What is the Best Stretch for the Pectoralis Minor?

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This post came about from some of the live Q&A that we had following my webinar last week on “assessing asymmetry in the overhead athlete – does asymmetry mean pathology?” (the webinar is now recorded and available for download if you couldn’t make the live session).  We discussed some asymmetries with the scapula and talked about stretching the pectoralis minor.  I thought this would be a good topic to post on for everyone to discuss.

The Best Stretch for the Pectoralis Minor?

As our knowledge has increased of the importance of posture and scapular position in normal shoulder function, the need to adequately lengthen the pectoralis minor becomes apparent.  Any restrictions in pec minor length will pull the scapula into a protracted and anterior tilted position, which has been shown to inhibit strength of the lower trapezius and decrease the width of the subacromial space.

A problem exists, however.  Many, if not all, of the standard stretches for the pectoralis minor place a decent amount of strain on the anterior capsule.  This is typically something that many patient populations would want to avoid.  We discussed some stretches for the pec minor in the past, but I wanted to talk about this again now that a year has past.

 

What does the evidence show?

There is some evidence behind stretching.  A study by Borstad in JSES in 2006 compared three different techniques of stretching and found that they all produced changes in muscle length, but that the doorway stretch was superior:

  1. The doorway stretch = +2.24 cm
  2. A manual stretch in the sitting position = +0.77 cm
  3. A supine manual stretch = +1.7 cm

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imageWhile the doorway stretch may have been superior, it has hard to coach and even more difficult to monitor when the person goes home and starts torquing on their shoulder.  This is a good exercise for some with adhesive capsulitis but I tend to avoid it in most patients that need pec minor stretching only.  I like the sitting stretch, I think it may be worth trying.  But I think we can improve on their supine manual imagestretch.  The arm should be in a different  position and I believe that proximal hand position is to far over the anterior aspect of the shoulder and not on the coracoid and pec minor.  If you look at the fibers of the pec minor, you’ll see that the muscle is orientated in a fashion that require a greater amount of elevation.  Just like any other stretch it is important to align the joint according to the position and orientation of the muscle origin and insertion.

Not a bad start in terms of efficacy but I wish there were more stretches involved in the study.

 

Home Stretch for the Pectoralis Minor

image So what do I do for patients at home if I don’t like the doorway stretch?  Considering this is likely a postural adaptation, I would like to see more of a low load long duration stretch of the joint.  I tend to do this mostly supine with a half foam roll, though a towel roll could substitute.  You can do this two ways, first by just laying supine with the foam imageroll  between your shoulder blades and allowing your shoulders to drop back and externally rotate.  The key is to relax in this position for a prolonged duration.  Secondly, I would add a more specific stretch to the pec minor by elevating the arms and repeating the hold.  I find these stretches to be safer and potentially as effective as a doorway stretch.

image Another thing worth mentioning is the thoracic pivot, which is a great tool that is even better than the half foam roll.  It is more comfortable and a more specific curve to meet your thoracic spine.  I use one and love it.  The draw back is that it is more expensive that a foam roll.  But I also have the cervical pivots and use them all the time on patients and myself to work on posture and reduce tension headaches, shoulder pain, and scapular dyskinesis.  Don’t buy them from OPTP, they are 25% less on Amazon.

 

Manual Stretching the Pectoralis Minor

I think we can do better using manual stretching in addition to the postural exercises I recommend above for at home.  To stretch the pec minor, I have settled on a manual supine technique the combines aligning the shoulder in the correction orientation of the pectoralis minor muscle fibers and stabilizing the muscle by the coracoid.  Notice I said stabilizing the muscle.  I place a broad four finger grip deep into the pec minor just off from the coracoid.  But it is important to note that I do this with the arm/pec in a loose position.  You need to think of it as stabilizing, or “pinning” as I call it, the pec minor down.  What you’ll find is that you will obtain a stretch in the pec (not the anterior shoulder) and you wont be able to bring the arm far down past the plane of the table.

