You can only view 3 videos without an account. Become a Member to access all videos on the website.
Pectoralis Major and Subclavius Static Manual Release (Soft Tissue Mobilization)
Pectoralis Major and Subclavius Static Manual Release (Soft Tissue Mobilization) is a therapeutic technique that can improve movement within the upper body, reduce pain and pressure on your nerves, and relieve tension and tightness in the muscles and connective tissues. This technique uses slow, precise movements to lengthen, stretch and mobilize the pectoralis major and subclavius muscles, as well as the surrounding fascia and connective tissues. It helps restore optimal
Transcript
00:00:0400:00:07
This is Brent of the Brookbush
00:00:0400:00:07
Institute, and in this video we're bringing
00:00:0700:00:09
you another manual technique. Now if you're watching this video I'm assuming
00:00:0900:00:13
you're watching it for educational purposes, and that you are a licensed
00:00:1300:00:17
manual therapist following the laws regarding scope of practice in your
00:00:1700:00:20
state or region. That means athletic trainers, chiropractors, physical
00:00:2000:00:25
therapists, osteopaths, licensed massage therapists you are likely in the clear
00:00:2500:00:30
to do these techniques. Personal trainers this probably does not fall within your
00:00:3000:00:33
scope of practice, although you might be able to use the palpation portion of
00:00:3300:00:38
this video to aid in learning your functional anatomy in an educational
00:00:3800:00:43
setting, supervised by a licensed manual therapist. Now before we place our hands
00:00:4300:00:48
on a patient or client it is important that we assess, and have a good rationale
00:00:4800:00:53
for doing so, and of course if we're going to assess then we should be
00:00:5300:00:57
reassessing to ensure that the manual technique we're using is effective, and
00:00:5700:01:01
we have a good rationale for continuing to use that technique. We're going to go
00:01:0100:01:05
over static manual release of the pectoralis major and subclavius muscles.
00:01:0500:01:08
My friend Melissa is going to help me demonstrate this technique. We're going
00:01:0800:01:11
to use that same palpate and compress release technique we've used in all of
00:01:1100:01:15
our static manual release videos. We are going to break it down a little bit
00:01:1500:01:20
though, and use our four-step process of differentiate, know where our common
00:01:2000:01:23
trigger points are, know what tissues we probably shouldn't be compressing are,
00:01:2300:01:27
and of course patient client and professional positions so that we have
00:01:2700:01:30
good technique and our patient and client is comfortable. Now let's start
00:01:3000:01:36
off with how large the pectoralis major is because that's going to be the first
00:01:3600:01:42
step in our palpation. I think individuals kind of underestimate how
00:01:4200:01:49
big this muscle is. It essentially attaches its origin to all of the
00:01:4900:01:52
clavicle that isn't covered by the deltoid, so the medial two-thirds of the
00:01:5200:01:57
clavicle, and then this is the the really large part, it also goes from
00:01:5700:02:04
sternoclavicular joint all the way down to the xiphoid process. So this is a very
00:02:0400:02:11
broad muscle and all of these fibers converge into the lateral lip of the
00:02:1100:02:14
occipital groove, which you guys can see kind of how all this tissue right here
00:02:1400:02:17
converges into the shoulder, kind of passing
00:02:1700:02:21
underneath the anterior deltoid here. We do need to think about a couple muscles
00:02:2100:02:27
that run underneath the pectoralis major, we have the pectoralis minor underneath
00:02:2700:02:32
the lateral side of the pectoralis major. The nice thing from a palpation
00:02:3200:02:37
standpoint is the pectoralis minor runs nice and vertical, while most of the
00:02:3700:02:41
pectoralis major fibers run horizontal. So if you happen to be releasing this
00:02:4100:02:45
pectoralis major trigger point then all of a sudden start hitting fibers that go
00:02:4500:02:50
this way, you know you're not on pec major. Now if you want to release the
00:02:5000:02:55
pec minor that's fine, but be cognizant of what you're releasing and ensure that
00:02:5500:02:59
it's going to contribute to your goal. The other muscle that is underneath your
00:02:5900:03:03
pectoralis major, I've marked a trigger point off with an X here, I'm going to
