netter anatomy , pectoralis minor , physiotherapy

PECTORALIS MINOR- THE NEGLECTED MUSCLE

Pectoralis minor ,proactive physiotherapy, kinetic chain

Coutsey : Wikipedia.com

Human body is designed in such an intricate manner that upper limbs are for manipulative activities and lower limbs are for mobility. When each of the body segments is aligned properly it gives a pleasant appearance as well as a disorder free body. While poor posture and muscular imbalance often results into pain and loss of function.

Physiotherapy musculoskeletal assessment format consists of many points in observation, palpation and examination which are extremely important for proper diagnosis, treatment planning and knowing the prognosis. However, many a times while assessing shoulder and cervical region; one of the important muscle- Pectoralis Minor is often neglected. A shortened pectoralis minor muscle commonly contributes to muscular imbalance and pain in shoulder and cervical region.

Poor upper body posture is many a times referred to as a ‘forward head posture’, ‘slouched posture’, ‘poking chin posture’, or ’rounded shoulder posture’ and is considered to be a potential etiological factor in the pathogenesis and perpetuation of many clinical syndromes like Thoracic outlet syndrome, Scapular downward rotation syndrome, Scapular winging & tilting syndrome, shoulder impingement syndrome and also upper cross syndrome involving the neck and shoulder.1, 2

origin insertion of pectoralis minor , neurokinetic

The pectoralis minor attaches at the coracoid process of the scapula and at the third, fourth, and fifth ribs near their sternocostal junctions. A short pectoralis minor muscle increases the muscles passive tension with arm elevation resulting in restriction of normal scapular movements such as external rotation, upward rotation and posterior tipping and this in turn will affect glenohumeral and cervical motion.1, 3

 

Few Clinical tests have been recommended to test for shortening of this muscle.

AT Distance: 1, 4, 5

Pectoralis length test

Courtsey:www.musculoskeletalkey.com

The patient in supine lying, arms by side or resting on abdomen and instructed to relax. With the help of rigid standard plastic transparent right angle, measure the linear distance in millimeters between the posterior border of the acromion and the table. Take care not to exert any downward pressure into the table and place the base on the treatment table and the vertical side adjacent to the lateral aspect of the acromion. A distance greater than 2.54 cm (1 inch) suggests short pectoralis minor.

Pectoralis Minor Length Index (PMI): 1, 4, 5, 6

The PMI is calculated by dividing the resting muscle length measurement by the subject height and multiplying by 100.The resting muscle length is measured between the caudal edge of the 4th rib to the inferomedial aspect of the coracoid process with a measuring tape or sliding caliper. PMI is suggested to reflect a shortened pectoralis minor when 7.65 or lower.

 

Referances :

  1. Jain S, Shukla Y. “To find the intra-rater reliability & concurrent validity of two methods of measuring Pectoralis Minor tightness in Periarthritic Shoulder patients.” Indian Journal Of Physical Therapy 2013;1(2):34-38
  2. Lewis J.S., Valentine R.E. “The Pectoralis minor length test: a study of the intra-rater reliability & diagnostic accuracy in subjects with & without shoulder symptoms.” BMC Musculoskeletal Disorders. 2007; 8:64.
  3. Borstad J.D. “Resting position variables at the shoulder: Evidence to support a posture-impairment association.” Journal of the American Physical Therapy Association. 2006; 86(4):549-557.
  4. Borstad J.D. “Measurement of Pectoralis Minor Muscle Length: Validation and Clinical Application.” Journal of Orthopaedic and Sports Physical Therapy. 2008; 38(4):169-174.
  5. Struyf F., Nijs J., Mottram S., Roussel N., Ann M J Cools, Meeusen R. “Clinical assessment of the scapula: a review of the literature.” Br J Sports Med 2012;0:1–8.
  6. Muraki T, Aoki M., Izu.mi T, Fujii M., Hidaka E., Miyamoto H. “Lengthening of the pectoralis minor muscle during passive shoulder motions & stretching techniques: a cadaveric biomechanical study.” Phys Ther. 2009; 89(4).
  7. Pic : Netter`s Anatomy

 

Gluteal Amnesia and selecting the most effective interventions

Most people spend a huge proportion of their time in a position of hip flexion (sitting down). An inactive lifestyle is a Janda approachsure-fire way to create glute dysfunction. Extended periods of time in this posture over the long term will lead to negative adaptations in the hip flexor muscles.

