00:00:0400:00:06
This is Brent of the Brookbush Institute
00:00:0600:00:08
and in this video we're going over static
00:00:0800:00:09
manual release of the pectoralis minor.
00:00:0900:00:11
Now, if you're watching this video, I'm
00:00:1100:00:12
assuming you're watching it for
00:00:1200:00:14
educational purposes and that you are a
00:00:1400:00:16
licensed manual therapist. That is, you
00:00:1600:00:19
are legally allowed to perform manual
00:00:1900:00:21
techniques based on your scope of
00:00:2100:00:23
practice. Generally, that includes
00:00:2300:00:24
physical therapists, athletic trainers,
00:00:2400:00:26
chiropractors, massage therapists, and
00:00:2600:00:28
osteopaths. I'm sure I'm forgetting a
00:00:2800:00:31
couple, but if you're unsure of whether
00:00:3100:00:32
you're allowed to do this technique,
00:00:3200:00:35
please look those laws up in your state
00:00:3500:00:36
or region. Personal trainers, this
00:00:3600:00:39
technique probably does not apply to
00:00:3900:00:41
your scope, but you could use the
00:00:4100:00:43
palpation portion of this video in an
00:00:4300:00:46
educational setting to help you learn
00:00:4600:00:48
your anatomy. I'm going to have my friend, Crystal,
00:00:4800:00:49
come out. She's going to help me
00:00:4900:00:51
demonstrate this technique. Now, as this
00:00:5100:00:55
technique is on the pectoralis minor
00:00:5500:00:58
which is in a fairly sensitive area,
00:00:5800:01:00
especially when working with females, we
00:01:0000:01:03
do want to be 80%, 90% sure
00:01:0300:01:05
that the release of the pectoralis minor
00:01:0500:01:07
is going to have an effect on our
00:01:0700:01:10
outcomes, whether those be rehab or
00:01:1000:01:12
performance related. The only way I'm
00:01:1200:01:14
going to get there is by starting with
00:01:1400:01:16
assessment. We'd never have Crystal
00:01:1600:01:17
just lay down and start releasing her
00:01:1700:01:20
pectoralis minor. I might do overhead
00:01:2000:01:22
squat assessment, goniometry, manual
00:01:2200:01:25
muscle testing, muscle length tests, or
00:01:2500:01:28
special tests. There have been
00:01:2800:01:31
assessments and tests done before trying this
00:01:3100:01:33
technique that give me an indication
00:01:3300:01:36
that this is going to help me towards
00:01:3600:01:39
Crystal's goals, whether those be
00:01:3900:01:43
performance or rehab related. All of
00:01:4300:01:45
our manual techniques follow a very
00:01:4500:01:47
similar protocol, which is basically
00:01:4700:01:50
palpate and compress. We do want to be
00:01:5000:01:54
able to palpate and differentiate, so in
00:01:5400:01:57
the case of the pectoralis minor, we do
00:01:5700:01:59
want to make sure that we know the
00:01:5900:02:00
difference between where the pectoralis
00:02:0000:02:03
minor is, which is underneath the pec
00:02:0300:02:06
major, and not just be
00:02:0600:02:08
compressing down on pectoralis major
00:02:0800:02:10
fibers. If we're trying to affect
00:02:1000:02:13
scapular mobility, working on
00:02:1300:02:14
pec major
00:02:1400:02:17
isn't going to help, but pec minor will. Alright,
00:02:1700:02:19
so we need to be a little bit more
00:02:1900:02:23
specific than that. We do get some bonus
00:02:2300:02:24
points for knowing where the trigger
00:02:2400:02:26
points are, which in this case is in the
00:02:2600:02:28
middle of the pectoralis minor fibers.
00:02:2800:02:29
But, I think you guys are going to find a
00:02:2900:02:30
little bit like when we did the
00:02:3000:02:33
subscapularis video, it's not so easy to
00:02:3300:02:37
just put an X on that particular point.
