Comparison of three stretches for the pectoralis
minor muscle
John D. Borstad, PhD, PT,a and Paula M. Ludewig, PhD, PT,b Columbus, OH, and Minneapolis, MN
Pectoralis minor adaptive shortening in healthy individ-
uals is associated with altered scapular kinematics sim-
ilar to the alterations demonstrated in individuals with
subacromial impingement. This associative relationship
suggests that stretching of the pectoralis minor may
improve scapular kinematics and assist in the manage-
ment of shoulder impingement. Several stretches for
the pectoralis minor are used clinically, although it is
not known which stretch optimally lengthens the mus-
cle. The purpose of this analysis was to compare the
mean length change for 3 pectoralis minor stretches.
Fifty subjects without shoulder pathology were exam-
ined for the change in length of the pectoralis minor
during 3 separate stretches by use of an electromag-
netic motion-capture system. The stretches analyzed
were a unilateral self-stretch, a supine manual stretch,
and a sitting manual stretch. Each stretch was signifi-
cantly different from the other two (df, 2/98; F ratio,
39.09; P .00001), with the unilateral self-stretch
demonstrating the greatest length change (2.24 cm),
followed by the supine manual stretch (1.69 cm) and
the sitting manual stretch (0.77 cm). Knowledge of the
most effective method of elongating the pectoralis mi-
nor muscle may improve clinical decision making
when targeting this anterior scapulothoracic muscle as
part of intervention for or prevention of shoulder im-
pingement. (J Shoulder Elbow Surg 2006;15:
324-330.)
M any authors have described skeletal muscle adap-
tations such as muscle length changes and strength
imbalances.11,20,23 Postural faults,11,20,22 chronic
use of a muscle at a specific length or joint angle,9
and higher activation of muscles on one side of a joint
From the aPhysical Therapy Division, School of Allied Medical
Professions, The Ohio State University, Columbus, and bProgram
in Physical Therapy, Department of Physical Medicine and Re-
habilitation, University of Minnesota, Minneapolis.
Reprint requests: John D. Borstad, PhD, PT, Division of Physical
Therapy, The Ohio State University, 1583 Perry St, Columbus,
OH 43210-1234 (E-mail: borstad.1@osu.edu).
Copyright 2006 by Journal of Shoulder and Elbow Surgery
Board of Trustees.
1058-2746/2006/$32.00
doi:10.1016/j.jse.2005.08.011
324
compared with the antagonist muscles23 are all pro-
posed mechanisms of skeletal muscle adaptation. At
the shoulder complex, prolonged exposure to pos-
tures of increased scapular protraction and anterior
tipping is proposed to result in a shortening or tight-
ness of the pectoralis minor muscle.11,20 Repetitive
use of the upper extremities in positions that protract
and downwardly rotate the scapulae may also result
in pectoralis minor adaptive shortening.14,15 Manual
stretching of the pectoralis minor is, therefore, often
performed as an intervention when posture deviates
from neutral or for shoulder impingement.11,20 Home
exercise programs have also included a self-stretch
for the pectoralis minor.13,17,22
The pectoralis minor attaches at the coracoid pro-
cess of the scapula and at the third, fourth, and fifth
ribs near their sternocostal junctions. This muscle elon-
gates during arm elevation, allowing the scapula to
upwardly rotate, externally rotate, and tip posteriorly18
(Figure 1). A relatively short pectoralis minor muscle,
as a result of adaptation, would demonstrate less total
excursion than a relatively longer muscle,24,25 limit-
ing full scapular motion. Limitation of scapular motion
during arm elevation is believed to decrease the
available subacromial space and contribute to shoul-
der pathology.8,14,15,18,19,22 A decrease in the sub-
acromial space combined with exposure to overhead
use has demonstrated rotator cuff changes similar to
those seen in individuals with impingement.21 Individ-
uals with symptoms of shoulder impingement, includ-
ing workers exposed to overhead work, have exhib-
ited these scapular motion limitations in several
controlled studies.8,14,15 It is possible that one impor-
tant mechanistic connection between limitations in
scapular motion, particularly tipping, and shoulder
symptoms is a decreased resting length of the pecto-
ralis minor. A decreased resting length of the pecto-
ralis minor could be either a causative factor for
scapular kinematic alterations or a result of altered
scapular position or motion. The end result of either of
these possibilities is the need to stretch the muscle in
an attempt to increase its excursion and help restore
normal scapular kinematics during arm elevation.
