The obstinate pectoralis minor can produce a hailstorm of problems throughout the body, especially in the shoulders, arms, and neck, and with respiration. Working with it effectively goes a long way in helping your clients with neck and shoulder issues, breathing restrictions, and even wrist and elbow pain. If the iliopsoas is the hidden prankster of low-back pain,1 the pectoralis minor is the hidden prankster of the shoulder girdle. This feature reviews the anatomy of the pectoralis minor, common pathology, and suggestions for working with it.

Imagine three long fingers extending on an inferior and medial diagonal path from the coracoid process to ribs 3–5 (attachments have been found on ribs 2 and 6 on some people). This multitasking stabilizer connects the shoulder girdle (scapula and clavicle) to the thorax. The pectoralis minor seems to glory in pulling the coracoid process toward the ribs (whether it needs it or not), causing a profusion of myofascial and biomechanical distortions. The pectoralis minor drags the glenohumeral joint with it as it pulls the coracoid process toward the ribs.
Restrictions in blood flow can occur, as a portion of the axillary artery lies beneath the pectoralis minor. Tingling and numbness (the distal portion of the brachial plexus passes deep to the coracoid process) can also result from the pectoralis minor’s predilection for locking short. When the arm is abducted and externally rotated, the artery and nerves are stretched around the pectoralis minor close to its coracoid attachment—hence the tingling and numbness.
A tight pectoralis minor restricts scapular mobility and interferes with the scapulo-humeral rhythm, causing limited humeral mobility and scapular winging. Humeral mobility depends on both scapular mobility and fixation of the scapula at the right time and place.
The glenohumeral joint follows the scapula. Wherever the scapula goes, the glenohumeral joint is sure to tag along. If the scapula is superglued to the ribs, glenohumeral joint movement is compromised. My mantra is, “Restore scapula mobility and stability, and you’ll go a long way to restoring glenohumeral joint function.”
Let’s do this kinesthetic exercise: Place one hand on the greater tubercle on top of your humerus. Now depress and protract your scapula (the actions of the pectoralis minor). Can you feel how the head of the humerus went along for the ride? Next, abduct the humerus to at least 90 degrees. Feels yucky, right? When the scapula is protracted and depressed, the glenohumeral joint internally rotates and the greater tubercle moves anteriorly. That yucky feeling is the greater tubercle colliding with the acromion process. Repeated fender benders between the greater tubercle and the acromion process can result in impingement syndrome, impaired rotator cuff function, and disturbances up the kinetic chain to the neck and down the kinetic chain to the elbows, wrists, and hands.
One of my clients is a hairdresser who had chronic elbow and wrist pain for years. In addition to treating the plethora of trigger points in the flexors and extensors of her wrist and elbows, I treated her massively locked-short pectoralis minor, rotator cuff, and serratus anterior to restore scapular mobility and weight/energy transfer throughout her upper body. She’s been pain-free for several months. If I had just concentrated on her elbows and wrists, the results would have been temporary.
Working with the pectoralis minor
Let’s look at therapeutic interventions to restore the pectoralis minor to a happy, healthy resting length. These include:
1. Deep-tissue/trigger-point work.
2. Assisted pectoralis minor stretch.
3. Self-stretch.
4. Rolling the pectoralis minor with a foam roller.
5. Strength training scapula stabilizers.
1. Deep-Tissue/Trigger-Point Work
Since the pectoralis minor is so exquisitely tender on most people, a side-lying position for your client is a good choice for beginning work on this pesky muscle. I suggest laying a warm towel over the ribs for both comfort and increasing blood flow to the area.
1A. Palpating pec minor: Slide two or three fingers under the pectoralis major (I call this the pectoralis major tunnel). Feel for a diagonal band of tissue.
1B. Pin and Rock: We’ll start with a technique I call Pin and Rock. Passively shorten the muscle (protract and depress the scapula), gently pin the pectoralis minor with multiple fingers for a broad, dispersed pressure, and add a slow, rhythmic rocking of the joint. Rocking stimulates a parasympathetic response and prepares the pectoralis minor for deeper work. Come back to this technique whenever you need to give your client a break.
1C. Longitudinal stripping: When you feel the muscle relax a bit, begin longitudinal stripping from the attachments at the ribs to the attachment at the coracoid process. Stroking in this direction encourages the muscle to lengthen. As you work to release the pectoralis minor, place your other hand under your client’s back and passively move the scapula through a range of motion. These scapular mobilizations aid in freeing the scapula to assume its rightful role as a freely moveable bone. If your client finds this work too painful, you can hold the scapula in protraction and depression while you work, which puts the muscle in a slack position.