Shortened hip flexors don’t allow for full hip extension, which is where your glutes are able to contract with the most force. Additionally, being an antagonistic pair, short and tight hip flexors will actually inhibit your glutes. The actual physical compression associated with sitting on your gluteus maximus will also impair blood flow and neuromuscular function.

Gluteal amnesia is a condition where your body can’t or forgets how to properly activate the gluteal muscles, whether it’s due to postural flaws or lack of use. As a result, you may lose the ability to move your hips through a full range of motion which adds stress to your knee, lower back, and even your shoulder joints! Common injuries associated with gluteal amnesia are patellofemoral pain syndrome, Iliotibial Band Syndrome, Disc Herniation, and Piriformis Syndrome. Fortunately, you can reverse this condition with the right corrective exercises.

A postural flaw that can lead to gluteal amnesia is known as anterior pelvic tilt. This occurs when the pelvis tilts forward and the stomach protrudes. The forward tilt of the pelvis stretches your gluteals into a relaxed state which decreases your ability to properly activate them. Other causes of gluteal amnesia are as follows:

• Too many quadriceps dominant exercises.
• Poor sitting or static posture.
• Improper abdominal training.
• Soft tissue contractures (i.e., tight hip flexors and low back extensors).
• Articular (joint) fixations.
• Not landing properly from jumps (i.e., landing from a rebound in basketball).
• Knee or back pain sufferer.

The gluteus maximus and lower back stability
Activating and strengthening the glutes needs to form an important part of your core routine.

Co-contraction of the gluteus maximus with the psoas major contributes to lumbo-sacral stabilisation The gluteus maximus provides stability to the sacroiliac joint (SI joint) by bracing and compression. Excess movement at the SI joint would compromise the L5-S1 intervertebral joints and disc and could lead to SI joint dysfunction and low back pain.

kinetic chain, gluteus maximmus, eric dalton

Coutrsey : Ericdalton

The gluteus maximus also provides lower back stability through its connection with the erector spinae and thoraco-lumbar fascia. Some of its fibres are continuous with the fibres of the erector spinae. A contraction of the gluteus maximus will generate tension in the erector spinae muscle on the same side, providing stiffness to the spinal column.

Gluteus maximus contraction also exerts a pull on the lower end of the thoraco-lumbar fascia, which is a thick layer of ligamentous connective tissue. Tightening of this fascia stabilises the vertebras. People with low back pain often have weak and deconditioned glutes.

Here are some simple but superbly effective exercises to tone up glutes muscles.

Gluteal Squeeze :

Purpose: Strengthen the hips (especially for the gluteus maximus).
Start in a standing position with your feet shoulder-width apart.
Squeeze the gluteal muscles for two seconds, then relax for two seconds. Count the two seconds out loud to avoid holding your breath.
Sets/Reps: 1-2 x 10, with 5-10-second holds and 5-10 seconds rest.

Bird Dog :Core stability, proactive physio

Purpose: Strengthen the hips (especially for the gluteus maximus).

Start on your hands and knees. Slowly raise your right arm and left leg so they are level to the floor. Turn your left foot slightly outward so you feel your gluteus maximus tightening. Hold this position for 10 seconds. Repeat with the opposite arm and leg.
Suggested Sets/Reps: 1-2 x 10 of 10-second holds.

Double-Leg Squat Series :

 

Purpose: Strengthen the hips and legs.

