Pecs and Shoulder Pain

Published on 14 June 2024 at 18:10

Full technique video here: https://youtu.be/Gp3mJvvMEl8

 

When it comes to bad posture, “pectoralis minor” is a major player in subacromial impingement and neurogenic thoracic outlet. Now, we are learning chest wall tightness results from central nervous system (CNS) protective guarding and reflex spasm due to tension, nerve compression, altered joint neurology, and athletic overuse syndromes.

Nerve compression from joint alteration anywhere along the brachial plexus may cause the brain to reflexively “splint” anterior chest wall tissues in an attempt to prevent further perceived neural insult. Accompanying dural membrane irritation can set the stage for pain-spasm-pain cycles or, in the early stages, the client may only experience symptoms such as shortness of breath, emotional distress, and restricted glenohumeral mobility—with no pain at all.

“Sherrington’s Law of Reciprocal Innervation” showed that muscle inhibition is frequently found in injured, inflamed, and painful tissues and that the resulting inhibition or weakness leads to reciprocal facilitation of its antagonist.

The simple act of releasing tight agonist muscles as demonstrated in the video, may result in increased strength in the inhibited antagonist, likely mediated via Sherrington’s 1907 Law of Reciprocal Innervation.

 

ASSESSMENTS

 

Internal Rotation:

  • Client lies in the prone position more towards the side of the table that the shoulder is being tested.
  • Client is asked to internally rotate the shoulder to 60 degrees.
  • If the client has adequate movement, move on to the External Rotation test.
  • If the client does not have 60 degrees, passively rotate the client’s shoulder.
  • If the client has 60 degrees, the client has a stability dysfunction with shoulder internal rotation. If the client does not have 60 degrees passively, then the client has a mobility dysfunction with shoulder internal rotation.

 

External Rotation:

  • Client lies in the prone position more towards the side of the table that the shoulder is being tested.
  • Client is asked to externally rotate the shoulder to 90 degrees.
  • If the client has adequate movement, move on to the Shoulder Extension test.
  • If the client does not have 90 degrees, passively rotate the client’s shoulder.
  • If the client has 90 degrees, the client has a stability dysfunction with shoulder external rotation. If the client does not have 90 degrees passively, then the client has a mobility dysfunction with shoulder external rotation.

 

Shoulder Extension:

  • Client lies in the prone position.
  • Client is asked to raise the arm up to the ceiling keeping the arm straight to 50 degrees.
  • If the client has adequate movement, move on to the Shoulder Flexion and Abduction test.
  • If the client does not have 50 degrees, passively raise the client’s shoulder.
  • If the client has 50 degrees, the client has a stability dysfunction with shoulder extension. If the client does not have 50 degrees passively, then the client has a mobility dysfunction with shoulder extension.

 

Shoulder Flexion and Abduction Test:

  • Client lies in the prone position.
  • Client is asked to abduct the shoulder and continue raising the arm until the arm is in line with the ear. Like a swim stroke.
  • If the client has adequate movement, meaning smooth and full range of movement, then the client has met the criteria.
  • If the client does not have adequate movement, passively raise the client’s shoulder.
  • If the client has smooth movement, the client has a stability dysfunction with shoulder flexion and abduction. If the client does not, then the client has a mobility dysfunction with shoulder flexion abduction.

 

TECHNIQUE

 

Pec Pin and Stretch:

  • Client lies in the supine position.
  • Therapist abducts the client’s shoulder to around 110 degrees, if possible.
  • Therapist stands at the head of the table and places a soft forearm on the client’s pec tissue. Right below where the pecs come into the shoulder.
  • Therapist pins the pec tissue and at the same time grasps the client’s arm and externally rotates the shoulder. This is creating a pin and stretch. Repeat until external rotation is easier.

 

Articular Stretching for The Pecs:

  • Client lies in the supine position.
  • Therapist abducts the client’s shoulder to around 110 degrees if possible.
  • Therapist sits next to the client on the table below the arm. Therapist takes their forearm and pins the pec tissue. At the same time client is asked to rotate the shoulder internally and externally.
  • Therapist glides up the pec tissue towards the shoulder, glides over the shoulder, and down the arm to the elbow.
  • Repeat 3-5 times.

Pec Stretch:

  • Client is asked to lie on their side. Client is then asked to place their hand behind the head.
  • Therapist places their palm onto the client’s inferior aspect of the client’s shoulder blade.
  • The therapist’s other arm gently grasps the client’s elbow of the arm that is reaching behind the head.
  • Client is asked to pull the elbow down very gently to the hips.
  • Therapist resist the movement to a count of 5. The client then relaxes.
  • As the client relaxes on the exhale therapist gently pulls the elbow back to the new restrictive barrier. Make sure to keep the palm on the client’s shoulder blade and do not allow them to roll on their back.
  • Repeat 3-5 times.