The purpose of this study was to compare 3
stretches to determine the most effective method for
stretching the pectoralis minor muscle. This informa-
tion will be valuable to clinicians wishing to include a
J Shoulder Elbow Surg
Volume 15, Number 3
Figure 1 Three-dimensional scapular rotations. Upward rotation and downward rotation occur about an axis
perpendicular to the plane of the scapula. Anterior tipping and posterior tipping occur about a medial-lateral axis.
Internal rotation and external rotation occur about a vertical axis.
pectoralis minor stretch for their patients. We hypoth-
esized that manual stretches would be more effective
than would a self-stretch because more precise sepa-
ration of the muscles origin and insertion could be
obtained through direct contact by a therapist on the
coracoid process and through improved stabilization
of the thorax, as compared with the more general
anterior shoulder stretch performed by the patient.
MATERIALS AND METHODS
Subjects
Fifty healthy individuals without current shoulder pain or
a history of shoulder trauma were recruited for this analysis.
Subjects were required to be aged between 20 and 40
years (mean, 27.5 years) to ensure full skeletal growth
while avoiding the developing joint degenerative changes
that are common in individuals aged over 60 years.5 An
attempt to avoid including subjects with joint degenerative
changes was made to minimize the potential effect of this
variable on normal joint motion. Volunteers were recruited
by personal contact, advertising on campus (University of
Minnesota, Minneapolis, MN), and addressing graduate
classes in physical therapy and kinesiology. All subjects
were required to sign both a University of Minnesota
approved informed consent form and a Health Insurance
Portability and Accountability Act form before entering the
study. A clinical examination was performed on each sub-
ject to ensure that no underlying pathology was present in
the tested shoulder. The examination included range of
motion; the impingement tests of Hawkins, Neer, and Jobe;
the apprehension test for determining anterior instability;
and the sulcus sign to test laxity.16
Instrumentation
The Flock-of-Birds electromagnetic motion-capture sys-
tem (Ascension Technology Corp, Burlington, VT) was
used for measuring pectoralis minor length and analyz-
ing stretches in this study. To determine pectoralis minor
Borstad and Ludewig 325
length and length change, 3 mini-bird sensors were used
for each subject. A scapular sensor was fixed to the
subjects skin over the broad, flat area of the acromion,
and a sternal sensor was fixed to the skin just distal to the
sternal notch with double-sided adhesive tape. A third
sensor was attached to a thermoplastic cuff and secured
over the subjects distal humerus with Velcro straps. The
source transmitter of the system was located at acromion
height behind the subject. A digitization sequence estab-
lished local anatomically based axis systems for each
segment (Figure 2). In addition, the coracoid process and
the fourth rib/sternum junction were digitized to repre-
sent the length of the pectoralis minor. This length mea-
surement was validated in vitro with an Intraclass Corre-
lation Coefficient (ICC) of 0.96 comparing the surface
palpation and digitization of the previously mentioned
landmarks with digitization of the same landmarks after
dissection to visualize the actual origin and insertion of
the muscle.7 Reliability and validity of electromagnetic
tracking systems in capturing 3-dimensional movements
have been demonstrated.1,4,10 Data were collected at
100 Hz per sensor, and all post-processing was per-
formed by use of MotionMonitor software (Innovative
Sports Training, Chicago, IL) integrated with the Flock-of-
Birds system.
To determine the length of the pectoralis minor, the
digitized point representing the muscles origin and in-
sertion was mathematically converted to be in the refer-
ence frame of one of the local sensors. The coracoid
process point was calculated to be in the reference frame
of the scapular sensor, and the fourth rib point was
calculated in the reference frame of the trunk sensor. The
3-dimensional vector from each pectoralis minor land-
mark to its respective sensor was then calculated. Given
the assumption that the scapula and trunk are rigid
bodies, these landmark-to-sensor vectors remain con-
stant. The position and orientation of both sensors are
also calculated relative to the transmitter reference frame.
Finally, with these variables known, the 3-dimensional
326 Borstad and Ludewig J Shoulder Elbow Surg
May/June 2006

Figure 2 Local orthogonal axis systems for scapula, humerus, and trunk. Dotted lines on the humeral figure
represent the thermoplastic cuff used for sensor placement and digitization. Origins are the acromioclavicular joint
for the scapula, medial epicondyle for the humerus, and sternal notch for the trunk.

Figure 3 Unilateral corner stretch. The subjects forearm is stabi- Figure 4 Sitting manual stretch. The investigators hypothenar
lized by a vertical plane before the trunk is rotated in the opposite eminence is used to apply force to the scapula through the coracoid
direction. process.

