











































MANUSCRIPT TYPE


CLINCAL OUTCOMES RESEARCH 

 

42 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018 
 

Short Term Effects of a Pectoralis Minor Positional Release in 
Collegiate Swimmers: A Case Series  
Jonathan Roman, MS, ATC and Noelle M Selkow, PhD, ATC 
Illinois State University, Normal, IL  
 

 
ABSTRACT 

A tight pectoralis minor correlates to abnormal scapular 
kinematics, which can cause pain, loss of range of motion and 
even loss of function, due to the change in scapular position. 
With these muscular imbalances causing forward scapular 
posture, the pectoralis minor is a key component to address 
in the prevention and treatment of shoulder impingement and 
scapular dyskinesis. This study investigated the effectiveness 
of a single positional release therapy (PRT) treatment of the 
pectoralis minor on scapular posture in collegiate swimmers 
immediately and 24 hours post intervention. Seventeen 
Division III collegiate swimmers (7 males and 10 females) 
volunteered to participate, with only one shoulder being 
excluded due to recent injury (n=33). Researchers measured 
resting pectoralis minor muscle length, forward shoulder 
posture and scapular elevation of both shoulders. Data were 
collected a total of 3 times; prior to the PRT intervention, right 
after the intervention and again 24 hours post intervention. 
Each shoulder was treated with a single session of PRT on the 
pectoralis minor. There was a significant difference for 
resting pectoralis minor length immediately post-intervention 
compared to baseline (p=.016). Scapular positioning at 0° 
abduction had a statistically significant improvement in 
position from immediate post-intervention to 24 hours post-
intervention (p=.014). Scapular positioning at 90° of 
abduction also had a statistically significant increase in 
position from baseline to immediate post-intervention 
(p=.042). For forward shoulder posture, there was a 
statistically significant improvement in position from baseline 
to immediate post- intervention (p≤.001). The results of this 
case series show that a single treatment of PRT has an 
immediate effect in reducing resting pectoralis minor muscle 
length and decreasing rounded shoulder posture. However, 
this single treatment of PRT was not enough to maintain these 
effects after 24 hours, and should be combined with other 
manual therapies or rehabilitation protocols to address 
scapular positioning in collegiate swimmers. 

Key Phrases 
Manual techniques, injury risk reduction, college and 
university patient population 
 
Correspondence 
Dr. Noelle M Selkow, Illinois State University, School of 
Kinesiology and Recreation, Cmaous Box 5120, Normal, IL, 
61761. 
E-mail: nselkow@ilstu.edu  
Twitter: @docselkow 

Full Citation 
Roman J, Selkow NM. Short Term Effects of a Pectoralis 
Minor Positional Release in Collegiate Swimmers: A Case 
Series. Clin Pract Athl Train. 2018;1(2):42-48. 
https://doi.org/10.31622/2018/0002.7     
 
Submitted: August 29, 2018 Accepted: October 15, 2018 
 
INTRODUCTION 

There is a consistently growing population of 
collegiate swimmers within Division I, II, and III 
institutions totaling around 486,000 swimmers in 
the 2015-16 academic year.1 Competitive 
swimming athletes are at risk for shoulder injury 
due to an excessive amount of shoulder revolutions 
that can cause the anterior shoulder musculature 
to hypertrophy.2 During the freestyle, butterfly, 
and backstroke of competitive swimming, the 
athlete is consistently applying adduction and 
internal rotation forces from the shoulder in order 
to propel themselves through the water, which 
may lead to an imbalance of agonist-antagonist 
muscles.3 This muscular imbalance often leads to 
scapular dyskinesis, which is defined as abnormal 
movement patterns causing alteration of optimal 
scapular kinematics.4,5  

The pectoralis minor specifically has been related 
to shoulder pain in swimmers,2 and scapular 
dyskinesis due to its shortened muscle length.6,7 A 
tight pectoralis minor can be either a primary or 
secondary cause of shoulder pain,8 and the 
diminished muscle length prohibits proper 
scapular upward rotation, posterior tilting and 
external rotation.9-11 Often times swimmers with 
bilaterally tight pectoralis minor muscles develop 
forward scapular posture, which has been 
described as a forward head and rounded 
shoulders position, and contributes to shoulder 
impingement.2,9,12 Previous studies have stated 
that the pectoralis minor muscle tightness is 
typically due to adaptive changes in the muscle 
belly from repetitive motions that involve scapular 

https://doi.org/10.31622/2018/0002.7


Short Term Effects of a Pectoralis Minor Positional Release 
in Collegiate Swimmers: A Case Series. 

