0:04 This is Brent of the Brookbush Institute 0:06 and in this video we're going over static 0:08 manual release of the pectoralis minor. 0:09 Now, if you're watching this video, I'm 0:11 assuming you're watching it for 0:12 educational purposes and that you are a 0:14 licensed manual therapist. That is, you 0:16 are legally allowed to perform manual 0:19 techniques based on your scope of 0:21 practice. Generally, that includes 0:23 physical therapists, athletic trainers, 0:24 chiropractors, massage therapists, and 0:26 osteopaths. I'm sure I'm forgetting a 0:28 couple, but if you're unsure of whether 0:31 you're allowed to do this technique, 0:32 please look those laws up in your state 0:35 or region. Personal trainers, this 0:36 technique probably does not apply to 0:39 your scope, but you could use the 0:41 palpation portion of this video in an 0:43 educational setting to help you learn 0:46 your anatomy. I'm going to have my friend, Crystal, 0:48 come out. She's going to help me 0:49 demonstrate this technique. Now, as this 0:51 technique is on the pectoralis minor 0:55 which is in a fairly sensitive area, 0:58 especially when working with females, we 1:00 do want to be 80%, 90% sure 1:03 that the release of the pectoralis minor 1:05 is going to have an effect on our 1:07 outcomes, whether those be rehab or 1:10 performance related. The only way I'm 1:12 going to get there is by starting with 1:14 assessment. We'd never have Crystal 1:16 just lay down and start releasing her 1:17 pectoralis minor. I might do overhead 1:20 squat assessment, goniometry, manual 1:22 muscle testing, muscle length tests, or 1:25 special tests. There have been 1:28 assessments and tests done before trying this 1:31 technique that give me an indication 1:33 that this is going to help me towards 1:36 Crystal's goals, whether those be 1:39 performance or rehab related. All of 1:43 our manual techniques follow a very 1:45 similar protocol, which is basically 1:47 palpate and compress. We do want to be 1:50 able to palpate and differentiate, so in 1:54 the case of the pectoralis minor, we do 1:57 want to make sure that we know the 1:59 difference between where the pectoralis 2:00 minor is, which is underneath the pec 2:03 major, and not just be 2:06 compressing down on pectoralis major 2:08 fibers. If we're trying to affect 2:10 scapular mobility, working on 2:13 pec major 2:14 isn't going to help, but pec minor will. Alright, 2:17 so we need to be a little bit more 2:19 specific than that. We do get some bonus 2:23 points for knowing where the trigger 2:24 points are, which in this case is in the 2:26 middle of the pectoralis minor fibers. 2:28 But, I think you guys are going to find a 2:29 little bit like when we did the 2:30 subscapularis video, it's not so easy to 2:33 just put an X on that particular point. 2:37 Those trigger points 2:40 are going to be right between the 2:41 coracoid process and ribs three, four, and 2:43 five. The one thing we do have to 2:45 consider before I start digging 2:47 underneath her pectoralis major is do we 2:50 have other potential structures that 2:54 could be insulted or injured by 2:57 compression, and right underneath my 3:00 pectoralis minor runs my brachial plexus, 3:03 my axillary artery, and, of course, since 3:05 I'm messing around in the axillary 3:09 region, we do have to think about those 3:10 lymph nodes as well. So, guys, if you're 3:13 pressing through that tissue and 3:17 your patient or client complains of 3:19 numbness, tingling, pain, especially that 3:22 searing burning pain that comes along 3:23 with stretching a nerve, we're going to 3:25 go ahead and back off a little bit. Try 3:28 to move our thumbs or fingers around in 3:31 such a way that we can get around that 3:33 structure. Remember, nerves are very, very 3:36 thin. We're talking like a millimeter, so 3:38 it should be fairly easy to get around 3:40 that tissue. And, of course, last, we want 3:43 to think about patient comfort and our 3:45 comfort, so we want to get body position 3:48 where we are not going to wear ourselves 3:51 out and our patient is still comfortable. 