Healthcare and Medicine Reference
In-Depth Information
referenced above. Have the client allow his hands to
slide down the wall while you find shortened tissues,
and slide his hands back up the wall to assist and control
the stretch.
In terms of movement homework, the client can link
his fingers behind his lower back and stretch them down
toward his legs, so that the scapulae drop down the rib
cage in back and somewhat together toward the spine
(Fig. 7.9). This will stretch the pectoralis minor and sur-
rounding tissues (and strengthen the antagonistic lower
trapezius), but the client should beware of arching his
low back as he does it, as this will change the angle of
the rib cage and negate the stretch (see discussion of
scapular position at the end of this chapter, p. 164).
Fig. 7.8 The hand approaches the pectoralis minor from the axilla,
under the pectoralis major, with the fingers heading in the direction
of the sternoclavicular joint.
The biceps express
The short head of the biceps runs down from the cora-
coid to the radial tuberosity, thus affecting three joints:
the gleno-humeral joint, the humero-ulnar joint, and the
radio-ulnar joint (the shoulder, elbow, and the spin of
the lower arm) (Fig. 7.10 and DVD ref: Shoulders and Arm
Lines, 42:25-43:47). Contracting it can thus have the
effect of supinating the forearm, flexing the elbow, and
diagonally flexing the upper arm (any or all of these
movements, depending on the physics of the situation
and the contraction of surrounding, assisting, or antago-
nistic muscles).
This biceps 'express' (see Ch. 2, p. 69, for a definition)
has a series of 'locals' beneath it to help sort out its
multiple functions. The coracobrachialis runs under the
biceps from the coracoid process to the humerus, thus
adducting the humerus (DVD ref: Shoulders and Arm
Lines, 38:17-42:25). Thebrachialis runs from the humerus,
next to the coracobrachialis attachment, down to the
ulna, clearly flexing the elbow (DVD ref: Shoulders and
Arm Lines, 43:48-45:47). Finally, the supinator runs from
ulna to radius, supinating the forearm.
specific slips of the pectoralis minor are not felt. When
the muscle can specifically be felt, be aware that the first
slip you encounter is attached to the 5th rib. When this
is freed or 'melted', the next slip further in will be
attached to the 4th rib. In very open bodies, you can
sometimes feel the slip attached to the 3rd rib (and most
people will have an additional slip of fascia, some with
muscle in it, on the 2nd rib as well).
This is frequently a little-used area in our culture, so
stay within the limits of your client's tolerance for sensa-
tion; return at another time if necessary. When working
with women, be aware that lymphoid tissue connects
the breast around the edge of the pectoralis to the armpit.
By 'swimming' your fingers gently under the pectoralis
major along the ribs you can avoid any problem with
overstretching this tissue. It is also possible to contact
this area with the client side-lying, so that gravity takes
the breast away from you, although the instability of the
shoulder in this position as well as the resulting malpo-
sition of the opposite shoulder can present a disadvan-
tage in some clients (DVD ref: Shoulder and Arm Lines,
36:07-38:16).
In a few cases - especially those with breast surgery
of any kind, or radiation treatment - the pectoralis minor
can be fastened fascially to the posterior surface of the
pectoralis major. If the minor cannot be found by the
methods above, supinate your hand so that the finger-
pads face upward, and carefully strum along the poste-
rior surface of the major. The minor presents itself as a
series of fibers oblique to the direction of the pectoralis
major fibers. When this condition is encountered, the
minor can sometimes be teased away from the major by
crooking your fingers and working slowly and carefully
to make the separation between the fascial planes.
For movement therapists, you can contact these
tissues by having your client kneel before a wall and
having him slide his hands as far up the wall as possible
while maintaining a straight back, or keeping the manu-
brium (not the xiphoid) of the sternum close to the wall.
Kneel behind the client and slip your hands around the
ribs under the pectoralis minor to find the same slips
Fig. 7.9 Dropping the shoulder blades
down the back and bringing them
together while keeping the lumbars
back will stretch and open the
pectoralis minor and surrounding
tissues.
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