00:03:0300:03:07
show you guys how to get to it, but it's your subclavius. Your subclavius is
00:03:0700:03:16
a funny little muscle which can restrict posterior rotation and upward rotation,
00:03:1600:03:21
or what's actually called elevation of the clavicle. So it can affect elevation
00:03:2100:03:25
of the arm. We're going to show where that trigger point is, but it's it's way
00:03:2500:03:30
up here in the corner right next to your your sternoclavicular joint. You kind of
00:03:3000:03:37
have to wrap your finger underneath some of the pec major fibers. Now the trigger
00:03:3700:03:42
points for the most part, the majority of the trigger points are right in the
00:03:4200:03:47
middle of the length of these fibers. So I don't know if you guys can see these
00:03:4700:03:51
X's, of course we'll do a close-up so you guys can see these X's, but these X's run
00:03:5100:03:57
right down the middle, right right down the middle of the pec here, that's where
00:03:5700:04:02
the majority of our trigger points are. There's an additional trigger point out
00:04:0200:04:09
on this little wing of the pec major here and then we have one other trigger
00:04:0900:04:14
point which I just mentioned, which is way up in here and this is generally
00:04:1400:04:20
speaking a subclavius trigger point. Now getting into step 3, are there tissues
00:04:2000:04:25
that we probably don't want to compress. Well when we're here we probably want to
00:04:2500:04:30
be aware that we're kind of close to the brachial plexus, and if we put
00:04:3000:04:34
tension on the pec major and the pec minor we could compress the brachial
00:04:3400:04:38
plexus, and that's going to give us some some weird nerve sensations, either
00:04:3800:04:42
numbing or tingling in the fingers, or that sharp burning pain. Of course if you
00:04:4200:04:48
press down and any of that happens just move a little bit, nerves are fairly thin
00:04:4800:04:53
structures so you should be able to move a half centimeter in any direction and
00:04:5300:04:59
not be on that nerve tissue anymore. The bigger issue with pec major is if
00:04:5900:05:05
you happen to be a male therapist treating a female about half of the
00:05:0500:05:07
pectoralis major is covered by breast tissue.
00:05:0700:05:13
This creates not only a issue where we need to be sensitive and respectful, and
00:05:1300:05:18
also it kind of hurts to just smash breast tissue like that, that doesn't feel good
00:05:1800:05:23
for anybody. So when we talk about how we're going to lay our hands down that's
00:05:2300:05:27
going to be the biggest challenge, how do we lay our hands down get to these
00:05:2700:05:34
trigger points and not just compress and put our hands where they probably
00:05:3400:05:40
shouldn't be. Now with that being said you probably want to do a little bit
00:05:4000:05:46
extra work assessing, explaining to your client where you're going to place your
00:05:4600:05:52
hands, what you expect your outcome to be and get a verbal confirmation that it is
00:05:5200:05:58
okay for you to do this technique. Obviously we don't want to allow
00:05:5800:06:06
embarrassment or any sort of fear of sexual misconduct, which I know is a
00:06:0600:06:10
terrible thing. If you have to bring another female physical therapist in the
00:06:1000:06:12
room, or another female professional in the room because you feel uncomfortable
00:06:1200:06:17
great. We really don't want that stuff though to prevent us from being good
00:06:1700:06:22
practitioners. So I hope with the techniques I show you in this video you
00:06:2200:06:26
guys feel totally comfortable placing your hands where you need to place your
00:06:2600:06:32
hands. So patient and client positioning, you guys will notice I'm standing at
00:06:3200:06:37
about her shoulder height, and for most of the trigger points in the pec I'm
00:06:3700:06:43
actually not going to do the side closest to me, I'm going to do the side
00:06:4300:06:48
further from me, and the reason being is I can get my hands out straight this way.
00:06:4800:06:54
And then if you guys kind of see how I even put my hands just from
00:06:5400:06:59
practice, I kind of have that fingers tilted up position so I can put my hand
00:06:5900:07:03
down, starting at sternum and move laterally,
00:07:0300:07:10
keep my fingers up and I'm nowhere close to sensitive areas. Melissa doesn't feel
00:07:1000:07:14
uncomfortable, I don't feel uncomfortable, we're all in the clear once we're there.