Pin the muscle down with the arm loose:

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And then bring the arm down:

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Notice in these two photos below that by just adding this “pinning” of the pec minor I completely change stretch and take the strain of the anterior shoulder.  In this position it is also pretty easy to utilize some MET and ART techniques as well, both of which I have found effective.  The perspective is a bit hard to tell from the angle, but note that on the pinning stretch, the arm is about even with the table (perpendicular to the ground) to just barely past the table, without the pinning it dips about 20 degrees past the table:

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You’ll know if you are doing this stretch right but asking the person what they feel – nice stretch in the pec versus a stretch in anterior shoulder.  Sometimes they’ll even experience a tingle down their arm or in their hand, which is an obvious sign you are stretching too much of the anterior shoulder.  I should also mention, it takes 2-3 sessions for the patient to get used to this stretch as you finger tips in this area are not always comfortable.  Resist the urge to broaden you contact spot and use the palm of your hand etc, it never works as well.

So what do you think?  Have you tried any of these stretches?  Anything else I missed?

 

Pec Minor Photo: Wikipedia

Borstad, J., & Ludewig, P. (2006). Comparison of three stretches for the pectoralis minor muscle Journal of Shoulder and Elbow Surgery, 15 (3), 324-330 DOI: 10.1016/j.jse.2005.08.011

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20 Responses to “What is the Best Stretch for the Pectoralis Minor?”

  1. Hey Mike,

    One thing I've always wondered about the doorway stretch is how to differentiate the stretch between the pec major and pec minor.

    Thoughts?

  2. Mark, probably tough to do, but one could argue that you could into more elevation for pec minor. Tough one, though, you are are right.

  3. Interesting post.

    Question for you Mike.
    How do you assess for pec minor tightness?

    Supine position and observe position around the AC?

    Any other tests that you use?

    Cheers.

  4. Mike,
    Thanks for the information about pec minor stretching – very informative. With regards to the thoracic pivot, do you align the wider part cranially or caudally? Being new to your site, have you posted previously on how you use the cervical pivots for posture, tension headaches, and shoulder problems. If not, I would love for you to write about that sometime.
    Thank you.

  5. With the doorway stretch I have the patient maximally exhale holding the exhale to get a great pec minor stretch. It attaches to ribs 3, 4 and 5 so if they depress you will get more lengthening. Try it and you'll feel it! I do like the pinning method. Maybe the best way would be to pin it and breath out maximally.

    Matt McFadden, MSPT, OMPT

  6. Kory Zimney, PT February 8, 2010 at 3:45 pm

    I like to sometimes get into the origin region on the rib attachments of the pec minor and mobilize/stretch from that end some as well. Utilizing the same "pinning" idea. I agree with Matt about utilizing breathing with the stretch to get the ribs to move. I find often times these patients don't expand into their ribs very well with their breathes. Also shallow breathing and/or upper respiratory/accessory breathing noted with some of them. (I work more with injuried workers and middle age poppulation – not high end athletes, so may not see the same in the higher end athlete.)

  7. Mike,

    For those without access to a treatment table, would performing those home stretches while lying supine on a foam roller allow enough space between arms and floor to appropriately perform those?

    Also, if someone is to perform them for extended periods of time, would it be at all desirable to let them sink into the position as far as the arms will comfortably go and then place some support under the arms to allow them to really relax and hold the position (possibly lowering it a bit as things improve)?

    And one last question, if I may…..with regards to the doorway stretch, is that always going to place stress on the anterior capsule, even if the person has the shoulder blades fully retracted and depressed, or does it become stressful if people get a bit sloppy/lax with it and are otherwise occupied instead of focusing on maintaining a certain position?

    Thanks for sharing all of this content.

    ~Dave Clausen

  8. Trevor Winnegge DPT,MS,OCS,CSCS February 9, 2010 at 5:56 am

    Mike,
    I do like the pinning techniques and pec minor stretch. I find a lot of shoulder impingement patients can't tolerate the positioning, so I use the manual stretch cited in the article in the beginning.

    Also, not sure if anyone watched ESPN yesterday, but there was a piece on Drew Brees injury, with an interview with his surgeon Dr James Andrews. Andrews spoke highly of physical therapy, in particular his therapist Kevin Wilk. Good to see positive press about PT, especially after that Ny Times article you posted on here a few weeks back!!!!!!

  9. Good discussion so far!

    some answers:

    1. How do i assess, yes i think supine is decent, you can actually measure how much higher off the table the shoulder is. This can also be done standing against a wall.