 

 

43 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

protraction and anterior tilting and/or by 
maintaining a static shortened position over 
time.8,9 With these muscular imbalances causing 
forward scapular posture, the pectoralis minor is 
a key component to address in the prevention and 
treatment of shoulder impingement and scapular 
dyskinesis.9,11,13,14 Manual therapies such as 
stretching,13-15 Muscle Energy Technique (MET),16 
and Myofascial Trigger Point17 have shown to be 
effective in treating shoulder impingement 
symptoms. Previous research articles have 
addressed the need for interventions that can 
increase the pectoralis minor resting length in 
shoulder rehabilitation protocols.2,7,11,12 

Positional Release Therapy (PRT), under the 
umbrella of strain–counterstrain,18 is similar to 
Myofascial Trigger Point.19 Strain-counterstrain 
addresses dysfunctional tissue by putting them in 
a slacked position to decrease activity from 
proprioceptors.20 However, PRT uses tender points 
and a position of comfort to resolve the associated 
dysfunction, instead of attempting to stretch the 
muscle.21,22 Unlike Myofascial Trigger Points that 
are hyperirritable bands of tissue, tender points 
are discrete areas of tissue tenderness that can 
occur anywhere in the body.21,22 PRT treatment 
begins by identifying a tender point, the clinician 
positioning the patient in a position of comfort that 
is typically obtained by shortening tissues around 
the tender point while a slight touch monitors the 
position.23,24 This position is then held for 90 
seconds, and then slowly returning the patient to 
normal resting position.22,23 Although this 
technique has been around for many years,25 and 
there has been some evidence of its clinical 
usefulness,26-28 further research on the effects of 
PRT are still needed.21,22,29-31  

The purpose of this study was to investigate the 
effectiveness of a single PRT treatment of the 
pectoralis minor on scapular posture in collegiate 
swimmers immediately and 24 hours post 
intervention. The hypothesis is that the PRT 
intervention will lengthen the pectoralis minor, 
decrease the forward scapular position and 
increase scapular upward rotation in the group of 
collegiate swimmers. 

 

METHODS 

Design 

This design of this investigation was a case series, 
where the athletic trainer for the swim team 
performed all PRT treatments and measurement. 
The athletic trainer was certified for 1.5 years. 
The athletic trainer attended a PRT course for the 
upper extremity and was trained in the technique 
utilized in this study. All participants received the 
intervention on both shoulders, unless excluded. 
There was no true control group, as the athletic 
trainer and coach wanted all swimmers to receive 
a potentially beneficial treatment. Hence, this was 
a sample of convenience. The independent 
variables were intervention (PRT to the pectoralis 
minor) and time (baseline, immediately post 
intervention, and 24-hours post intervention). The 
dependent variables were pectoralis minor length 
(cm), forward shoulder posture as measured with 
the double square (cm), and scapular position in 
0°, 45°, and 90° of shoulder abduction (cm). 

Participants 

Participants included 17 Division III Collegiate 
swimming athletes (7 males and 10 females; Age: 
20.0 ± 1.4 years; Height: 170.9 ± 8.6 cm; Mass: 
69.3 ± 12.8 Kg). Shoulders of swimmers that had 
a recent history (past 6 months) of upper 
extremity injury or any history of upper extremity 
surgery were excluded from the study Only one 
participants’ shoulder was not measured due to 
recent injury (n=33). All participants were in the 
post season at the time of data collection. Both left 
and right shoulders were used for data collection. 
The institutional review board at the university 
approved this study and all participants signed 
informed consent.  

Resting Pectoralis Minor Length Measurement 

Participants were instructed to lie supine with arms 
at their side in a relaxed position. The 
measurement landmarks were from the medial 
inferior angle of the coracoid process to the 
anterior-inferior edge of the 4th rib, 1 finger width 
lateral to the sternum.32 Using the Pectoralis Minor 
Index (PMI),9 each shoulder was measured in 
centimeters then divided by the participants 



Short Term Effects of a Pectoralis Minor Positional Release 
in Collegiate Swimmers: A Case Series. 

