Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Effectiveness of Myofascial Release and Muscle

Energy Technique on Pectoralis Minor Length in
Subjects with Shoulder Impingement Syndrome:
A Comparative Study
Dr. Narayanavarapu Priyanka, Dr. Patchava Apparao, Dr. Rayudu.Geetha Mounika
Department of Physiotherapy, Swatantra Institute of Physiotherapy & Rehabilitation, Rajamundry, India
Corrresponding Author: N. Priyanka

Abstract:- Background and Objective - Shoulder Energy Technique, Participants were given intervention
Impingement Syndrome (SIS) is a common cause of thrice a week for 6 weeks. The outcome measures of this
shoulder pain in adults. People with this condition intervention were measured in term of VAS for Pain,
experience pain related to the shoulder's tendons and soft SPADI for Function and PMI for Pectoralis Minor
tissues when lifting the arm overhead. The Pectoralis Length.
Minor muscle was found to be significantly more active
during elevation in subjects with SIS. Increased activity is Result - Independent‘t’test was used to compare the mean
indicative of a shortened muscle. When this muscle is in a significance difference between continuous variables.
shortened position however, it can limit scapular upward Paired‘t’test was used to assess the Statistical significance
rotation, which is necessary for shoulder elevation, while difference between Pre and Post test scores. Statistical
causing excessive anterior tilting and internal rotation of analysis of the data revealed that within the group
the scapula. The increased anterior tilt and internal comparison, both groups showed significant
rotation caused by Pectoralis Minor tightness improvement in all parameters. Whereas in between the
mechanically reduce the Subacromial space, and has been group’s comparison Muscle Energy Technique showed
associated with symptoms commonly seen with SIS. better improvement when compared to Myofascial
Physiotherapy techniques like Myofascial Release (MFR) Release.
and Muscle Energy Technique (MET) have been
proposed as an adjunct to Conventional therapy to treat Conclusion - After 6 weeks of intervention, Both
Shoulder Impingement Syndrome. Both the techniques Myofascial Release and Muscle energy technique
have been proven to be effective on increasing Pectoralis intervention showed significant improvement on
Minor length, reducing Pain, improving Function in Pectoralis minor length, Pain and function. However,
Subjects with Shoulder Impingement Syndrome and Muscle Energy Technique group is found to be more
studies are limited on their Comparison. Hence need of effective when compared to Myofascial Release group.
the Study arise. From the findings of the current study, it is recommended
that Muscle energy technique protocol may be
Methods - Prospective study design. 64 subjects with age incorporated in the management of Shoulder
groups between 18 and 35 years having a Clinical Impingement Syndrome.
Diagnosis of Shoulder Impingement Syndrome were
randomly allocated in to two groups. In Group A (n=32) Keywords:- Shoulder Impingement Syndrome, Pectoralis
subjects were treated with Myofascial Release (MFR) Minor Length, Myofascial Release, Muscle Energy
whereas in Group B (n=32) subjects received Muscle Technique

