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Pectoralis Minor Manual Static Release
Pectoralis Minor Manual Static Release is a form of manual therapy designed to target the pectoralis minor muscle to settle tension and improve range of motion in the shoulder joint. This technique applies a single gentle static pressure to the muscle and can be used in combination with stretching, stretching and strengthening exercises. It can be used to reduce pain, improve mobility and maximize performance.
Transcript
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This is Brent of the Brookbush Institute
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...blank
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and in this video we're going over static
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manual release of the pectoralis minor.
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Now, if you're watching this video, I'm
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assuming you're watching it for
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educational purposes and that you are a
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licensed manual therapist. That is, you
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are legally allowed to perform manual
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techniques based on your scope of
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practice. Generally, that includes
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physical therapists, athletic trainers,
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chiropractors, massage therapists, and
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osteopaths. I'm sure I'm forgetting a
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couple, but if you're unsure of whether
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you're allowed to do this technique,
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please look those laws up in your state
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or region. Personal trainers, this
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technique probably does not apply to
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your scope, but you could use the
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palpation portion of this video in an
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educational setting to help you learn
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your anatomy. I'm going to have my friend, Crystal,
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come out. She's going to help me
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demonstrate this technique. Now, as this
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technique is on the pectoralis minor
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which is in a fairly sensitive area,
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especially when working with females, we
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do want to be 80%, 90% sure
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that the release of the pectoralis minor
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is going to have an effect on our
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outcomes, whether those be rehab or
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performance related. The only way I'm
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going to get there is by starting with
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assessment. We'd never have Crystal
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just lay down and start releasing her
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pectoralis minor. I might do overhead
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squat assessment, goniometry, manual
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muscle testing, muscle length tests, or
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special tests. There have been
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assessments and tests done before trying this
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technique that give me an indication
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that this is going to help me towards
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Crystal's goals, whether those be
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performance or rehab related. All of
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our manual techniques follow a very
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similar protocol, which is basically
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palpate and compress. We do want to be
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able to palpate and differentiate, so in
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the case of the pectoralis minor, we do
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want to make sure that we know the
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difference between where the pectoralis
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minor is, which is underneath the pec
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major, and not just be
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compressing down on pectoralis major
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fibers. If we're trying to affect
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scapular mobility, working on
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pec major
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isn't going to help, but pec minor will. Alright,
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so we need to be a little bit more
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specific than that. We do get some bonus
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points for knowing where the trigger
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points are, which in this case is in the
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middle of the pectoralis minor fibers.
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But, I think you guys are going to find a
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little bit like when we did the
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subscapularis video, it's not so easy to
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just put an X on that particular point.
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Those trigger points
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are going to be right between the
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coracoid process and ribs three, four, and
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five. The one thing we do have to
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consider before I start digging
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underneath her pectoralis major is do we
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have other potential structures that
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could be insulted or injured by
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compression, and right underneath my
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pectoralis minor runs my brachial plexus,
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my axillary artery, and, of course, since
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I'm messing around in the axillary
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region, we do have to think about those
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lymph nodes as well. So, guys, if you're
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pressing through that tissue and
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your patient or client complains of
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numbness, tingling, pain, especially that
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searing burning pain that comes along
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with stretching a nerve, we're going to
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go ahead and back off a little bit. Try
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to move our thumbs or fingers around in
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such a way that we can get around that
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structure. Remember, nerves are very, very
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thin. We're talking like a millimeter, so
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it should be fairly easy to get around
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that tissue. And, of course, last, we want
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to think about patient comfort and our
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comfort, so we want to get body position
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where we are not going to wear ourselves
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out and our patient is still comfortable.