 

 

44 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

height in centimeters and multiplied by 100 to 
account for limb height. (Figure 1) 

Forward Shoulder Posture Measurement 

After palpating the anterior tip of the acromion 
process on the participants shoulder, the location 
was marked on the participant’s skin with a 
permanent marker. The participant was then 
instructed to move backwards towards the wall 
until their heels and back touched the wall. The 
examiner then positioned the double square 
instrument over the shoulder being examined. 
With one square flush against the wall, the other 
square adjusted until it touched the tip of the 
acromion process marked previously measured in 
centimeters (cm).33 (Figure 2) 

Scapular Positioning  

We measured the participant’s scapular mobility 
using the Lateral Scapular Slide Test (LSST).34  The 
examiner used a cloth measuring tape to 
determine the distance from the inferior angle of 
the scapula to the nearest spinous process in 3 
different shoulder positions in centimeters (cm). 
The first position was with their arms relaxed at 
their sides (0° abduction). The second was with the 
participant’s hands on their hips with their fingers 
on the anterior side and thumbs on the posterior 
side of their waist, with about 10° of shoulder 
extension (45° abduction). The third position is 
with their arms at 90° of shoulder elevation with 
their thumbs pointed downward. (Figures 3-5) 

Positional Release Therapy for the Pectoralis Minor 

The participant was placed supine on the table. 
Using one hand to palpate for tender points, the 
examiners other hand grasped the forearm of the 
treatment side. Upon finding a tender point, the 
examiner monitored the palpation and began to 
move the treatment arm across the body towards 
the opposite hip, and then applied a distraction 
force with internal rotation to fine tune the position 
so that the fasciculation response was most 
prominant.22 The fasciculation response is a 
continuous small amplitude twitch, similar to a 
pulse, where the tender point is located and 
examiner’s fingers are located. The position of 
comfort was painless and allowed the participant 

to relax. The examiner held this position for 90 
seconds (Figure 6) and then slowly returned the 
arm to neutral and re-evaluated the tender point. 
A successful treatment was determined by a 
decrease in pain on the tender point as indicated 
by the patient. The examiner repeated the 
procedure for all tender points located on the 
involved pectoralis minor muscle. No other 
interventions were used. 

Procedures 

Data measurements were collected a total of 3 
times on each participant. They were measured 
prior to the PRT intervention, right after the 
intervention and again 24 hours post intervention. 
During the length of the study (24 hours), the 
participants were not to participate in any 
physical activity. 

Statistical Analysis 

Separate paired-samples t-test were conducted 
to evaluate the effect of PRT for the pectoralis 
minor on pectoralis minor length, scapular 
positioning, and forward shoulder posture. 
Cohen’s d effect sizes were calculated for 
significant findings. Alpha was set a priori at 
α=0.05.  IBM SPSS Statistics 25 (Chicago, IL) was 
used for statistical analysis. 
 
RESULTS 

Means and standard deviations, along with p-
values and effect sizes are presented in Table 1. 
The only significant finding with an effect size that 
did not cross zero was for forward shoulder 
posture. Forward shoulder poster decreased 
immediately after the PRT intervention, but the 
results were not maintained 24 hours post-
intervention.  

DISCUSSION  

Due to the nature of the sports, repetitive motions 
of the shoulder tend to cause muscular imbalances 
and can lead to injury.2,3 Because of this, clinicians 
and health care professionals utilize a variety of 
manual techniques to address the over active 
anterior muscles that may contribute to injury.  



Short Term Effects of a Pectoralis Minor Positional Release 
in Collegiate Swimmers: A Case Series. 

 

 

45 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

  

Although PRT is becoming more popular among 
clinicians, there is no previous research using PRT 
on the pectoralis minor in swimmers. This case 
series has indicated that there is merit to PRT, 
when used to address the pectoralis minor in 
asymptomatic swimmers, to decrease rounded 
shoulders posture after a single treatment session. 

A tight or shortened pectoralis minor has been 
correlated to abnormal scapular kinematics, 
causing the rounded shoulder posture observed in 
most swimming athletes.2,6,12,15,16 The increased 
anterior tilting, internal rotation and downward 
rotation of the scapula is partly due to the line of 
pull of the pectoralis minor,9 along with other 
muscles, such as the pectoralis major and scapular 
retractors.35 

From our findings, PRT seems to influence forward 
shoulder posture immediately after intervention to 
the pectoralis minor. Clinicians can utilize this 
technique during a rehabilitation session to help  

 

position the scapula in more neutral position 
before strengthening exercises are implemented.  