IJISRT21NOV350 www.ijisrt.com 774

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
I. INTRODUCTION for planning interventions and assess the effect of those
interventions5.
Shoulder pain is the third most common
musculoskeletal complaint in orthopedic practice and Measuring PM muscle length using the coracoid process
Impingement Syndrome is one of the more common and the fourth rib as origin-insertionlandmarks is considered
underlying cause. The prevalence of shoulder pain in India the "gold standard" method. A tape measure demonstrated
has been reported to be 7% to 34%, often with 26.4% for good reliability, to measure pectoralis minor muscle length,
Shoulder Impingement Syndrome (SIS) as the underlying and is readily available and easily manipulated in clinical
etiology with an incidence of 14.7 new cases per 1000 practice. The PMI was first proposed by “Borstad and
patients per year seen in clinics. Gender wise prevalent cause Ludewig” to classify relatively short and long PM and
of shoulder pain with Subacromial Impingement in males evaluate the effect of PM length on scapula kinematics. In
17.24% and in females 11.11% 1. addition, a direct measurement is more useful for making
clinical decisions about an individual patient 6.A thorough
In 1972 “Neer” described it as a painful condition in history and physical examination are key to the diagnosis of
which the soft tissues of the Subacromial space were Shoulder Impingement Syndrome and Special tests are key
entrapped and compressed between the humeral head and the components of the physical examination. Imaging studies are
coracoacromial arch, due to narrowing of subacromial space often performed to confirm the diagnosis and rule out other
or superior migration of the humeral head caused by pathologies6.
weakness or muscle imbalance. Typically occurs in younger
individuals with pain located in the anterior or anterolateral There are various Physiotherapy treatment protocols
aspect of the shoulder. The symptoms are usually activity- such as Cryotherapy, Massage, Stretching,, Strengthening,
specific and involve overhand activities2. Dry needling, Soft tissue Mobilization, Manual Therapy
Neer categorised Impingement in to three stages namely3 , procedures, Electrotherapy reported better outcomes with
evidence on increasing muscle length, reducing Pain,
 Stage-I is characterized by edema or bleeding of Improving the functional activities of the Subjects with
subacromial bursa and rotator cuff usually in people aged Secondary Shoulder Impingement Syndrome, Among them
under 25 years; Myofascial Release and Muscle Energy Technique have
 Stage-II represents fibrosis or tendinitis of rotator cuff drawn much attention in the management of Shoulder
usually occurs in patients aged between 25and 40 years Impingement Syndrome. Studies suggested that these
of age with thickening and fibrosis of subacromial soft techniques are more effective in increasing muscle length,
tissues; Reducing Pain, Improving Function in Shoulder
 Stage-III includes tendon tear leading to progressive Impingement Syndrome7.
failure of limb motor function which is common in
patients aged over 40 years. Both Myofascial Release and Muscle Energy
Technique have been proved to be effective on increasing
Etiology of Shoulder Impingement Syndrome has both Muscle length, reducing Pain and improving Function in
primary and secondary forms. Primary impingement is due to subjects with Shoulder Impingement Syndrome. However,
structural changes that mechanically narrow the subacromial literature is limited in their comparison. Hence, the need of
space these include bony narrowing on the cranial side or an the study arises.
increase in the volume of the subacromial soft tissues due to
Subacromial bursitis or calcific tendinitis on the caudal side. II. METHODS AND MATERIALS
Secondary External Impingement related to abnormal
Scapulohumeral kinematics, strength balance alteration  Study design:
resulting in functional disturbance in the centering of the Prospective Study Design
humeral head, leading to an abnormal displacement of the
center of rotation when the arm is elevated, Generally caused  Ethical clearance and informed consent:
by weakness of the Rotator Cuff Muscles and scapular The study protocol was approved by the Ethical
muscles4. Committee of GSL Medical College & General Hospital; the
investigator explained the purpose of the study and given the
Muscle tightness has been implicated in Shoulder patient information sheet. The participants were requested to
Impingement. In particular, during elevation, anterior provide their consent to participation in the study. All the
shoulder girdle muscle tension may affect the tension on the participants signed the informed consent and the rights of the
leading edge of the coracoacromial ligament, predisposing it included participants have been secured.
to tightness ultimately leading to structural impingement.
Shortening or tightness of Pectoralis Minor muscle is one of  Study population:
the potential biomechanical mechanism associated with Subjects clinically diagnosed as Shoulder Impingement
scapular protraction by tilting it anteriorly and limits scapular Syndrome by an Orthopedician. Study setting: The study
upward rotation, and posterior tilt, thereby reducing was conducted at out Patient Department of Physiotherapy,
subacromial space. The resting length of PM is identified as GSL Medical College and General Hospital,
a potential contributor to detrimental shoulder kinematics; a Rajamahendravaram, Andhra Pradesh, India.
reliable clinical assessment of resting length will be valuable