00:02:3700:02:40
Those trigger points
00:02:4000:02:41
are going to be right between the
00:02:4100:02:43
coracoid process and ribs three, four, and
00:02:4300:02:45
five. The one thing we do have to
00:02:4500:02:47
consider before I start digging
00:02:4700:02:50
underneath her pectoralis major is do we
00:02:5000:02:54
have other potential structures that
00:02:5400:02:57
could be insulted or injured by
00:02:5700:03:00
compression, and right underneath my
00:03:0000:03:03
pectoralis minor runs my brachial plexus,
00:03:0300:03:05
my axillary artery, and, of course, since
00:03:0500:03:09
I'm messing around in the axillary
00:03:0900:03:10
region, we do have to think about those
00:03:1000:03:13
lymph nodes as well. So, guys, if you're
00:03:1300:03:17
pressing through that tissue and
00:03:1700:03:19
your patient or client complains of
00:03:1900:03:22
numbness, tingling, pain, especially that
00:03:2200:03:23
searing burning pain that comes along
00:03:2300:03:25
with stretching a nerve, we're going to
00:03:2500:03:28
go ahead and back off a little bit. Try
00:03:2800:03:31
to move our thumbs or fingers around in
00:03:3100:03:33
such a way that we can get around that
00:03:3300:03:36
structure. Remember, nerves are very, very
00:03:3600:03:38
thin. We're talking like a millimeter, so
00:03:3800:03:40
it should be fairly easy to get around
00:03:4000:03:43
that tissue. And, of course, last, we want
00:03:4300:03:45
to think about patient comfort and our
00:03:4500:03:48
comfort, so we want to get body position
00:03:4800:03:51
where we are not going to wear ourselves
00:03:5100:03:54
out and our patient is still comfortable.
00:03:5400:03:58
Now, I'm going to throw my comfort out
00:03:5800:03:59
the window for you guys for just a
00:03:5900:04:01
second here, so that I can show you where
00:04:0100:04:03
you're going to be placing your hands
00:04:0300:04:08
Notice that I very casually, but very
00:04:0800:04:11
meaningfully, took this hand and put it
00:04:1100:04:15
behind Crystal's head. It's actually a
00:04:1500:04:18
really convenient position to do
00:04:1800:04:20
pectoralis minor release in, because
00:04:2000:04:23
that will posteriorly tip and
00:04:2300:04:27
upwardly rotate my scapula, which then
00:04:2700:04:28
lengthens out my
00:04:2800:04:31
pectoralis minor, and it gets her arm out of
00:04:3100:04:35
the way of her axilla. So, all of that-
00:04:3500:04:37
nice easy position, this is a nice
00:04:3700:04:39
comfortable position for her, and now
00:04:3900:04:42
it's easy for me to get in there with my
00:04:4200:04:44
hands. Your pectoralis minor is
00:04:4400:04:47
underneath your pectoralis major. The way
00:04:4700:04:49
I would go about identifying this, guys,
00:04:4900:04:51
is you see this tissue here is her
00:04:5100:04:55
anterior delt, which then kind of folds
00:04:5500:05:00
into her pec major. So, I just follow
00:05:0000:05:03
that anterior delt down and reach just
00:05:0300:05:07
underneath pec major here, and I very
00:05:0700:05:11
gently start trying to coerce my fingers
00:05:1100:05:12
deeper and deeper underneath that pec
00:05:1200:05:16
major. What I will run into is while my
00:05:1600:05:20
pec major fibers run this way, my pec
00:05:2000:05:23
minor fibers run this way, so instead of
00:05:2300:05:25
having all of these horizontally
00:05:2500:05:27
oriented fibers that I'm kind of pushing
00:05:2700:05:30
into, all of a sudden I'll run into this
00:05:3000:05:32
very distinct lateral border on the
00:05:3200:05:35
upper lateral portion of her pectoral
00:05:3500:05:40
region. Once I find those tissues, I can
00:05:4000:05:43
press in just a little bit deeper, so
00:05:4300:05:46
that I know I am affecting the fibers of
00:05:4600:05:49
pectoralis minor, inserting into ribs
00:05:4900:05:52
three, four, and five. The fibers inserting
00:05:5200:05:54
into ribs three just being a little bit
00:05:5400:05:56
more medial, four a little lateral to that, and
00:05:5600:05:58
five lateral to that. I push a little
00:05:5800:06:03
deeper. I can definitely affect all
00:06:0300:06:06
of those tissues, and then I can come in
00:06:0600:06:12
here and find the most tender point,
00:06:1200:06:14
superior to inferior, inferior or
00:06:1400:06:17
superior within those
00:06:1700:06:21
vertically oriented fibers. Now, of course,
00:06:2100:06:23
I wouldn't do that reaching cross body
00:06:2300:06:26
this way. That's actually a fairly
00:06:2600:06:29
inconvenient way to do this technique. It's
00:06:2900:06:31
not easy for me. Obviously I don't get
00:06:3100:06:33
much of a visual reference here. I'm
00:06:3300:06:34
having to kind of
00:06:3400:06:38
feel around with my hands. The way I
00:06:3800:06:39
would actually do this from my body
00:06:3900:06:42
position is, once again, have Crystal's
00:06:4200:06:44
hand up this way. I'm going to take this
00:06:4400:06:47
hand, the one closest to her head, and I'm
00:06:4700:06:48
going to put my hand over the top of her
00:06:4800:06:51
anterior delt. I'm just going to use
00:06:5100:06:54
this thumb to slide right underneath
00:06:5400:06:59
her pec major, and then once I get deep
00:06:5900:07:04
enough, I'll find that vertical border. I can
00:07:0400:07:06
go superior to inferior, inferior to
00:07:0600:07:09
superior. Make sure with these fibers
00:07:0900:07:11
you're taking short strokes. I
00:07:1100:07:14
wouldn't start at her anterior delt and then
00:07:1400:07:16
keep dragging skin with me all the way
00:07:1600:07:20
to rib five. If I start up high, I want to
00:07:2000:07:23
lift up my finger and then try a spot a
00:07:2300:07:25
little lower, lift up my finger and try a
00:07:2500:07:26
spot a little lower, and lift up my finger and
00:07:2600:07:29
try a spot a little lower until I find
00:07:2900:07:32
that most tender point, or that point of
00:07:3200:07:36
highest tissue density. Once I'm there,
00:07:3600:07:39
and I found it, I can then use my other
00:07:3900:07:42
thumb if I need to, to add a little
00:07:4200:07:45
bit more pressure. So this is one
00:07:4500:07:47
position. The other position that also
00:07:4700:07:50
gets used is I can have Crystal lay on her
00:07:5000:07:54
side, facing away from me. I can lower the
00:07:5400:07:57
table a little bit.
