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