00:07:1400:07:19
We can then use those same palpatory techniques we've been going through in
00:07:1900:07:23
all of our videos. I know these fibers are horizontal, all
00:07:2300:07:28
right so I'm going to use a perpendicular stroke to find the most
00:07:2800:07:35
dense or overactive fibers. Now a little trick here guys so that you don't play
00:07:3500:07:40
the finger on top of a wet marble game, where the marble keeps trying to shoot
00:07:4000:07:44
out, you want to pin these tissues down a little bit so you can really get your
00:07:4400:07:48
fingers on top of one of these hyperactive nodules. I'm going to go
00:07:4800:07:53
ahead and have Melissa place her hands behind your head. Now that she has her
00:07:5300:07:59
hands behind her head I'm going to go ahead and start my perpendicular strokes,
00:07:5900:08:06
and I can feel some nice nice overactive fascicles right there, and once I find
00:08:0600:08:10
those overactive fascicles I will then search the length of the fiber, I told
00:08:1000:08:15
you it's usually closer to the middle. Once I get close to the middle of
00:08:1500:08:21
these fibers I do in fact feel like a little nodule of hyperactivity, what I'm
00:08:2100:08:24
going to do is I'm going to actually keep my hand with my fingers flared out
00:08:2400:08:31
like this, and then rather than try to like grip or press down with this hand,
00:08:3100:08:35
I'm going to leave this is my dummy thumb. So if I keep my hand off of breast
00:08:3500:08:39
tissue, I'm going to use this hand to apply pressure with kind of that
00:08:3900:08:45
pisiform hamate grip we'd use for mobilizations, just like so. And you
00:08:4500:08:50
can see Melissas face turn, I think I got that trigger point. It is a little tough
00:08:5000:08:54
to play with the tension on these because the the muscle becomes pretty
00:08:5400:08:59
thin here, but do try to be careful to not press too hard. You're
00:08:5900:09:05
just pressing enough to get a little tissue tension back. Once you feel a
00:09:0500:09:10
little increase in tissue tension then you just want to hold real still. So in
00:09:1000:09:14
this position with my arms long using my right arm to apply most of the pressure,
00:09:1400:09:21
I can just kind of lean in a little bit and then wait for a release. Now if this
00:09:2100:09:26
technique you're not comfortable with, you could use thumb over thumb. I have
00:09:2600:09:32
seen that, I have seen this before right, that tends to work too. I think a lot of it is
00:09:3200:09:36
going to depend for you guys on the size of your hands. I happen to have some
00:09:3600:09:40
pretty large hands and some very long fingers so this works better for me. I
00:09:4000:09:44
have seen people do it this way who don't have as large hands, and this
00:09:4400:09:49
is comfortable for them, so they put down this way and they end up keeping their
00:09:4900:09:53
hands out of any sensitive areas. You're going to want to practice on a partner
00:09:5300:09:56
and figure out what techniques work best for you.
