STRETCHING ON THE FOLLOWING MUSCLES

1. PECTORALIS MINOR
- The pectoralis minor action is to internally rotate and anteriorly tilt the scapula.
- It can also help with inspiration when the insertion (coracoid process) is fixed. This is
achieved through stabilizing the arms on a high surface like a counter top.

 Assessing the Pectoralis Minor Length

- The proper position to the length of the pec minor is in supine (lying face up).

1. Lie face up on a flat surface

2. Place towel rolls under the elbows and rest forearms on abdomen.
3. Measure the distance from the acromion to the table. Normal is 1” from the table.
Excessive is greater than 1” from the table.

 Stretching the Pectoralis Minor

- In the position described above, stretch the pec minor by performing the following:

1. Stand at the side and place outer border of hands on the coracoid area.
2. Press slightly towards the table, carefully noting discomfort or stretch.
3. Monitor the trunk and rib cage for elevation.
4. If rib cage elevates, provide cue to contract abdominals to stabilize trunk.

 Self Stretching the Pectoralis Minor

- One of the most effective self stretches of the pec minor is to start in the supine position
listed above and to follow these steps:

1. Start lying face up on surface with arms 90˚ to side and with elbows flexed to 90˚ – this
should resemble a goal post sign.
2. The head should be aligned so that a slight chin tuck is maintained through the next
motion.
3. Slide arms up the table towards your head, keeping the back flat on the table.
4. Only move until a mild stretch is felt. Do not push through pain or push beyond a mild
stretch.
5. Breathe while holding the stretch for 10 seconds and return. Make sure to maintain slight
chin tuck during the entire motion.
 Pec minor Door Stretch

1. Facing a door frame, place your arms along the frame as pictured above.
2. Gently press in towards the door to feel a stretch along the inside of your arms.
3. Hold the stretch for up to 20 seconds, repeating 3-4 times.

 The pec minor is a key muscle in maintaining posture and scapular alignment. Properly
stretching the pec minor can help with correcting forward shoulders, alleviate tightness in
the chest, and to strengthen the back muscles which may be lengthened due to the
shortened position of the pec minor.

Stretching technique A: Physical therapist Assisted

 Patient is lying on back with shoulder flexed 90° and elbow in free flexion.
 Therapist applies pressure with the hypothenar of the hand towards the body of
muscle away from insertion while using the other hand to press the elbow
downwards.
  Tension-relaxation technique: Patient tries to extend shoulder joint for 5 sec while
therapist resists. Patient is then instructed to gradually relax muscles while
therapist applies stretching technique.

 Notice: This stretch often fails by applying pressure either too low or too far
towards the middle of the chest. The pressure with the hypothenar should start just
below the coracoid process and not reach lower than fifth rib or level of mammary
papilla in men.

2. BICEPS SHORT HEAD

Stretching technique: PHYSICAL THERAPIST ASSISTED
 Patient is lying on back with upper arm abducted approximately 45°.
 Therapist applies pressure at the muscle-tendon junction towards the body of the
coracobrachialis muscle with the hypothenar of the hand while using other hand
to press down on the upper arm.

Tension-relaxation technique: Patient tries to flex shoulder joint for 5 sec while therapist
resists. Patient is then instructed to gradually relax muscles while therapist applies
stretching technique.

3. LEVATOR SCAPULAE

Self- stretching technique

 Sit on a chair or bench with your feet wide apart and your back and abs slightly tightened.
Reach behind you with your right hand and grab the edge of the chair. Lean your upper
body to the left, keeping your head upright. You will feel a light pull in your right
shoulder or upper arm.
 Now try to lift your right shoulder toward the ceiling for five seconds. Do not allow your
body to move sideways. Relax for a couple of seconds and then lean your upper body a
little more to the side. You have now reached the correct starting position for the stretch.
 Rotate your head 45 degrees to the left. Place your left hand behind your head and gently
pull it at an angle toward your knee. Stretch the muscle in this manner for 5 to 10
seconds. Stop the movement when you feel a slight sting in the right side of your neck.
Next, relax the muscle for 5 to 10 seconds.
 Resist by carefully pushing your head backward into your hand. Next, relax the muscle
for 5 to 10 seconds.
 Deepen the stretch by slowly pulling your head toward your chest in the direction of your
knee until you reach a new ending point.
 Repeat two or three times.
STRETCHING TECHNIQUE: PHYSICAL THERAPIST ASSISTED
 Patient is lying on side with the upper arm over therapist's forearm.
 Therapist grasps around the superior, medial angle of the scapula and pulls the
scapula downwards while using the thenar of other hand to rotate and lateral flex
cervical facet joints away in the contralateral direction.

Tension-relaxation technique: Patient tries to lift head up for 5 sec while therapist
actively resists. Patient is then advised to gradually relax as therapist performs stretch.

Notice: Side bending and rotation is allowed to happen in the same direction, because
rotation towards opposite direction will restrict the side bending and thus stretching will
be less effective.

Stretching technique B:

 Patient is lying on back with head flexed and supported against therapist's body,
Therapist rotates and lateral flexes facet joints at level C1-4 to same side by
moving her body forwards while with the thenar of the other hand pressing down
on superior angle of scapula at the muscle insertion.