3:54 Now, I'm going to throw my comfort out 3:58 the window for you guys for just a 3:59 second here, so that I can show you where 4:01 you're going to be placing your hands 4:03 Notice that I very casually, but very 4:08 meaningfully, took this hand and put it 4:11 behind Crystal's head. It's actually a 4:15 really convenient position to do 4:18 pectoralis minor release in, because 4:20 that will posteriorly tip and 4:23 upwardly rotate my scapula, which then 4:27 lengthens out my 4:28 pectoralis minor, and it gets her arm out of 4:31 the way of her axilla. So, all of that- 4:35 nice easy position, this is a nice 4:37 comfortable position for her, and now 4:39 it's easy for me to get in there with my 4:42 hands. Your pectoralis minor is 4:44 underneath your pectoralis major. The way 4:47 I would go about identifying this, guys, 4:49 is you see this tissue here is her 4:51 anterior delt, which then kind of folds 4:55 into her pec major. So, I just follow 5:00 that anterior delt down and reach just 5:03 underneath pec major here, and I very 5:07 gently start trying to coerce my fingers 5:11 deeper and deeper underneath that pec 5:12 major. What I will run into is while my 5:16 pec major fibers run this way, my pec 5:20 minor fibers run this way, so instead of 5:23 having all of these horizontally 5:25 oriented fibers that I'm kind of pushing 5:27 into, all of a sudden I'll run into this 5:30 very distinct lateral border on the 5:32 upper lateral portion of her pectoral 5:35 region. Once I find those tissues, I can 5:40 press in just a little bit deeper, so 5:43 that I know I am affecting the fibers of 5:46 pectoralis minor, inserting into ribs 5:49 three, four, and five. The fibers inserting 5:52 into ribs three just being a little bit 5:54 more medial, four a little lateral to that, and 5:56 five lateral to that. I push a little 5:58 deeper. I can definitely affect all 6:03 of those tissues, and then I can come in 6:06 here and find the most tender point, 6:12 superior to inferior, inferior or 6:14 superior within those 6:17 vertically oriented fibers. Now, of course, 6:21 I wouldn't do that reaching cross body 6:23 this way. That's actually a fairly 6:26 inconvenient way to do this technique. It's 6:29 not easy for me. Obviously I don't get 6:31 much of a visual reference here. I'm 6:33 having to kind of 6:34 feel around with my hands. The way I 6:38 would actually do this from my body 6:39 position is, once again, have Crystal's 6:42 hand up this way. I'm going to take this 6:44 hand, the one closest to her head, and I'm 6:47 going to put my hand over the top of her 6:48 anterior delt. I'm just going to use 6:51 this thumb to slide right underneath 6:54 her pec major, and then once I get deep 6:59 enough, I'll find that vertical border. I can 7:04 go superior to inferior, inferior to 7:06 superior. Make sure with these fibers 7:09 you're taking short strokes. I 7:11 wouldn't start at her anterior delt and then 7:14 keep dragging skin with me all the way 7:16 to rib five. If I start up high, I want to 7:20 lift up my finger and then try a spot a 7:23 little lower, lift up my finger and try a 7:25 spot a little lower, and lift up my finger and 7:26 try a spot a little lower until I find 7:29 that most tender point, or that point of 7:32 highest tissue density. Once I'm there, 7:36 and I found it, I can then use my other 7:39 thumb if I need to, to add a little 7:42 bit more pressure. So this is one 7:45 position. The other position that also 7:47 gets used is I can have Crystal lay on her 7:50 side, facing away from me. I can lower the 7:54 table a little bit. 7:58 I can go ahead and place her arm up 8:00 like this, and now I can go 8:05 down towards the table to affect these 8:08 tissues. Once again, I'm still going to 8:09 start with my hand up here on her 8:11 anterior delt. I just reach my thumb 8:13 underneath her pec major, and then I can 8:16 come this way. I'll use this technique as 8:19 often. It's not as convenient for me, but 8:22 it does occasionally come in handy, 8:24 especially in individuals who are a 8:27 little bit more well-endowed, especially 8:31 women who are more well-endowed. This 8:33 will allow the breast tissue to fall 8:35 towards the table so that you don't feel 8:38 like you have to have your hands in 8:40 sensitive areas. So, once again, guys just 8:43 to review- go ahead and lay back on your 8:45 back for me. We're going to go ahead and 8:47 take Crystal's hand up and put it behind her 8:49 head. That's going to upwardly rotate and 8:51 posteriorly tip my scapula. Now, I'm 8:54 going to start just below my 8:58 anterior delt as it runs into my 9:00 pec major. I'm going to reach under those 9:02 fibers, closer to the table. Alright, 9:06 feel those ribs against your fingers. 9:11 Once I find that lateral border, I can 9:16 then search that lateral border for the 9:19 most tender tissue. 