Healthcare and Medicine Reference
In-Depth Information
Fig. 7.7 The fascial 'fabric' connection
between the pectoralis minor and the
biceps is clear, even when the coracoid
process is removed from underneath.
The DFAL is primarily a stabilizing line (comparable
to the Deep Front Line in the leg), from the thumb to the
front of the chest. In the quadruped, and in a rugby
scrum or a yoga 'plank', this line would manage (restrict-
ing or allowing) side-to-side movement of the upper
body. In the free arm, the DFAL controls the angle of the
hand, principally via the thumb, and also the thumb's
grip.
Although a muscular pectoralis minor, especially the
outer more vertical slips, may be felt through the over-
lying and more horizontal pectoralis major, approach-
ing from the axilla is to be preferred over treating the
minor through the major. Position your client supine
with her arm up, elbow bent, so that the back of her
hand is resting on the table near her ear. If this is diffi-
cult, support the arm on pillows, or alternatively bring
the arm down by the client's side so that it rests on your
wrist.
Put your fingertips on her ribs in the armpit between
the pectoralis and latissimus tendons. Kneeling beside
the table facilitates the proper angle of entry. Slide up
slowly under the pectoralis major in the direction of the
sternoclavicular joint, keeping your finger pads in
contact with the front of the rib cage. It is vitally impor-
tant to slide along the ribs, not into them or away from
them. Pushing into the tissues overlying the ribs is a
common error when first attempting this approach;
since the rib periostea are highly innervated, this pres-
sure creates strong and useless pain. With the open
client, the correct angle, and soft fingers, however, it is
possible to go quite far underneath the pectoralis major,
so a little practice is required to figure out how much
skin to take with you - skin stretch is not the object (DVD
ref: Shoulders and Arm Lines, 30:12-36:00).
Draw an imaginary line down and slightly medial
from the coracoid process to the outer and upper attach-
ment of the rectus abdominis. You must go far enough
under the pectoralis major to meet this line before you
would have any expectation of encountering the outer
edge of the pectoralis minor. When you do, it varies
from a few skinny slips of muscle plastered to the wall
of the ribs to a full, free, distinctly palpable muscle (the
desired condition - though even in this condition it can
be muscularly or fascially short). In most cases no harm
will come (and much benefit to shoulder mobility will
arise) from going under the leading edge of the pecto-
ralis minor, lifting the muscle away from the rib cage
and stretching it toward its insertion at the coracoid. The
client can help with a long slow inhale, or by lifting his
arm toward the top of his head (Fig. 7.8). Be sure the arm
is supported, not hanging free in the air.
Since the pectoralis minor muscle is embedded in
the clavipectoral fascia, there is benefit in stretching
the tissue under the pectoralis major muscle even if the
The pectoralis minor
The pectoralis minor and the clavipectoral fascia are
difficult to find and stretch in isolation from the over-
lying pectoralis major. Excessive shortness in this myo-
fascia can negatively affect breathing, neck and head
posture, and, of course, the easy functioning of the
shoulder and arm, especially in reaching upward.
Hanging from a branch, or even putting the arm into
hyperflexion (as in a deep 'Downward Dog' posture or
kneeling before a wall and sliding the hands as far as
possible up the surface), may result in creating a stretch
in these tissues, but it is difficult for the practitioner to
tell from the outside, as lifting the upper ribs by tilting
the rib cage (and thus avoiding the pectoralis minor
stretch) is a common compensation. Here is a reliable
way to manually contact this vital and often restricted
structure at the proximal end of the DFAL.
Three indications for functional shortness in the pecto-
ralis minor and clavipectoral fascia include: (1) restriction
in upper rib movement in inspiration, such that the
shoulders and ribs move in strict concert, (2) if the client
has trouble flexing the arm and lifting the shoulder to
reach the top shelf in the cupboard, and (3) if the scapula
is anteriorly tilted or the shoulders 'rounded'. To deter-
mine this last, view the client from the side: the medial
border of the scapula should hang vertically, like a cliff. If
it is sitting at an angle, like a roof, then a shortened pec-
toralis minor is likely pulling interiorly on the coracoid
process, tilting the scapula. The longer, outer slips of the
pectoralis minor - to the 4th and 5th ribs - will be impli-
cated in this pattern. If the shoulders are 'rounded'
(medial rotation or strong protraction of the scapula -
often seen when the client is supine and the tips of the
shoulders are well off the table), the inner shorter slips to
the 2nd (sometimes named as the costocoracoid liga-
ment) and 3rd ribs are the ones that require lengthening.
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