Therefore, the muscles around the scapula will be 
strengthened in a more optimal position. 
Strengthening exercises alone may take as long 
as 8 weeks to correct scapular positioning.36 
Compared to other manual therapy treatments, 
muscle energy technique has been shown to 
increase pectoralis minor length and decrease 
forward shoulder posture after a 6-week 
intervention,16 although it is unknown what 
changes would occur after 1 session of muscle 
energy technique. With limited research on 
manual therapy for forward shoulder posture, PRT 
seems to be a good option when initially 
addressing this condition.  

There were some limitations to this study that could 
attribute to the results that were found. The PRT 
treatment session was altered from the current 
treatment protocol of holding the position of 
comfort until fasciculation decreases significantly 

Table 1. Means, SD, and p-values of Clinical Outcomes. Effect sizes for significant p-vales provided 
 
 Baseline Post-

Intervention 
Post-
Intervention 
to Baseline p 
value 

24 hrs Post-
Intervention 

24 hrs Post-
Intervention to 
Post-
Intervention p 
value 

24 hrs Post-
Intervention 
to Post-
Intervention p 
value 

Pectoarlis 
Minor 
Length 
(cm) 

 
18.02±1.14 

 
18.38±1.25 

 
P=.016 
ES=.36  
(-.12 -.85) 

 
18.06±1.17 

 
P=.016 
ES=.26  
(-.22 -.75) 

 
P=.813 

Scapular 
Position 0° 
(cm) 

 
9.40±1.53 

 
9.47±1.67 

 
P=.701 

 
9.76±1.89 

 
P=.014 
ES=.18  
(-.31-.66) 

 
P=.098 

Scapular 
Position 
45° (cm) 

 
10.18±1.44 

 
10.18±1.48 

 
P=.955 

 
10.26±1.45 

 
P=.162 

 
P=.441 

Scapular 
Position 
90° (cm) 

 
10.53±1.84  

 
10.23±1.71  

 
P=.042 
ES = -.17  
(-.65-.32) 

 
10.79±1.82  

 
P≤.001 
ES = .35  
(-.13-.84) 

 
P=.172 

Forward 
Shoulder 
Posture 
(cm) 

 
15.81±1.55  

 
14.85±1.5  

 
P≤.001 
ES = -.67  
(-1.16– 
-.17) 

 
15.64±1.42  

 
P≤.001 
ES = -.54  
(-1.03– 
-.05) 

 
P=.379 



Short Term Effects of a Pectoralis Minor Positional Release 
in Collegiate Swimmers: A Case Series. 

 

 

46 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

or ceases, to holding for a set time of 90 seconds, 
to help standardize the treatment for all 
participants in this study.21,22,31 Furthermore, when 
using PRT to treat injuries of the shoulder, such as 
shoulder impingement or scapular dyskinesis, 
multiple muscles need to be identified and 
treated over multiple sessions to correct the 
problem.22,31 Lastly, the single PRT session was 
done by a clinician with novice training, and not a 
full certified PRT clinician. 
 
For future research studies a full PRT treatment 
involving multiple targeted muscles should be 
performed as outlined by Speicher.22 The 
treatment should be performed by a PRT certified 
clinician, and there needs to be more than one 
treatment session. Furthermore, more 
measurements should be taken, such as a visual 
analog pain rating scale, humeral abduction ROM 
and humeral horizontal abduction ROM. Also, 
future research should look into seeing if dominant 
arm and breathing side plays a role in ROM 
restrictions in each swimmer.  

CLINICAL APPLICATION 

This case series was used to identify if PRT was an 
effective treatment method to influence scapular 
posture in collegiate swimmers. The results of this 
case series show that a single treatment of PRT 
may have an immediate effect in reducing resting 
pectoralis minor muscle length and decreasing 
rounded shoulder posture. However, this single 
treatment of PRT was not enough to maintain these 
effects after 24 hours, and should be combined 
with other manual therapies or rehabilitation 
protocols to address scapular dyskinesis in 
collegiate swimmers. 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

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Short Term Effects of a Pectoralis Minor Positional Release 
in Collegiate Swimmers: A Case Series. 

 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

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