9:23 Once I find that most tender tissue, I 9:26 can then apply pressure thumb over thumb, 9:29 hold for 30 to 120 seconds, wait for a 9:32 release, or that tissue to melt underneath my 9:35 fingers, and then reassess. And, now for the 9:37 close-up recap. The first thing I'm going 9:39 to have Crystal do is go ahead and take 9:41 her hands and put them behind her head. 9:42 This will automatically put her scapula 9:45 in a position of posterior tipping and 9:47 upward rotation, which is going to 9:49 lengthen out those pectoralis fibers for 9:51 me a little bit. It's also going to give 9:53 me access to her axilla, so that I can 9:55 get behind her pec major and get to that 9:59 lateral border of her pectoralis minor. 10:01 If I take my hand and I just kind of put 10:03 it over her anterior delt, my thumb will 10:06 be in good position to just go ahead and 10:09 reach underneath that pec major, 10:12 these fibers right here. And I'm just 10:15 going to go right over ribs three, four, 10:18 and five. Alright, so I can feel her ribs 10:22 right there. Kind of search through this 10:24 tissue and make sure that you're taking 10:26 small, small strokes as you're 10:29 investigating, as your palpating. 10:31 You never want to take large strokes in 10:34 this area. And you never want to start 10:35 somewhere far from where you want to be 10:38 and start pulling a lot of skin tissue 10:40 with you, because you will make somebody 10:41 very uncomfortable. As I take these 10:44 short strokes, find the lateral border of 10:47 the pectoralis minor. There it is. We can 10:50 see Cystal's face change just a little 10:52 bit as soon as I find her pec minor, 10:54 which is definitely a little overactive. 10:56 Then I'm going to look for the 10:57 tightest point. Once again, use short strokes. 11:03 Notice, I picked up my finger there. And 11:05 there we go, there's a nice tight nodule. 11:08 It is a little hard to get thumb over 11:10 thumb in this position. This position 11:13 doesn't really allow us to get a 11:16 braced technique like this, at least not 11:20 without getting our hands into places 11:22 they probably shouldn't be. But for this 11:25 particular technique, having having the 11:28 ability to 11:28 brace the anterior delt makes this 11:32 technique not too rough on the hands. Now, 11:34 the other way we could do this is I'm 11:38 going to go ahead and have Crystal turn 11:40 on her side. When she turns on her 11:45 side, I can now use both hands this way 11:49 and go right underneath her pec major, 11:53 and I can go ahead and palpate that 11:58 lateral border. Once again, I'm picking up my 12:00 fingers as I need to. I can straighten 12:02 out my arms, and again. wait for that 12:05 release for 30 to 120 seconds. Be very 12:10 careful with this one, guys, and remember that 12:12 regardless of which hand position or 12:14 which body position you use, you do have 12:18 all of the nerves coming out from 12:19 underneath the pectoralis minor, coming 12:21 off that brachial plexus, and you have that 12:24 axillary artery. We don't want to 12:26 impinge and stretch those tissues out, 12:27 because we'll definitely feel 12:29 uncomfortable. Between the two positions, 12:33 I find it easier to do the one on the 12:35 back. However, this position is nice to 12:38 have handy, in case you do have a female 12:41 with a lot of breast tissue. A nice 12:43 caveat to this particular technique is 12:45 as soon as you roll them onto their side, 12:47 that breast tissue falls away from where 12:49 you're going to need to put your hands 12:51 to begin with. There you guys have it, static 12:54 manual release of the pectoralis minor. 12:56 Please make sure that before you're 12:58 putting your hands on somebody, you're 80% 13:00 to 90% sure that 13:03 that intervention is going to affect 13:05 your outcomes. The only way to get there 13:07 is through assessment. So, before you 13:09 start doing a pectoralis minor release, 13:11 things like your overhead squat 13:13 assessment, goniometry, muscle length 13:16 tests, and even some special tests should be 13:21 indicating that this particular 13:23 technique is going to improve range of 13:26 motion, reduce pain, or maybe increase 13:30 activity of antagonists. If you can, find 13:34 colleagues that you can practice this on 13:36 before trying this technique on a 13:39 patient. That will get you through a lot 13:42 of the portion of this technique, or 13:44 learning of this technique that makes 13:47 you feel clumsy. You want to be confident 13:49 when you actually apply this technique 13:51 in practice. If you can find a mentor 13:54 or a live workshop to attend so you can 13:58 get some hands-on education, of course 14:01 there is no replacement. I hope you guys 14:03 enjoyed this video. I hope you'll leave 14:05 your questions in the comments boxes 14:07 below. I'll be happy to answer. I look 14:09 forward to talking to you guys again 14:10 soon. 14:19
