Scalenes, Pec Major, Pec Minor, Subscapularis – STR

This video shows a sequence of techniques from my Side Lying Massage DVD. This sequence may be helpful for clients with Thoracic Outlet Syndrome.

Scalenus Posterior

Have your client facing toward the floor.

Scalenus Medius

Have your client facing straight ahead.

Scalenus Anterior

Have your client facing toward the ceiling.

Sit behind your client so that your thigh is supporting their back. Bring your client’s shoulder forward and also upwards (anterior and superior) toward their ear, then hook your fingers into the space superior to the medial end of the clavicle right next to the sternum. Press inferiorly with your fingertips then pull your fingers laterally out toward the notch at the acromioclavicular joint while you pull your client’s shoulder in an inferior and posterior direction with your other hand.

Tightness in the scalene muscles may compress nerves of the brachial plexus, causing referred pain, tingling, and numbness into the arm and hand.

A variation on the scalene technique can be found here.

Pectoralis Stretch Stroke

Sit on the table behind your client so that their back is supported by your knee and thigh. Hold your client’s arm by the elbow and bring it back posteriorly while stroking the upper fibers of the pectoralis major with your fingertips, going from the sternum to the humerus.

On women work high up on the pectoralis major so that you are not on breast tissue.

Work into the distal fibers of the pectoralis major with the heel of your hand while stretching your client’s arm back and overhead.

Pectoralis Minor

Sit on the table behind your client so that their back is supported by your knee and thigh. Hold your client’s arm by the elbow then slide your fingers on the chest wall underneath the front wall of the axilla (pectoralis major) until you contact the fibers of the pectoralis minor. Work up the fibers of the pectoralis minor while bringing your client’s arm overhead. Go gently as this can be tender.

This can be done slowly with your client’s breathing. Have your client inhale deeply, then press into the pectoralis minor and bring their arm overhead as they exhale.

Subscapularis

Sit on the table behind your client so that their back is supported by your knee and thigh. Hold your client’s arm by the elbow then wrap your fingers around the back wall of the axilla and the scapula, so that they are on the subscapularis. Press into the subscapularis while bringing the arm overhead and into external rotation. Go gently as this can be tender.

Thoracic Outlet Syndrome

The thoracic outlet is the area in between the clavicle and the upper two ribs. Nerves and blood vessels for the upper extremity pass through this space and may be impinged. Impingement of the brachial plexus may be from tight scalenes, or may be from pinching between the first rib and clavicle when the scalenes pull the first rib into the clavicle.

Common symptoms of Thoracic Outlet Syndrome (TOS) are:

• Pain, tingling or numbness down the medial side of the arm going to the 4th & 5th fingers (C8 dermatome).
• The arm goes to sleep at night or when held overhead.
• The radial pulse diminishes when the arm is held overhead

Thoracic Outlet Syndrome can cause carpal tunnel symptoms and is often confused with Carpal Tunnel Syndrome.

When working with nerve entrapment it is important to begin at the proximal ends of the nerves and release any restrictions before working with the more distal areas of entrapment. When there is pain, tingling or numbness into the arm the following areas may be sites of impingement and may be treated in the order shown.

Cervical nerve roots

Scalenes

First Rib

Pectoralis Minor

Bicipital Aponeurosis

Pronator Teres

Flexor Retinaculum