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Now, I'm going to throw my comfort out
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the window for you guys for just a
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second here, so that I can show you where
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you're going to be placing your hands
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Notice that I very casually, but very
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meaningfully, took this hand and put it
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behind Crystal's head. It's actually a
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really convenient position to do
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pectoralis minor release in, because
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that will posteriorly tip and
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upwardly rotate my scapula, which then
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lengthens out my
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pectoralis minor, and it gets her arm out of
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the way of her axilla. So, all of that-
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nice easy position, this is a nice
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comfortable position for her, and now
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it's easy for me to get in there with my
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hands. Your pectoralis minor is
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underneath your pectoralis major. The way
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I would go about identifying this, guys,
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is you see this tissue here is her
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anterior delt, which then kind of folds
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into her pec major. So, I just follow
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that anterior delt down and reach just
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underneath pec major here, and I very
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gently start trying to coerce my fingers
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deeper and deeper underneath that pec
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major. What I will run into is while my
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pec major fibers run this way, my pec
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minor fibers run this way, so instead of
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having all of these horizontally
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oriented fibers that I'm kind of pushing
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into, all of a sudden I'll run into this
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very distinct lateral border on the
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upper lateral portion of her pectoral
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region. Once I find those tissues, I can
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press in just a little bit deeper, so
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that I know I am affecting the fibers of
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pectoralis minor, inserting into ribs
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three, four, and five. The fibers inserting
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into ribs three just being a little bit
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more medial, four a little lateral to that, and
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five lateral to that. I push a little
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deeper. I can definitely affect all
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of those tissues, and then I can come in
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here and find the most tender point,
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superior to inferior, inferior or
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superior within those
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vertically oriented fibers. Now, of course,
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I wouldn't do that reaching cross body
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this way. That's actually a fairly
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inconvenient way to do this technique. It's
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not easy for me. Obviously I don't get
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much of a visual reference here. I'm
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having to kind of
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feel around with my hands. The way I
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would actually do this from my body
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position is, once again, have Crystal's
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hand up this way. I'm going to take this
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hand, the one closest to her head, and I'm
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going to put my hand over the top of her
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anterior delt. I'm just going to use
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this thumb to slide right underneath
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her pec major, and then once I get deep
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enough, I'll find that vertical border. I can
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go superior to inferior, inferior to
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superior. Make sure with these fibers
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you're taking short strokes. I
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wouldn't start at her anterior delt and then
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keep dragging skin with me all the way
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to rib five. If I start up high, I want to
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lift up my finger and then try a spot a
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little lower, lift up my finger and try a
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spot a little lower, and lift up my finger and
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try a spot a little lower until I find
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that most tender point, or that point of
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highest tissue density. Once I'm there,
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and I found it, I can then use my other
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thumb if I need to, to add a little
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bit more pressure. So this is one
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position. The other position that also
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gets used is I can have Crystal lay on her
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side, facing away from me. I can lower the
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table a little bit.
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I can go ahead and place her arm up
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like this, and now I can go
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down towards the table to affect these
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tissues. Once again, I'm still going to
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start with my hand up here on her
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anterior delt. I just reach my thumb
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underneath her pec major, and then I can
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come this way. I'll use this technique as
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often. It's not as convenient for me, but
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it does occasionally come in handy,
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especially in individuals who are a
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little bit more well-endowed, especially
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women who are more well-endowed. This
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will allow the breast tissue to fall
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towards the table so that you don't feel
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like you have to have your hands in
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sensitive areas. So, once again, guys just
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to review- go ahead and lay back on your
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back for me. We're going to go ahead and
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take Crystal's hand up and put it behind her
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head. That's going to upwardly rotate and
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posteriorly tip my scapula. Now, I'm
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going to start just below my
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anterior delt as it runs into my
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pec major. I'm going to reach under those
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fibers, closer to the table. Alright,
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feel those ribs against your fingers.
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Once I find that lateral border, I can
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then search that lateral border for the
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most tender tissue.
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Once I find that most tender tissue, I
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can then apply pressure thumb over thumb,
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hold for 30 to 120 seconds, wait for a
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release, or that tissue to melt underneath my
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fingers, and then reassess. And, now for the
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close-up recap. The first thing I'm going
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to have Crystal do is go ahead and take
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her hands and put them behind her head.