1D. Releasing trigger points with Pin and Move: Once you have felt the muscle soften and yield a bit, it’s time to release trigger points and fascial binding with an active movement technique I call Pin and Move. You’ve been working with multiple fingers; now it’s time to go to one finger for specificity. When you find a congested area, pin the tissue to the first barrier (deep pressure is not necessary here—the active movement is the portal to the muscle’s deeper layers). Have your client do an active movement. Suggestions for active movement include retraction, protraction, upward rotation, downward rotation, depression, and elevation of the scapula, along with humeral movement. I always invite my clients to contribute to the movement pattern. Take advantage of the wisdom of their body. After 4–5 repetitions, check in with your client with the question, “Is this point better, worse, or the same?” If it’s better, ask how much better; 50 percent or more is what we’re going for here. If it’s worse, chances are you’ve landed on a trigger point at a deeper layer. If it’s the same or less than 50 percent better, try another movement pattern or add resistance to the current movement pattern. The body will yield its secrets if we are patient, creative, and curious. Since the pectoralis minor can be difficult to release, I have found massaging it, then stretching it, then massaging it again to be effective.
1E. This muscle needs all the help it can get, so I always include supine work. Working with muscles from different positions allows you to access different fibers. You can palpate the pectoralis minor in the supine position by grabbing the pectoralis major in a pincer grip. Push your thumb under the pectoralis major toward the midline. Feel for a diagonal band of tissue. Use the techniques described above: Pin and Rock, longitudinal stripping, and Pin and Move.
2. Assisted Pectoralis Minor Stretch
With the client side-lying, abduct the humerus 180 degrees, externally rotate the shoulder joint, then elevate and retract the scapula. Make sure the client’s lower back does not fall backward or forward. Hold the stretch for 15–20 seconds (three or four deep breaths), then repeat. As mentioned before, it’s helpful to intersperse the stripping and trigger-point work with this stretch.
3. Band Stretch
The pectoralis minor is a key muscle in maintaining posture and scapular alignment. Properly stretching the pectoralis minor can help with correcting forward shoulders, alleviating tightness in the chest, and strengthening the back muscles, which may be lengthened due to the shortened position of the pectoralis minor.
This stretch can be done with a Thera-Band, towel, scarf, or belt. The band allows the most versatility.
• Hold one end of the band in each hand, and lift your arms up over your head. Shrug your shoulders up, then let them fall down.
• Slowly press your arms back, keeping the elbows straight but not locked. Hold for 15–25 seconds. Do 3–5 repetitions.
4. Rolling the Pectoralis Minor with a Ball
Here’s another excellent self-treatment for the stubborn pectoralis minor. The combination of stretching and rolling helps the pectoralis minor stay supple. There are many excellent balls on the market. Pick one that is soft enough that the pectoralis minor doesn’t go into shock, yet one firm enough that it does some good. Place the ball on the pectoralis minor and roll from inferior (attachment at ribs) to superior (attachment at the coracoid process) to lengthen.
5. Strength Training the Scapula Stabilizers
Forward roll on an exercise ball:  
• Starting position: Kneeling on the floor with the palms together as if praying. The hands should be on the part of the ball nearest your body.
• Gently retract the scapulae (squeeze them together) and, from this position, roll forward until your elbows rest atop the ball.
• Lift your toes.
• Only roll far enough to feel the shoulder girdle muscles engage. Rolling too far will target the abdominals. You want to make sure you feel the movement more in the shoulder girdle.
• Maintaining a neutral position of the lumbar and cervical spine, keep your hips extended throughout the exercise.
• Make sure the hips are in line with the spine and not hiked upward.

Note
1. Janet Travell, David Simons, and Lois Simons, Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual (Philadelphia: Lippincott Williams & Wilkins, 1998).

Peggy Lamb is the author of Releasing the Rotator Cuff, Stretch Your Clients! (Massage Publications, 2004), and The Core of the Matter: Releasing the Iliopsoas and Quadratus Lumborum (Massage Publications, 2013). An educator and bodyworker for more than 25 years, Lamb brings her eclectic and extensive background into her teaching for an interesting and enlightening learning experience. Visit her website at www.massagepublications.com or email her at info@massagepublications.com.