00:09:5600:10:02
Alright so as I mentioned, perpendicular strokes, perpendicular strokes then go
00:10:0200:10:05
the length of the tissue to find the tightest nodules, and you can see I have
00:10:0500:10:11
common trigger points I found earlier already marked off here, but just to show
00:10:1100:10:17
you guys can you use this, perfect, up, there, yup, yep, okay right. And
00:10:1700:10:21
then once again I'm just going to put this part of my hand right
00:10:2100:10:25
over this thumb, this becomes my dummy thumb. I can even lay this down on top of her
00:10:2500:10:32
sternum, like my thenar eminence over my sternum
00:10:3200:10:37
here, and then just apply a little pressure just like this, and go ahead and
00:10:3700:10:43
release all those trigger points. Now there's two trigger points that require
00:10:4300:10:47
slightly different technique. The nice thing is they're not nearly, they're not
00:10:4700:10:53
in the same sensitive areas. We have the lateral, very lateral trigger point of
00:10:5300:10:57
the pectoralis major, which is really close to the shoulder. You guys can see I
00:10:5700:11:02
have it marked off here. This one I actually do on the same side. I think I
00:11:0200:11:06
showed you guys a technique when we did pectoralis minor, the hand position I
00:11:0600:11:09
like to use for this stuff is I actually just take this hand
00:11:0900:11:13
the hand that's farthest from my patient I guess now, and I just cup their
00:11:1300:11:17
shoulder. So I'm just going to go up and grab their shoulder just like so. If I
00:11:1700:11:22
grab their shoulder that puts my thumb right over these lateral fibers, and then
00:11:2200:11:26
I can do my perpendicular strokes because these fibers are now running
00:11:2600:11:30
this way. I can do my perpendicular strokes like this and then use this hand
00:11:3000:11:38
to apply pressure. How's that feel? Yeah that's tender right. So I just cup her
00:11:3800:11:43
shoulder, use this thumb to palpate, use this thumb for pressure. The trickiest
00:11:4300:11:49
one is subclavius, because if you just put your hand down right here on the
00:11:4900:11:55
let's say just lateral and just inferior to the sternoclavicular joint,
00:11:5500:12:01
you end up on some really thick pectoralis major fibers. This is not your
00:12:0100:12:06
subclavius, your subclavius is a thin little muscle. So what you have to do is
00:12:0600:12:12
you have to find a way to fall, either fall off the clavicle inferiorly
00:12:1200:12:17
underneath these thick fibers that are the pec major, or you need to find a way
00:12:1700:12:23
to fall superiorly off the thick fibers of the pectoralis major into the
00:12:2300:12:29
depression that's created right between the clavicle and the bulk of the pec
00:12:2900:12:34
major. And of course if you're very careful with your palpation, meaning you
00:12:3400:12:41
don't over press too fast you really work to find the depth that allows you
00:12:4100:12:47
to kind of scan that layer of tissues, you'll find a trigger point which I just
00:12:4700:12:53
did, and then you can kind of press on in. All right, so this one up here guys
00:12:5300:13:00
is the subclavius trigger point, and just keep in mind that it's not just
00:13:0000:13:06
lateral and inferior to your sternoclavicular joint, it's off the
00:13:0600:13:11
pectoralis major fibers, in fact you might have to kind of push the
00:13:1100:13:14
pectoralis major fibers out of the way with like a scooping motion so that they
00:13:1400:13:20
lay on the inferior aspect of your thumb there. So just a quick review because I
00:13:2000:13:23
know I just went over a whole bunch of stuff.
00:13:2300:13:28
Most of the pectoralis major trigger points fall right down the middle of the
00:13:2800:13:34
pec major, which means you need to do some experimenting with hands position
00:13:3400:13:42
on a partner that maybe is not a patient, to figure out what the best position for
00:13:4200:13:46
your size hands are, and I mentioned a few different ways. For me it works best
00:13:4600:13:54
to use this hand as a dummy thumb, all right so the the inferior hand here
00:13:5400:13:58
compared to my patient, and then use this hand to apply pressure, and I kind of
00:13:5800:14:03
keep this like up and flared out position for my hand. I think it would
00:14:0300:14:09
probably be fine to go thumb over thumb too, especially if maybe you had slightly
00:14:0900:14:14
smaller hands than I do. Somebody who has smaller hands than I do
00:14:1400:14:22
might also find it's fine to curl under and go on the same side. All these
00:14:2200:14:26
techniques are very acceptable providing you can get into a position that is
00:14:2600:14:32
straight-armed, using your bodyweight not your hand strength, and you're trying to
00:14:3200:14:36
keep your fingertips which of course makes this a little bit more
00:14:3600:14:43
affectionate, off breast tissue right. Again we don't want to let embarrassment
00:14:4300:14:49
or any sort of fear of sexual misconduct, keep us from doing techniques
00:14:4900:14:51
that are going to be effective. So make sure you're communicating with your
00:14:5100:14:55
client, make sure they understand what's going on, and if you have to if you
00:14:5500:15:00
happen to be a male therapist with a female patient, bring another female
00:15:0000:15:03
colleague into the room so everybody feels nice and comfortable. With the most
00:15:0300:15:08
lateral trigger point remember my cupping the anterior deltoid trick. I think
00:15:0800:15:12
it works great, you got your thumb here it gives you a lot of leverage and then
00:15:1200:15:18
subclavius is going to be inferior to the clavicle, lateral to the
00:15:1800:15:25
sternoclavicular joint, but off these thick superior pectoralis major fibers.
