A New Stretch for Pec Minor

imagePectoralis minor tightness is a common finding in people with shoulder dysfunction.  We’ve discussed how to stretch the pec minor in the past with mixed results – it’s a hard muscle to stretch well.  There are a few techniques I like to perform including pinning the muscle and relaxing in a positional release that fits my reverse posturing theory.  Chris Johnson has recently shared with me another great manual techniques that he has put a lot of thought and research into.

 

Stretching the Pec Minor

Decreased length of the pectoralis minor is a common impairment in patients presenting with shoulder dysfunction and musculoskeletal imbalances such as the “upper crossed syndrome.” Restrictions in pec minor length are problematic because they cause scapular protraction, loss of posterior scapular tilt, inhibition of the lower trapezius, and decreased width of the subacromial space. Identifying optimal treatment regimens is therefore critical to engender successful outcomes for patients exhibiting decreased pec minor length. Currently, a dearth of research exists pertaining to the most effective approach for improving the length of this muscle.

Borstad and Ludewig (J Shoulder Elbow Surg 2006) have conducted the only study to date, which specifically investigated the efficacy of three pectoralis minor stretches. Their results demonstrated that a corner stretch was superior to a supine and seated manual stretch. As Mike has mentioned, however, the corner stretch may subject the anterior capsule to deleterious forces, and patients need to be closely monitored to ensure proper execution of this stretch.

The technique in the below video is what I have anecdotally found to be the safest and most effective approach for increasing pectoralis minor length. This technique was predominantly influenced by the work of Shirley Sahrmann, Thomas Meyers, and Vladimir Janda, and involves a myofascial stretch followed by a retraining exercise of the posterior shoulder musculature. For the stretch portion of the technique, make sure that your pressure is applied at the level of the coracoid process (insertion of the pectoralis minor & origin of the short head of the biceps) rather than the humerus and direct your force into posterior scapular tilt. I generally hold this stretch for 90 seconds and repeat it 5 times based on the work of Magnusson et al (Scan J Med Sci Sports 1995).

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Avoid applying excessive pressure distally at the level of the wrist as it may cause discomfort in the elbow region. Immediately following each stretch, I have the patient maintain the newly lengthened position for 10 seconds to retrain the posterior shoulder musculature, particularly the lower trapezius.

As part of a home program, I also have my patients assume anatomical position for 30 seconds periodically throughout the day to facilitate carryover. I specifically instruct them to stand with their feet shoulder width apart, gently tighten their abdominal wall, rotate their hands so the palms are facing forward, draw their shoulder blades down and back towards their back pants pockets, and gently retract the chin. I use this exercise as a postural “reset” anytime one finds themselves crossing their arms or assuming a hands on hips position.

I am confident that you will find this technique to be a “game changer” and I look forward to hearing your thoughts on it. I would also like to personally thank Mike for giving me the opportunity to share my clinical thoughts on his blog as well as Force Therapeutics for allowing me to share this video.

Chris Johnsonhttp://www.chrisjohnsonpt.com

Thanks for sharing Chris, I like it!  Yet another tool in our belt!  Try this stretch out and leave some feedback, I want to hear what everyone else thinks.

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7 Responses to “A New Stretch for Pec Minor”

  1. Yoga Teacher Training San Francisco Reply October 18, 2010 at 6:34 am

    Much like the intensive stretches athletes perform to prepare their muscles for a workout or sporting event, yoga allows practitioners to reduce the effects of harmful stress and previous poor health practices on their entire bodies.

  2. I like this stretch, however Sahrmann has a bit of a different approach, so I wouldn't really call this the same thing. Since protracted and anteriorly tipped scapulae tend to occur in pairs, I like crossing my arms and using the hypothenar eminences to reverse the improper positioning into retraction and posterior tilting. This will decrease the tendency to "roll" the body while applying unilaterally. I agree though, pec minor stretching is a HUGE key to scapular/GH dysfunction. Now, if we could only teach a similarly effective HEP component THEN WE'D BE TALKING!!

  3. Don't overlook this 2009 PTJ cadaveric study, which found that performing the stretch of the pec minor without shoulder flexion resulted in less lengthening than in flexed or abducted shoulder positions. Of course, in vivo research needed. http://ptjournal.apta.org/content/early/2009/02/26/ptj.20080248.short

  4. Dr. Seth and Eric,

    Thanks for taking the time to watch and critically review this technique. You both make good points. I am by no means saying that this stretch is the same as the Shirley Sahrmann technique but rather that it was influenced by her technique. Eric…you make a good point with regards to the research article. If we take a close look at the anatomy of the pect minor and short head of the biceps, anecdotally, I just have not found stretch that gives the same carryover when combined with retraining of the antagonistic muscles. Of even greater interest is the fact that after performing this stretch, I often find a dramatic improvement in IR ROM at 90 degrees of abduction without even stretching the posterior shoulder. It has taken me three shoulder surgeries, a clavicle fracture, a small rotator cuff tear, and losing the chance to play a professional sport secondary to a SICK scapula to arrive at this technique and I hope you give it a shot. Thanks again for being interested and interesting!

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