IJISRT21NOV350 www.ijisrt.com 775

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
intolerable pain or worst type of pain. Studies show that
 Study duration: VAS has high amount of reliability and validity and can be
The study was conducted during the period between used as a measurement tool. VAS was used to measure Pain
13
July 2020 to June 2021 at baseline and at the end of 6 weeks .
 Sampling method:  THE SHOULDER DISABILITY INDEX (SPADI) 11:
Systematic Random Sampling. The shoulder pain and disability index is a self-
report questionnaire developed to measure the pain and
 Intervention Duration: disability associated with shoulder pathology. The SPADI
3 sessions a week for 6 weeks. consists of 13 items in two subscales: pain "5 items" and
disability "8 items". Validity was established by correlating
 Sample size: SPADI total and subscale scores with shoulder range of
A total of 100 subjects were screened in that 64 subjects motion. SPADI was used to measure Shoulder disability at
were recruited who are willing to participate in the study. baseline and at the end of 6weeks.
Recruited participants were explained the purpose and
relevanceof the study. Those who willing to voluntarily be  PECTORALIS MINOR LENGTH (PMI) 12:
included in the study after obtaining informed consent. All A standard tape technique is used to obtain the linear
eligible participants were conservatively randomized in to measurement of pectoralis minor muscle length. Participants
either Myofascial Release Group or Muscle energy technique stood upright and distance from the inferomedial aspect of 4th
Group with 32 in each group. rib to the coracoids process of scapula was measured in
centimetres, this distance was measured by participants in
 MATERIALS USED: height in centimeters, 3 trails were performed and averaged
Inch Tape. for analysis. This measurement has been shown to have high
intra-rater reliability over a 7 day period. PMI was used to
A. Inclusion Criteria: measure Pectoralis minor muscle length at baseline and at the
Subjects with unilateral Secondary Shoulder end of 6 weeks.
impingement syndrome diagnosed by orthopaedician and Pectoralis Minor Index =Pm Length (Cm)/Subject Height
referred to physiotherapy OPD 8. (Cm) X100
1. Both male and female subjects between the age of 18 and
35 years. D. Intervention
2. Pain of more than one month localized [anterior and or
anterolateral] to the acromion  PROCEDURE FOR PML MEASUREMEN13:
3. Pain at rest, aggravating at overhead activity or on lying Participants were positioned in supine; A pillow placed
on the affected shoulder under their head, without impacting upon the shoulder
4. Pain with palpation of rotator cuff tendon. position. Both arms relaxed by their sides, elbows were
5. Patients who show positive Neer impingement sign, extended with the palm of the hand against their thighs. The
Hawkins-Kennedy test, Painful arc syndrome, Empty medial border of the anterior aspect of the coracoid process
can test. was palpated and then the fourth rib. The measurement was
taken with a tape measure between these points. The tape
B. Exclusion Criteria: measure was removed before two further measurements were
Documented US and/or MRI evidence of Stage III then repeated and the average was taken
Impingement andclinical inability to lift the arm (drop arm
sign) 9.  GROUP A MYOFASCIAL RELEASE TECHNIQUE14:
1. Primary Shoulder Impingement Syndrome Subject’s position was supine lying with shoulder flexed
2. Recent history of Trauma, Contusion, fall, or Sudden to 90 to 120 degrees. The investigator was standing by the
Jarring. Dislocation of the Glenohumeral joints on the side of the patient at the angle of 45 degree from midline of
affected side. the patient, investigator’s thumbs slide underneath the
3. Clinical findings of Shoulder Injury, Adhesive pectoralis minor and the hands grasped the muscle firmly
Capsulities, between the thumbs and fingers, is gently lifted or bent away
4. Excluded if they had Ligament laxity based on Positive from the thorax. With one hand maintaining the same position
Sulcus Test, had Apprehension during Apprehension as described above, the thumbs moved posteriorly until in
Test. contactwith the pectoralis minor. The muscle is difficult to
5. Known or suspected Polyarthritis, Rheumatoid Arthritis palpate, but if the ribs are palpable, the muscle is being
or diagnosed of fibromyalgia. palpated. The thumbs pressed onto the pectoralis minor, and
a gentle “cross-friction type” technique performed.
C. Outcome Measures
 GROUP B MUSCLE ENERGY TECHNIQUE15:
 VISUAL ANALOGUE SCALE (VAS) 10: The subject is in a side-lying position for application of
is a numerical scale which measures the pain of the the method for shoulder flexion, abduction and the supine
individual. It is a 10 cm line with one end marked as position for shoulder internal and external rotation. The
Zero indicates no pain and other end with Ten indicates

IJISRT21NOV350 www.ijisrt.com 776

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
therapist stands by the side of the subject. The therapist 10 seconds the subject is instructed to cease the effort
performs the movement when the first physiological barrier simultaneously with the therapist gradually.
is reached, the subject is asked to oppose the movement
utilizing no more than 20% ofavailable strength, building After complete relaxation, the shoulder is moved to the
up force slowly. This effort is firmly resisted, and after 7- next restriction barrier

Fig: 1 Pectoralis Minor Muscle Length

Fig: 2 Therapist Performing Myofascial Release

Fig: 3 Therapist Performing Muscle Energy Technique

IJISRT21NOV350 www.ijisrt.com 778

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig: 4 Subject Performing Seated Rows

Fig: 5 Therapist Performing Lateral Pull Downs

Fig: 6 Scapular Protraction and Retraction Exercises

Fig: 7 Subject performing, Depression Elevation, Internal and External Rotation

IJISRT21NOV350 www.ijisrt.com 778

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
ENROLLMENT

Assessed for eligibility (n=100) Excluded (n=36)

Not meeting inclusion
criteria (n=30)
Refused to participate
(n=6)
Randomized (n=64)
RANDOMIZATION

Randomization (n=32) for each group

Refused to
participate (n=4)
ALLOCATION

ALLOCATION
GROUP - A
Allocated intervention (n=32) GROUP- B
Allocated intervention (n=32)
Myofascial Release +
Muscle Energy Technique +
Conventional Physiotherapy
Outcome measures: VAS, SPADI, PMIConventional Physiotherapy
BASELINE OUTCOMES
& INTERVENTION

R
Discontinued Intervention (n=2)

Due to COVID
Discontinued Intervention (n=2)

Due to COVID.
OUTCOMES &DROP

6 weeks

Analyzed for Pain, Function, PML

OUTS

6 weeks

Analyzed for Pain, Function, PML

POST TEST ANALYSIS
DROP OUT & OUTCOME

Analyzed (n=30) Analyzed (n=30)

Outcome measures: VAS, SPADI, PMI

Fig: 8 FLOW CHART

IJISRT21NOV350 www.ijisrt.com 779

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 CONVENTIONAL PHYSIOTHERAPY: STRENGTHENING:
The strengthening program was standardized in terms of the exercise, but the number of repetitions and order of exercises was
varied on a case-by- case basis across 18 sessions over 6 weeks16.