00:07:5800:08:00
I can go ahead and place her arm up
00:08:0000:08:05
like this, and now I can go
00:08:0500:08:08
down towards the table to affect these
00:08:0800:08:09
tissues. Once again, I'm still going to
00:08:0900:08:11
start with my hand up here on her
00:08:1100:08:13
anterior delt. I just reach my thumb
00:08:1300:08:16
underneath her pec major, and then I can
00:08:1600:08:19
come this way. I'll use this technique as
00:08:1900:08:22
often. It's not as convenient for me, but
00:08:2200:08:24
it does occasionally come in handy,
00:08:2400:08:27
especially in individuals who are a
00:08:2700:08:31
little bit more well-endowed, especially
00:08:3100:08:33
women who are more well-endowed. This
00:08:3300:08:35
will allow the breast tissue to fall
00:08:3500:08:38
towards the table so that you don't feel
00:08:3800:08:40
like you have to have your hands in
00:08:4000:08:43
sensitive areas. So, once again, guys just
00:08:4300:08:45
to review- go ahead and lay back on your
00:08:4500:08:47
back for me. We're going to go ahead and
00:08:4700:08:49
take Crystal's hand up and put it behind her
00:08:4900:08:51
head. That's going to upwardly rotate and
00:08:5100:08:54
posteriorly tip my scapula. Now, I'm
00:08:5400:08:58
going to start just below my
00:08:5800:09:00
anterior delt as it runs into my
00:09:0000:09:02
pec major. I'm going to reach under those
00:09:0200:09:06
fibers, closer to the table. Alright,
00:09:0600:09:11
feel those ribs against your fingers.
00:09:1100:09:16
Once I find that lateral border, I can
00:09:1600:09:19
then search that lateral border for the
00:09:1900:09:22
most tender tissue.
00:09:2300:09:26
Once I find that most tender tissue, I
00:09:2600:09:29
can then apply pressure thumb over thumb,
00:09:2900:09:32
hold for 30 to 120 seconds, wait for a
00:09:3200:09:35
release, or that tissue to melt underneath my
00:09:3500:09:37
fingers, and then reassess. And, now for the
00:09:3700:09:39
close-up recap. The first thing I'm going
00:09:3900:09:41
to have Crystal do is go ahead and take
00:09:4100:09:42
her hands and put them behind her head.
00:09:4200:09:45
This will automatically put her scapula
00:09:4500:09:47
in a position of posterior tipping and
00:09:4700:09:49
upward rotation, which is going to
00:09:4900:09:51
lengthen out those pectoralis fibers for
00:09:5100:09:53
me a little bit. It's also going to give
00:09:5300:09:55
me access to her axilla, so that I can
00:09:5500:09:59
get behind her pec major and get to that
00:09:5900:10:01
lateral border of her pectoralis minor.
00:10:0100:10:03
If I take my hand and I just kind of put
00:10:0300:10:06
it over her anterior delt, my thumb will
00:10:0600:10:09
be in good position to just go ahead and
00:10:0900:10:12
reach underneath that pec major,
00:10:1200:10:15
these fibers right here. And I'm just
00:10:1500:10:18
going to go right over ribs three, four,
00:10:1800:10:22
and five. Alright, so I can feel her ribs
00:10:2200:10:24
right there. Kind of search through this
00:10:2400:10:26
tissue and make sure that you're taking
00:10:2600:10:29
small, small strokes as you're
00:10:2900:10:31
investigating, as your palpating.