vector lengths between the 2 digitized points were cal-
culated in the varying stretch positions.7
Procedures
To determine the pectoralis minor resting length reference
value for each subject, data were collected for 1 second in the
normal, relaxed standing position. The pectoralis minor resting
length was defined as the mean vector length calculated over
this 1-second file. The stretched pectoralis minor vector length
was subsequently determined by data collected during each of
the 3 stretches. The first stretch was a self-stretch done in the
standing position and required the subject to abduct the hu-
merus to 90 with the elbow flexed to 90 and place the palm
on a flat planar surface. The subject then rotated the trunk
away from the elevated arm, increasing the horizontal abduc-
tion at the shoulder and maximizing the stretch across the chest
(Figure 3). The subject held this position for 3 seconds. The
second and third stretches were both performed after lowering
the transmitter to keep the sensors within the magnetic field.
The second stretch was performed manually by the examiner
with the subject sitting in a plastic chair without resting against
the back of the chair and the arm in the dependent position.
The subject was instructed to inhale deeply and hold his or her
breath while the muscle was fully elongated by the examiner.
To stretch the muscle, the examiner applied a posterior force to
the coracoid process with one hand while stabilizing the
inferior angle of the scapula with the other hand (Figure 4).
J Shoulder Elbow Surg
Volume 15, Number 3
Figure 5 Supine manual stretch. The investigator holds the ipsilat-
eral shoulder in 90 abduction and elbow in 90 flexion before
applying force to the scapula through the coracoid process with the
hypothenar eminence. The subject is lying with a towel roll between
the thoracic spine and the treatment table.
After positioning the muscle in the stretch position, the subject
was instructed to exhale.12 The examiner held this stretch
position for 3 seconds. The third stretch was performed man-
ually by the examiner with the subject lying in a supine
position on a treatment plinth with a towel roll running the
length of the thoracic spine. The examiner positioned the
subjects shoulder at 90 of abduction and external rotation
and the elbow at 90 flexion while applying a posterior force
to the coracoid process, again holding the stretch position for
3 seconds (Figure 5).
The resting length value for each subject was sub-
tracted from each stretch length value to arrive at a length
change for each stretch position. This resulted in change
values for each stretch relative to an individual subjects
pectoralis minor resting length. A 1-way repeated-mea-
sures analysis of variance with stretch type as the re-
peated factor was used to examine potential differences
between stretches. The dependent variable was the
length change score for each stretch type. Statistically
significant main effects of stretch type were further ex-
plored with a post hoc Tukey-Kramer multiple compari-
sons test.
A limitation of the Flock-of-Birds system is that the accu-
racy and validity of the values may be compromised by
motion between the skin-mounted sensor and the underlying
bone with positioning into extreme ranges of motion.10 This
is more likely to be a problem with the arm at 90 because
larger errors are created as arm elevation progresses to
angles above 120 humeral elevation.10 This potential
effect was examined by digitizing 1 subject according to
the protocol, recording a corner self-stretch, and then digi-
tizing this same subject a second time as he held the corner
stretch position. The pectoralis minor origin and insertion
landmarks were also directly palpated and re-digitized
after the subject was in the stretch position. This second
digitization calculated the distance between the pectoralis
Borstad and Ludewig 327
Table I Mean length change for pectoralis minor by stretch type
Stretch type Mean (SE) (cm)
Corner 2.24 (0.10)
Sitting manual 0.77 (0.11)
Supine manual 1.70 (0.19)
minor landmarks after skin motion would have occurred as
a result of the combined effect of arm elevation and the
stretch position.
RESULTS
A summary of the amount of change from resting
length for each stretch type is presented in Table I.
There was a statistically significant main effect of
stretch type (df, 2/98; F ratio, 39.09; P .00001)
(Table II). The Tukey-Kramer multiple comparisons test
indicated that each stretch type was significantly dif-
ferent from each of the other two stretch types (Table
III). The corner stretch demonstrated the greatest
change (2.24 cm), followed by the supine manual
stretch (1.69 cm) and the sitting manual stretch (0.77
cm) (Figure 6).
For the single-subject skin-slip assessment, the
value for the pectoralis minor length was 17.35 cm
during the original condition and 17.50 cm in the
re-digitized validation condition, an offset of 0.15
cm. This offset value is similar to the SEM for the
change in pectoralis minor length during all stretches
(Table I). In addition, the pectoralis minor was esti-
mated to be longer in the re-digitized condition, an
indication that the length used for the stretch compar-
isons was likely to be underestimated. The amount of
offset is also not enough to influence the between-
stretch differences, which were all considerably
larger than 0.15 cm.