00:15:2500:15:30
You kind of got to push them out of the way. Stay tuned for a close-up recap. In
00:15:3000:15:33
this view you guys can see that the trigger points which I've marked off
00:15:3300:15:37
with X's here, fall right in the middle of the length
00:15:3700:15:41
of the pectoralis major fibers, and that's the middle of the pectoralis
00:15:4100:15:46
major fibers running all the way from sternoclavicular joint to the xiphoid
00:15:4600:15:50
process. So you can see here even these lower X's getting cut off would go all
00:15:5000:15:56
the way down, having a trigger point at each of the bands of the pectoralis
00:15:5600:16:00
major fibers. We talked about several hand positions. We're going to need to
00:16:0000:16:05
not only address these trigger points, but our subclavius trigger point as well
00:16:0500:16:10
as these trigger points on the lateral aspect of the pectoralis major fibers.
00:16:1000:16:15
Let's talk about the majority of the trigger points first and the hand
00:16:1500:16:21
position we used for that. We used a cross-body hand position in this one. I
00:16:2100:16:26
find that it is most comfortable for me to reach across with my fingers turned
00:16:2600:16:33
up, and this helps to keep my hands off of sensitive areas and to get my arms
00:16:3300:16:37
straight so that I can use bodyweight and leaning, rather than hand strength to
00:16:3700:16:42
try to release these trigger points. We talked about perpendicular strokes to
00:16:4200:16:48
find the most dense fascicles, that would be fascicles we're going to presume that
00:16:4800:16:55
are overactive. And then once we find a dense fascicle, we can then go along the
00:16:5500:17:03
length of that fascicle to find any acute point of overactivity, a nodule, a
00:17:0300:17:10
trigger point. Once we find that trigger point we can lay our thenar eminence
00:17:1000:17:17
here, over the sternum so that our hands anchored and relaxed. This turns into our
00:17:1700:17:22
dummy thumb and we can use our other hand, and I just use my pisiform hamate
00:17:2200:17:30
here over my thumb to apply pressure, pushing just hard enough to get a little
00:17:3000:17:34
give back from the tissue. So I feel like this give, give, give and then the tension
00:17:3400:17:36
increases in a tissue and that's right where I'm going to hold it,
00:17:3600:17:44
just at tension, 30 seconds to two minutes until I get a release. Of course
00:17:4400:17:48
guys these are the hardest trigger points to release because
00:17:4800:17:51
you end up having to do this turned up position with your fingers, to try to
00:17:5100:17:57
keep your hands from laying down over sensitive tissues. The easier trigger
00:17:5700:18:02
points to release are the lateral trigger points. The lateral trigger
00:18:0200:18:08
points can be easily addressed by cupping the anterior deltoid, just put your
00:18:0800:18:12
thumb in perfect position to do perpendicular strokes of these lateral
00:18:1200:18:20
fibers. So you guys can see where I marked off the two common trigger points
00:18:2000:18:26
here, find the densest fascicles. Once I find the densest fascicles I'm going to go
00:18:2600:18:32
on the length of that fascicle for an acute point. Sometimes you're going to
00:18:3200:18:36
want to pick up your finger there just so you don't take too much skin with you
00:18:3600:18:40
and just get a skin short stretch, that wouldn't feel good, and once I find it,
00:18:4000:18:47
again I can use this part of my hand right here over this palpating thumb now
00:18:4700:18:52
becoming my dummy thumb, and just apply a little pressure until I get a release.