Stand with your feet shoulder-width apart. Looking straight ahead, slowly squat down until your thighs are parallel to the floor while simultaneously raising both arms out in front of you like you are guarding an opponent in basketball or skiing down a hill.
Try to keep your knees behind your toes, maintain a normal arch in your lower back and keep your core tight. Once you master perfect technique using your body weight with this simple exercise (feet side by side)

Single-Leg Squats :

Purpose: Strengthen the hips and legs.

Stand facing a step and hold on to a rail. Slowly step up and down on one side. Repeat with the opposite leg. Alternate version: perform the Step-Ups from the side, and progress by varying the step height from 4 or 6 inches to 8 inches.
Suggested Sets/Reps: 1-2 x 10-15

Side-Step Walking :

Purpose: Strengthen the hips and legs.

Start in a squatting position with your feet slightly wider than hip-width as if you were guarding an opponent in basketball.
Take five to 10 steps to the right. Your step lengths should be approximately 50 percent of the starting position distance between your feet.
Keep your knees aligned with the second toe. Repeat five to 10 steps to the left.
Once you master perfect technique using your own body weight.

Side-Lying Straight-Leg Abduction :

Hip abduction, core and posture st

Courtsey:Dr. Alex Jimenez D.C.,C.C.S.T

Purpose: Strengthen the hips and core.

Start by lying on your right side with your top leg straight and bottom leg bent. Place your top hand on the floor or mat in front of you for good support. Slowly raise your top leg up to approximately 40 degrees for the designated sets/reps.
Keep your hips level and don’t over-arch your back.
Repeat on the other side.
To increase the difficulty, place an elastic band around your thighs (just above the knees) or an ankle weight just above your ankle.
Sets/Reps: 2-3x 0-15

Side-Lying Bent-Leg Abductions: gluteus strengthning, gluteus activation

Purpose: Strengthen the hips and core

Start by lying on your right side with both knees bent 90 degrees and hips bent 45 degrees. Place your right arm under your head and your left arm on the floor in front of you for stability. Slowly raise your top leg up to 30 degrees of abduction, then lower slowly for the designated sets/reps. To increase the difficulty, hold the 30-degree hip-abducted position for five to 30 seconds as a single repetition.
Sets/Reps: 2-3×10-15

Supine Bridge:proactive physiotherapy

Purpose: Strengthen the hips and core

Start by lying on your back with your knees bent 90 degrees and feet hip-width apart. Place a small, soft ball between your knees and squeeze with no more than 50 percent effort.
Lift your hips off the floor approximately 4 inches, then slowly lower them while relaxing the squeeze between your knees.
To increase the difficulty, hold for five to 10 seconds as a single set.
Sets/Reps: 2-3×10-15

 

Referances :

  1. Distefano LJ, Blackburn JT, Marshall SW, Padua DA, Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. Jul;39(7):532-40, 2009.
  2. Vleeming A, Van Wingerden JP, Snijders CJ, Stoeckart R and Stijnen T (1989): Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics. Clinical Biomechanics, 4(4), 204-209.
  3. Snijders CJ, Vleeming A and Stoeckart R (1993): Transfer of lumbosacral load to iliac bones and legs. Clinical Biomechanics 8, 285-294.
  4. Sean GT Gibbons and Mark J Comerford (2001) Strength versus stability: Part 1: Concept and terms. Orthopaedic Division Review. March / April: 21-27
  5. Gibbons SGT 2005 Integrating the psoas major and deep sacral guteus maximus muscles into the lumbar cylinder model. Proceedings of: “The Spine”: World Congress on Manual Therapy. October 7th – 9th, 2005, Rome, Italy.
  6.  Kankaanpää M, Taimela S, Laaksonen D, Hanninen O and Airaksinen O (1998): Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of 100 NZ Journal of Physiotherapy – November 2005. Vol. 33, 3 Physical Medical Rehabilitation 79, 412-417.