    2. Pivots – the photo above shows the pivot from top to bottom, the wider side is on top. For cervical i do use them with decent success, i just have th patient relax in one of them for 5-10 minutes as part of their treatment (while you are working on someone else). This helps with tension and holds them in good posture, then you can get better manual work done. This is a good home tool for the patient to relax more, reduce stress and tension. I use them myself s decent amount, i tend to get cervicogenic headaches.

    @Matt – That is a great addition, exhaling with the stretch. I have used this in the past as well but must admit I tend to forget about it, but yes it absolutely helps. As you and @Kory mention, breathing has to be considered, and teaching people to breathe with their diaphragm is important.

    @Dave – Yes, yes, and yes, but sometimes you need the doorway stretch. Tight patients after adhesive capsulitis, capsulolabral tears etc, these are the patients i use it on.

    @Trevor, dont give up on the stretch, try backing off the coracoid a bit. It isnt the most comfortable stretch, but they do get used to it and sometimes you need it. The sitting one is a good alternative, though, like you suggest.

  10. Preston Collins SDPT February 10, 2010 at 1:53 pm

    Mike and others-

    Love the topic… I am a 1st year DPT student, and my program has recommended a pec minor stretch involving the pt supine with arms rested at sides. The PT crosses their arms and stands over the pt, and imposes a posterior/superior pressure over the coracoid processes to initiate the stretch. Thoughts on this? Has anyone used this technique? Would this increase or decrease the pressure on the anterior capsule that you mention in your post?

    Thanks

    -Preston

  11. Jess Barsotti, DPT, ATC February 11, 2010 at 5:43 am

    @Preston – That technique works very well, though the addition of a pivot or half foam roll will increase the intensity of the stretch.

    @Mike – I'd be cautious with any patients who experience tingling down the arm with your stretch. Remember that the brachial nerves run directly underneath the pec minor, and the stretch position you're using could potentially cause neural tension symptoms. Tingling down the arm would not immediately indicate too much stress on the anterior shoulder. An easy fix would be to flex the elbow in order to put the nerves on more slack.

  12. @Preston – yes good stretch.

    @Jess – Sorry if i want clear, you definitely want to avoid neuro signs down the arm with this stretch.

  13. Hi Mike,
    Think the website is great

    i just want to make one observation regarding your "pinning' technique. The pec minor only works on the scapula (and ribs), so how are you achieving a stretch by taking the arm into elevation and horizontal abduction? Also by doing this movement there is no possible way to "pin" the pec minor as the major would eventually "pop" you off. To accurately release the minor you must "layer' through the major. As well to lengthen the scapula must be moved.

  14. Good comments anony, by bring the arm back you are moving the scapula towards posterior tilt, the pressure you apply is firm enough to stabilize the pec minor (and major).

  15. The most important thing we can do for patients with forward shoulder posture is to have them assume anatomical position for 30-60sec holds throughout the day…the funny thing is that this is probably the first position that we are taught in PT school yet so many of us get away from it. The whole key is to "slide the scapula" around the costal cage and maintain the upper extremities with the palms facing forward. The beauty of this is that it can be done anywhere and anytime. Here's to simplicity. Da Vinci was way ahead of his time. Don't forget to add gentle neck retraction as well.

  16. testing

  17. In 2009 a cadaver study identified an effective pec minor stretch.
    “Based on our findings, scapular retraction at 30 degrees of flexion is the stretching technique that causes the greatest change in the length of the PMi.”
    Lengthening of the Pectoralis Minor Muscle During Passive Shoulder Motions and Stretching Techniques: A Cadaveric Biomechanical Study.
    Takayuki Muraki, Mitsuhiro Aoki, Tomoki Izumi, Misaki Fujii, Egi Hidaka and
    Shigenori Miyamoto. Physical Therapy April 2009 vol. 89 no. 4. Pgs 333-341.
    Published online before print
    26 February 2009doi: 10.2522/ptj.20080248

  18. Hi Mike, those images dont show up anymore. Can you please upload them again, I have Pec Minor and shoulder impingement and any stretch which stretches P minor but doesnt put stress on the shoulder joint would be very helpful.

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