00:18:5200:18:58
Now the trickiest palpation is the subclavius trigger point because if I
00:18:5800:19:02
just push down right here, I'm actually not going to hit it. If I push down right
00:19:0200:19:07
here I just get these thick, I don't know if you guys can see a little bit of
00:19:0700:19:14
Melissa's hypertrophied pecs as she's obese, she works out hard, but this
00:19:1400:19:18
is all really thick pectoralis major fibers. I need to find a way to get
00:19:1800:19:22
around these. So you kind of have two options, you can either find these fibers
00:19:2200:19:28
and then fall off them superiorly, pushing them down inferiorly as you do,
00:19:2800:19:35
so you fall into the canyon between these fibers and your clavicle. Or what's
00:19:3500:19:40
probably easier is put your thumb on the clavicle, and then fall
00:19:4000:19:45
off the clavicle by pushing these pectoralis major fibers out of the way.
00:19:4500:19:51
Once you're there, you're going to search that level of tissue for anything that
00:19:5100:19:56
feels like a increase in tissue density, feels a little bit more tender to your
00:19:5600:20:01
patient. You can watch their face in this position. Sometimes you find that first once
00:20:0100:20:05
you're there, maybe thumb over thumb technique works here because we just
00:20:0500:20:10
don't have as much room. I don't want to put my hand down over somebody's neck
00:20:1000:20:14
that's going to be real uncomfortable. So I might just do a little thumb over
00:20:1400:20:18
thumb here, maybe use a little bit more hand strength than I would on the other
00:20:1800:20:22
techniques. So there you have it knowing your functional anatomy will definitely
00:20:2200:20:26
help your manual technique. It'll help you differentiate structure so you can
00:20:2600:20:29
place your hands where they need to be, as well as make you aware of these
00:20:2900:20:33
sensitive structures around the tissue that you're trying to target. Things like
00:20:3300:20:38
nerves and lymph nodes, and arteries. Make sure that if you're going to place your
00:20:3800:20:41
hands on a patient that you have done an assessment and have a good rationale for
00:20:4100:20:45
placing your hands on that patient, and if you're going to assess make sure you
00:20:4500:20:49
reassess to ensure that your technique was effective, and you have a good
00:20:4900:20:55
rationale for using that technique again. Now with manual therapy, one on one live
00:20:5500:21:00
education is incredibly important. Please be looking for opportunities like
00:21:0000:21:06
workshops and mentorships, and maybe even classes at your local university that
00:21:0600:21:11
can get you some one-on-one individual instruction, or at least some live
00:21:1100:21:18
classroom instruction, so you've had a chance to be critiqued and mentored by
00:21:1800:21:22
somebody senior to you with some experience in manual therapy techniques.
00:21:2200:21:29
And before you bring this stuff back to your rehab fitness or performance
00:21:2900:21:35
setting, please practice on colleagues, there is no substitute for practice, and
00:21:3500:21:40
it is going to take a while to get accustomed to some of the techniques
00:21:4000:21:45
that we show in these manual technique videos, don't expect to learn them in two
00:21:4500:21:50
or three, or even five minutes. You want to have hours of experience under your
00:21:5000:21:56
belt working on various different body sizes and shapes, so that when you do get
00:21:5600:21:59
that first paying client first paying customer and you're really trying to
00:21:5900:22:06
make a good positive impact, really trying to promote better outcomes, you
00:22:0600:22:09
feel comfortable with that technique. I look forward to hearing about your
00:22:0900:22:13
outcomes and hearing your questions in the comment section of this
00:22:1300:22:17
video. I'll talk with you soon.
Related Videos
Thoracic Pistol Manipulation
Combined Deep Cervical Flexor and External Rotator Activation
Quadruped Crawl Sled Pull
Static Lunge to Row (Posterior Oblique Subsystem) Integration Progressions
Thoracic Spine Manipulation
Rope Row
Single Leg Alternating Horizontal Abduction with External Rotation
Wobble Lunge
Wobble Squat
Splenius Cervicis and Splenius Capitis Static Manual Release (Soft Tissue Mobilization)
Biceps Femoris Manual Static Release
Tensor Fasciae Latae (TFL) Static Manual Release
Gastrocnemius and Soleus Manual Static Release
Pectoralis Major and Subclavius Static Manual Release (Soft Tissue Mobilization)
Rhomboid Static Manual Release (Soft Tissue Mobilization)
Anterior Adductors Static Manual Release
Psoas and Illiacus Static Manual Release
Scalene Static Manual Release (Soft Tissue Mobilization)