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Pectoralis Minor Manual Static Release

This video will show you an effective Manual Static Release technique for tightness and pain in the Pectoralis Minor muscles. After watching, you'll feel relief and be able to move with greater ease and comfort.

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Transcript

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

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