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This will automatically put her scapula
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in a position of posterior tipping and
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upward rotation, which is going to
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lengthen out those pectoralis fibers for
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me a little bit. It's also going to give
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me access to her axilla, so that I can
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get behind her pec major and get to that
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lateral border of her pectoralis minor.
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If I take my hand and I just kind of put
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it over her anterior delt, my thumb will
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be in good position to just go ahead and
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reach underneath that pec major,
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these fibers right here. And I'm just
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going to go right over ribs three, four,
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and five. Alright, so I can feel her ribs
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right there. Kind of search through this
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tissue and make sure that you're taking
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small, small strokes as you're
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investigating, as your palpating.
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You never want to take large strokes in
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this area. And you never want to start
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somewhere far from where you want to be
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and start pulling a lot of skin tissue
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with you, because you will make somebody
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very uncomfortable. As I take these
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short strokes, find the lateral border of
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the pectoralis minor. There it is. We can
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see Cystal's face change just a little
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bit as soon as I find her pec minor,
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which is definitely a little overactive.
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Then I'm going to look for the
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tightest point. Once again, use short strokes.
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Notice, I picked up my finger there. And
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there we go, there's a nice tight nodule.
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It is a little hard to get thumb over
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thumb in this position. This position
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doesn't really allow us to get a
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braced technique like this, at least not
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without getting our hands into places
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they probably shouldn't be. But for this
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particular technique, having having the
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ability to
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brace the anterior delt makes this
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technique not too rough on the hands. Now,
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the other way we could do this is I'm
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going to go ahead and have Crystal turn
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on her side. When she turns on her
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side, I can now use both hands this way
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and go right underneath her pec major,
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and I can go ahead and palpate that
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lateral border. Once again, I'm picking up my
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fingers as I need to. I can straighten
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out my arms, and again. wait for that
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release for 30 to 120 seconds. Be very
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careful with this one, guys, and remember that
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regardless of which hand position or
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which body position you use, you do have
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all of the nerves coming out from
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underneath the pectoralis minor, coming
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off that brachial plexus, and you have that
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axillary artery. We don't want to
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impinge and stretch those tissues out,
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because we'll definitely feel
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uncomfortable. Between the two positions,
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I find it easier to do the one on the
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back. However, this position is nice to
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have handy, in case you do have a female
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with a lot of breast tissue. A nice
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caveat to this particular technique is
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as soon as you roll them onto their side,
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that breast tissue falls away from where
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you're going to need to put your hands
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to begin with. There you guys have it, static
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manual release of the pectoralis minor.
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Please make sure that before you're
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putting your hands on somebody, you're 80%
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to 90% sure that
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that intervention is going to affect
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your outcomes. The only way to get there
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is through assessment. So, before you
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start doing a pectoralis minor release,
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things like your overhead squat
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assessment, goniometry, muscle length
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tests, and even some special tests should be
00:13:2100:13:23
indicating that this particular
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technique is going to improve range of
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motion, reduce pain, or maybe increase
00:13:3000:13:34
activity of antagonists. If you can, find
00:13:3400:13:36
colleagues that you can practice this on
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before trying this technique on a
00:13:3900:13:42
patient. That will get you through a lot
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of the portion of this technique, or
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learning of this technique that makes
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you feel clumsy. You want to be confident
00:13:4900:13:51
when you actually apply this technique
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in practice. If you can find a mentor
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or a live workshop to attend so you can
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get some hands-on education, of course
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there is no replacement. I hope you guys
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enjoyed this video. I hope you'll leave
00:14:0500:14:07
your questions in the comments boxes
00:14:0700:14:09
below. I'll be happy to answer. I look
00:14:0900:14:10
forward to talking to you guys again
00:14:1000:14:13
soon.
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