm still going to
08:09 - 08:11start with my hand up here on her
08:11 - 08:13anterior delt. I just reach my thumb
08:13 - 08:16underneath her pec major, and then I can
08:16 - 08:19come this way. I'll use this technique as
08:19 - 08:22often. It's not as convenient for me, but
08:22 - 08:24it does occasionally come in handy,
08:24 - 08:27especially in individuals who are a
08:27 - 08:31little bit more well-endowed, especially
08:31 - 08:33women who are more well-endowed. This
08:33 - 08:35will allow the breast tissue to fall
08:35 - 08:38towards the table so that you don't feel
08:38 - 08:40like you have to have your hands in
08:40 - 08:43sensitive areas. So, once again, guys just
08:43 - 08:45to review- go ahead and lay back on your
08:45 - 08:47back for me. We're going to go ahead and
08:47 - 08:49take Crystal's hand up and put it behind her
08:49 - 08:51head. That's going to upwardly rotate and
08:51 - 08:54posteriorly tip my scapula. Now, I'm
08:54 - 08:58going to start just below my
08:58 - 09:00anterior delt as it runs into my
09:00 - 09:02pec major. I'm going to reach under those
09:02 - 09:06fibers, closer to the table. Alright,
09:06 - 09:11feel those ribs against your fingers.
09:11 - 09:16Once I find that lateral border, I can
09:16 - 09:19then search that lateral border for the
09:19 - 09:22most tender tissue.
09:23 - 09:26Once I find that most tender tissue, I
09:26 - 09:29can then apply pressure thumb over thumb,
09:29 - 09:32hold for 30 to 120 seconds, wait for a
09:32 - 09:35release, or that tissue to melt underneath my
09:35 - 09:37fingers, and then reassess. And, now for the
09:37 - 09:39close-up recap. The first thing I'm going
09:39 - 09:41to have Crystal do is go ahead and take
09:41 - 09:42her hands and put them behind her head.
09:42 - 09:45This will automatically put her scapula
09:45 - 09:47in a position of posterior tipping and
09:47 - 09:49upward rotation, which is going to
09:49 - 09:51lengthen out those pectoralis fibers for
09:51 - 09:53me a little bit. It's also going to give
09:53 - 09:55me access to her axilla, so that I can
09:55 - 09:59get behind her pec major and get to that
09:59 - 10:01lateral border of her pectoralis minor.
10:01 - 10:03If I take my hand and I just kind of put
10:03 - 10:06it over her anterior delt, my thumb will
10:06 - 10:09be in good position to just go ahead and
10:09 - 10:12reach underneath that pec major,
10:12 - 10:15these fibers right here. And I'm just
10:15 - 10:18going to go right over ribs three, four,
10:18 - 10:22and five. Alright, so I can feel her ribs
10:22 - 10:24right there. Kind of search through this
10:24 - 10:26tissue and make sure that you're taking
10:26 - 10:29small, small strokes as you're
10:29 - 10:31investigating, as your palpating.
10:31 - 10:34You never want to take large strokes in
10:34 - 10:35this area. And you never want to start
10:35 - 10:38somewhere far from where you want to be
10:38 - 10:40and start pulling a lot of skin tissue
10:40 - 10:41with you, because you will make somebody
10:41 - 10:44very uncomfortable. As I take these
10:44 - 10:47short strokes, find the lateral border of
10:47 - 10:50the pectoralis minor. There it is. We can
10:50 - 10:52see Cystal's face change just a little
10:52 - 10:54bit as soon as I find her pec minor,
10:54 - 10:56which is definitely a little overactive.
10:56 - 10:57Then I'm going to look for the
10:57 - 11:03tightest point. Once again, use short strokes.
11:03 - 11:05Notice, I picked up my finger there. And
11:05 - 11:08there we go, there's a nice tight nodule.
11:08 - 11:10It is a little hard to get thumb over
11:10 - 11:13thumb in this position. This position
11:13 - 11:16doesn't really allow us to get a
11:16 - 11:20braced technique like this, at least not
11:20 - 11:22without getting our hands into places
11:22 - 11:25they probably shouldn't be. But for this
11:25 - 11:28particular technique, having having the
11:28 - 11:28ability to
11:28 - 11:32brace the anterior delt makes this
11:32 - 11:34technique not too rough on the hands. Now,
11:34 - 11:38the other way we could do this is I'm
11:38 - 11:40going to go ahead and have Crystal turn
11:40 - 11:45on her side. When she turns on her
11:45 - 11:49side, I can now use both hands this way
11:49 - 11:53and go right underneath her pec major,
11:53 - 11:58and I can go ahead and palpate that
11:58 - 12:00lateral border. Once again, I'm picking up my
12:00 - 12:02fingers as I need to. I can straighten
12:02 - 12:05out my arms, and again. wait for that
12:05 - 12:10release for 30 to 120 seconds. Be very
12:10 - 12:12careful with this one, guys, and remember that
12:12 - 12:14regardless of which hand position or
12:14 - 12:18which body position you use, you do have
12:18 - 12:19all of the nerves coming out from
12:19 - 12:21underneath the pectoralis minor, coming
12:21 - 12:24off that brachial plexus, and you have that
12:24 - 12:26axillary artery. We don't want to
12:26 - 12:27impinge and stretch those tissues out,
12:27 - 12:29because we'll definitely feel
12:29 - 12:33uncomfortable. Between the two positions,
12:33 - 12:35I find it easier to do the one on the
12:35 - 12:38back. However, this position is nice to
12:38 - 12:41have handy, in case you do have a female
12:41 - 12:43with a lot of breast tissue. A nice
12:43 - 12:45caveat to this particular technique is
12:45 - 12:47as soon as you roll them onto their side,
12:47 - 12:49that breast tissue falls away from where
12:49 - 12:51you're going to need to put your hands
12:51 - 12:54to begin with. There you guys have it, static
12:54 - 12:56manual release of the pectoralis minor.
12:56 - 12:58Please make sure that before you're
12:58 - 13:00putting your hands on somebody, you're 80%
13:00 - 13:03to 90% sure that
13:03 - 13:05that intervention is going to affect
13:05 - 13:07your outcomes. The only way to get there
13:07 - 13:09is through assessment. So, before you
13:09 - 13:11start doing a pectoralis minor release,
13:11 - 13:13things like your overhead squat
13:13 - 13:16assessment, goniometry, muscle length
13:16 - 13:21tests, and even some special tests should be
13:21 - 13:23indicating that this particular
13:23 - 13:26technique is going to improve range of
13:26 - 13:30motion, reduce pain, or maybe increase
13:30 - 13:34activity of antagonists. If you can, find
13:34 - 13:36colleagues that you can practice this on
13:36 - 13:39before trying this technique on a
13:39 - 13:42patient. That will get you through a lot
13:42 - 13:44of the portion of this technique, or
13:44 - 13:47learning of this technique that makes
13:47 - 13:49you feel clumsy. You want to be confident
13:49 - 13:51when you actually apply this technique
13:51 - 13:54in practice. If you can find a mentor
13:54 - 13:58or a live workshop to attend so you can
13:58 - 14:01get some hands-on education, of course
14:01 - 14:03there is no replacement. I hope you guys
14:03 - 14:05enjoyed this video. I hope you'll leave
14:05 - 14:07your questions in the comments boxes
14:07 - 14:09below. I'll be happy to answer. I look
14:09 - 14:10forward to talking to you guys again
14:10 - 14:13soon.
14:19 - 14:21