DISCUSSION
Stretching of the pectoralis minor is often included
in the rehabilitation of individuals with shoulder symp-
toms.3,13,17,22 Manual stretches may be performed in
a clinical setting, and home stretches are also typi-
cally prescribed to patients. The frequency and dura-
tion guidelines for an effective stretch are not firmly
established,2 so it is important to maximize the muscle
length with the optimal stretch. The results of this
analysis indicate that a unilateral self-stretch most
effectively lengthens the pectoralis minor muscle rela-
tive to its resting length. The second most effective
stretch was demonstrated to be a unilateral manual
supine stretch, whereas a sitting manual stretch was
the least effective at maximizing the pectoralis minor
length. The 3 stretches were determined to be statis-
tically different from one another (Table II).
328 Borstad and Ludewig
Table II One-way repeated-measures analysis of variance for stretch type
Factor df Sum of squares
Subject 49 76.37
Stretch type 2 54.60
Subject stretch type 98 68.44
Total 149 199.41
*Statistically significant at P .05
Table III Tukey-Kramer multiple comparisons results for stretch type
(n 50)
Significantly Mean
different difference
Stretch type from type
Corner Sitting manual
Supine manual
Sitting manual Corner
Supine manual
Supine manual Corner
Sitting manual
A positive mean difference indicates a greater length change relative to the
comparison stretch type.
Both the self-stretch and the supine manual stretch
position the humerus at approximately 90 of both
abduction and external rotation, whereas the sitting
stretch positions the arm at the side in neutral rotation.
Because the sitting stretch was shown to be least effec-
tive, it may indicate that humeral elevation and external
rotation to 90 are important components of pectoralis
minor stretching. This humeral position likely tensions
soft tissues such as the anterior capsule, pulling the
scapula into posterior tipping and external rotation, thus
increasing the distance between the coracoid process
and the fourth rib landmarks.
It was hypothesized that manual pressure to the
coracoid process would create increased stretching
of the muscle by more precise separation of the
muscles origin and insertion. This hypothesis was not
supported, as the self-stretch was found to be most
effective and was the only stretch that did not require
manual assistance. The subjects may have felt that
they had increased control over how aggressively
and how far they stretched during the self-stretch.
Similarly, subjects may have had discomfort from the
pressure on the coracoid process provided by the
examiner, leading to more guarding and a less effec-
tive stretch. Perhaps with several repetitions of a
manual stretch over several treatment sessions, pa-
tient comfort would allow for a more effective manual
stretch. The self-stretch also may have created more
scapular external rotation in addition to scapular
posterior tipping than the manual stretches were able
to create. The combined effect of external rotation
J Shoulder Elbow Surg
May/June 2006
Mean square F ratio Probability level
1.56
27.30 39.09 .00001*
0.70
and posterior tipping may, therefore, be more effec-
tive than a stretch emphasizing either posterior tip-
ping or external rotation of the scapula in isolation.
The supine stretch was performed unilaterally with the
subject lying prone on a towel roll placed beneath the
(cm) thoracic spine. This stretch can also be performed bilat-
erally, which may be more effective. The bilateral stretch
1.47
0.54
will stabilize the client and prevent trunk rotation toward
1.47 the side of the stretch, possibly maximizing stretch effec-
0.93 tiveness. Another concern with this particular stretch is
0.54 scapular contact with the plinth. It is possible that there
0.93 were subjects who may not have reached the fullest
pectoralis minor length possible because of this mechan-
ical block. This stretch exhibited the largest SE, which
perhaps reflects these sources of variability. Even with
the limitations of this particular stretch, it was still deter-
mined to be more effective in changing muscle length
than the sitting manual stretch.
The potential influence of pectoralis minor adapta-
tion on scapular kinematics was recently analyzed in
2 asymptomatic groups separated by the normalized
resting length of the pectoralis minor.6 Healthy sub-
jects rather than subjects with impingement were used
because of the potential for pain to alter scapular
motion and confound the motion effects of pectoralis
minor length variability. The relatively short pectoralis
minor group demonstrated significantly limited scap-
ular posterior tipping at higher arm elevation angles
and increased scapular internal rotation compared
with the relatively long pectoralis minor group.6 This
associative relationship between pectoralis minor
length and scapular biomechanics is evidence sup-
porting the assessment of pectoralis minor length in
individuals with impingement symptoms and stretch-
ing the muscle if indicated.
Several studies have included pectoralis minor
stretching as part of an intervention intended to alter
scapular kinematics or to reduce shoulder impinge-
ment symptoms.3,13,17,22 Wang et al22 examined the
effects of shoulder posture and exercises on 3-
dimensional scapular kinematics. Twenty asymptom-
atic subjects with forward shoulder posture were an-
alyzed with regard to scapular kinematics at rest (arm
at side), at elevation in the scapular plane to horizon-
tal, and at maximum elevation in the scapular plane.