00:10:3100:10:34
You never want to take large strokes in
00:10:3400:10:35
this area. And you never want to start
00:10:3500:10:38
somewhere far from where you want to be
00:10:3800:10:40
and start pulling a lot of skin tissue
00:10:4000:10:41
with you, because you will make somebody
00:10:4100:10:44
very uncomfortable. As I take these
00:10:4400:10:47
short strokes, find the lateral border of
00:10:4700:10:50
the pectoralis minor. There it is. We can
00:10:5000:10:52
see Cystal's face change just a little
00:10:5200:10:54
bit as soon as I find her pec minor,
00:10:5400:10:56
which is definitely a little overactive.
00:10:5600:10:57
Then I'm going to look for the
00:10:5700:11:03
tightest point. Once again, use short strokes.
00:11:0300:11:05
Notice, I picked up my finger there. And
00:11:0500:11:08
there we go, there's a nice tight nodule.
00:11:0800:11:10
It is a little hard to get thumb over
00:11:1000:11:13
thumb in this position. This position
00:11:1300:11:16
doesn't really allow us to get a
00:11:1600:11:20
braced technique like this, at least not
00:11:2000:11:22
without getting our hands into places
00:11:2200:11:25
they probably shouldn't be. But for this
00:11:2500:11:28
particular technique, having having the
00:11:2800:11:28
ability to
00:11:2800:11:32
brace the anterior delt makes this
00:11:3200:11:34
technique not too rough on the hands. Now,
00:11:3400:11:38
the other way we could do this is I'm
00:11:3800:11:40
going to go ahead and have Crystal turn
00:11:4000:11:45
on her side. When she turns on her
00:11:4500:11:49
side, I can now use both hands this way
00:11:4900:11:53
and go right underneath her pec major,
00:11:5300:11:58
and I can go ahead and palpate that
00:11:5800:12:00
lateral border. Once again, I'm picking up my
00:12:0000:12:02
fingers as I need to. I can straighten
00:12:0200:12:05
out my arms, and again. wait for that
00:12:0500:12:10
release for 30 to 120 seconds. Be very
00:12:1000:12:12
careful with this one, guys, and remember that
00:12:1200:12:14
regardless of which hand position or
00:12:1400:12:18
which body position you use, you do have
00:12:1800:12:19
all of the nerves coming out from
00:12:1900:12:21
underneath the pectoralis minor, coming
00:12:2100:12:24
off that brachial plexus, and you have that
00:12:2400:12:26
axillary artery. We don't want to
00:12:2600:12:27
impinge and stretch those tissues out,
00:12:2700:12:29
because we'll definitely feel
00:12:2900:12:33
uncomfortable. Between the two positions,
00:12:3300:12:35
I find it easier to do the one on the
00:12:3500:12:38
back. However, this position is nice to
00:12:3800:12:41
have handy, in case you do have a female
00:12:4100:12:43
with a lot of breast tissue. A nice
00:12:4300:12:45
caveat to this particular technique is
00:12:4500:12:47
as soon as you roll them onto their side,
00:12:4700:12:49
that breast tissue falls away from where
00:12:4900:12:51
you're going to need to put your hands
00:12:5100:12:54
to begin with. There you guys have it, static
00:12:5400:12:56
manual release of the pectoralis minor.
00:12:5600:12:58
Please make sure that before you're
00:12:5800:13:00
putting your hands on somebody, you're 80%
00:13:0000:13:03
to 90% sure that
00:13:0300:13:05
that intervention is going to affect
00:13:0500:13:07
your outcomes. The only way to get there
00:13:0700:13:09
is through assessment. So, before you
00:13:0900:13:11
start doing a pectoralis minor release,
00:13:1100:13:13
things like your overhead squat
00:13:1300:13:16
assessment, goniometry, muscle length
00:13:1600:13:21
tests, and even some special tests should be
00:13:2100:13:23
indicating that this particular
00:13:2300:13:26
technique is going to improve range of
00:13:2600:13:30
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
00:13:3600:13:39
before trying this technique on a
00:13:3900:13:42
patient. That will get you through a lot
00:13:4200:13:44
of the portion of this technique, or
00:13:4400:13:47
learning of this technique that makes
00:13:4700:13:49
you feel clumsy. You want to be confident
00:13:4900:13:51
when you actually apply this technique
00:13:5100:13:54
in practice. If you can find a mentor
00:13:5400:13:58
or a live workshop to attend so you can
00:13:5800:14:01
get some hands-on education, of course
00:14:0100:14:03
there is no replacement. I hope you guys
00:14:0300:14:05
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