Subjects were instructed on a 6-week home exercise
program designed to mimic a clinical regimen. The
J Shoulder Elbow Surg Borstad and Ludewig 329
Volume 15, Number 3

Figure 6 Comparison of pectoralis minor stretch positions. The amount of change represents the mean difference
between maximum length during stretch and resting length in 50 subjects. The asterisk indicates statistically
significant differences between all 3 stretch types. Error bars represent SEM.

program included resisted strengthening exercises by
use of a Thera-band (Hygenic Corporation, Akron,
OH), as well as a corner stretch for the pectoralis
muscles, 3 times per week for 6 weeks. Significant
changes discovered included a decrease in scapular
upward rotation, an increase in scapular internal
rotation, and a decrease in scapular superior transla-
tion at horizontal, with a decrease in upper thoracic
inclination at all 3 positions. No kinematic changes
that could be attributed to increases in pectoralis
minor length or extensibility (eg, scapular posterior
tipping) were demonstrated. McClure et al17 exam-
ined the effects of a similar exercise program per-
formed at home for 6 weeks by 39 subjects with
impingement symptoms. Strengthening and flexibility
exercises were prescribed for all subjects after the
initial testing. All subjects were assessed by 3-dimen-
sional kinematic analysis, by analysis of range of
motion and posture, and by 2 outcome scales before
and after the intervention. The pectoralis minor stretch
was performed by grasping a doorway at shoulder
height and rotating away from the arm. Subjects
demonstrated improvement in some range-of-motion
and strength variables and reported subjective im-
provement in pain and functional scores but did not
demonstrate kinematic alterations.
Bang and Deyle3 compared the effects of a super-
vised exercise program with the same program plus
manual therapy for patients with shoulder impingement.
Exercises included 2 stretching exercises including 1 for
the pectorals, as well as 6 strengthening exercises. The
manual therapy group also received manual therapy
aimed at treating movement restrictions, such as tech-
niques to increase glenohumeral caudal glide range of
motion and thoracic or cervical mobility and to improve
soft-tissue restrictions in the pectoralis minor or other soft
tissues. Both groups showed improvement, but the man-
ual therapy group showed significantly greater improve-
ment.
Ludewig and Borstad13 examined the effects of a
home exercise program on shoulder pain and function
in construction workers. The exercise intervention con-
sisted of 2 stretching exercises including a bilateral
pectoralis minor stretch, 2 strengthening exercises, and
1 relaxation exercise. Subjects receiving the intervention
demonstrated statistically significant improvement in
pain and satisfaction with their shoulder and improve-
ments in work-related pain and disability scores.
330 Borstad and Ludewig
A limitation for these intervention studies is the inabil-
ity to partition out the effects of each specific exercise as
it relates to improvement in symptoms and function. It is
difficult to know whether the pectoralis minor stretch was
specifically beneficial in these analyses. With the deter-
mination in our study of the effectiveness of several
pectoralis minor stretches, interventions can be more
specific to this muscle when it is determined to be
adaptively short.
A potential limitation of our analysis is an order effect
of the stretches. The stretches were performed in the
same sequence for each subjectself-stretch, sitting
manual stretch, and supine manual stretch. It does not
appear that there was an order effect of preconditioning
the muscle to make it more extensible, as the first stretch
was determined to be the most effective, rather than the
last stretch. Similarly, an order effect of inhibiting exten-
sibility is not supported, because the last stretch was
determined to be more effective than the second stretch.
Even though the results do not indicate an order effect,
randomizing the stretch types would have strengthened
the study. Randomization was not done in an effort to
minimize subject movement from position to position
and to minimize the time required to complete data
collection. As mentioned in the Materials and Meth-
ods section, the possibility of skin slip is also a limitation
of our study. Skin-mounted sensors have been demon-
strated to be valid with the humerus below 120 eleva-
tion,10 which was the case for all 3 stretches.
In conclusion, this study demonstrated that, of the
stretches investigated, a unilateral self-stretch best ac-
complishes elongation of the pectoralis minor muscle,
followed by a unilateral supine manual stretch and,
finally, a unilateral sitting manual stretch. Monitoring the
subjects ability to relax during a manual stretch, adding
humeral abduction and external rotation, and position-
ing the scapula in external rotation in addition to poste-
rior tipping are factors to consider when attempting to
maximize the length of the pectoralis minor. Interven-
tions or intervention studies targeting shoulder impinge-
ment that include a pectoralis minor stretch can now
select a stretch based on experimental evidence.
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