Group Outcome Pre Post p-value

(Mean ± SD) (Mean ± SD)
VAS 7.76 ± 0.817 5.1±0.758 0.0004
GROUP A SPADI 70.97 ± 6.767 59.08±5.272 0.000
PMI 10.77±1.978 10.98±2.019 0.0001
VAS 7.8±0.805 59.08±5.272 0.000
GROUP B SPADI 72.97±6.767 69.65±5.655 0.002
PMI 11.02±0.483 11.96±0.550 0.0002
Table 1

 Scapular stabilizers with lateral pull-downs following the intervention.

 Rowing
 Shoulder shrugs and scapular protraction/retraction A total of 100 subjects were screened for eligibility,
exercises in the supine position Amongst 64 subjects were included in the study trail. All the
 Rotator cuff muscles with resistance bands during 64 subjects who met inclusion criteria have undergone
internal and external rotations, the coordination of baseline assessment and included.Subjects were randomized
muscles with compound movements. into two equal groups consisting 32 subjects each. In this
study 30participants completed training in Group A and 30
III. RESULTS participants completed training in Group B with dropouts of
2 in each group.
The results of the study were analysed in terms of
Reduction of Pain on Visual Analogue Scale and decrease in Comparison is done within the group as well as in
Shoulder Disability on SPADI, Increase in Pectoralis Minor between the two groups. So as to evaluate the intra group and
length on PMI. inter group effectiveness of Myofascial Release and Muscle
Energy Technique on Pectoralis Minor Length which are
The consort flow chart of the study organization in under considerations in the Present study.
terms of Subjects screening, Random allocation and analysis
A. Analysis Within the Group

Outcome Group A Group B (Mean ± SD) p-value

(Mean ± SD)
VAS 6.2±0.924 5.1±0.758 0.0005
SPADI 69.65±5.655 59.08±5.292 0.0004
PMI 10.98±2.019 11.96±0.550 0.0003
Table 2

B. Statistical Analysis Pectoralis Minor length.

All statistical analysis was done by using SPSS software For all statistical analysis, P< 0.05 was considered as
version 21.0 and Microsoft excel-2007. Descriptive data was statistically significant
presented in the form of mean ± standard deviation and mean
difference Percentages were Calculated and Presented. IV. DISCUSSION

 Within the groups: The aim of the study was to evaluate the
Paired Student “t” test was performed to assess the Effectiveness of Myofascial Release (Group-A) andMuscle
statistical difference within the groups for Pain, Shoulder energy Technique (Group-B) on Pectoralis Minor length in
Function, and PMI from Pre-test and Post-test values. subjects with Shoulder Impingement Syndrome. In this study
subjects were assessed for Pain, using VAS, and for function,
 Between the groups: SPADI and PMI for Pectoralis Minor length.
Independent student “t” test was performed to assess the
statistically significant difference in mean value between the In this study (Group-A) Myofascial Release group
groups Visual Analogue Scale for Pain, Shoulder Pain showed statistically significant difference within the groups
Disability Index for Function and Pectoralis Minor index for from pre-test to post-test values on increasing the length of

IJISRT21NOV350 www.ijisrt.com 780

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Pectoralis Minor muscle, reducing Pain, Improving function in MET is as a result of painful inhibition, through both the
in subjects with shoulder impingement. ascending and descending neurological passageway, after the
activation of muscle and joint mechano-receptors over the
In this study (Group-B) Muscle Energy Technique course of the isometric contractions21.
group showed statistically significant difference within the
groups from pre-test to post-test values on increasing the A shortened Pectoralis Minor restricts flexion of the
length of Pectoralis Minor muscle, reducing Pain, Improving shoulder joint by limiting scapular rotationand preventing
function in subjects with Shoulder Impingement. glenoid cavity from attaining the cranial orientation
necessary for complete flexion of the joint. When by
In MFR, the gentle forces applied to the facial applying the Myofascial Release and Muscle-Energy
restrictions will elicit vasomotor response and increase blood Technique individually on Pectoralis minor muscle MET
flow to the affected area, thereby enhancing lymphatic have shown highly significant improvement in length with
drainage of toxic metabolic wastes. It also realigns the facial P value (P<0.05) Our results are supported by22,23. Kluemper
planes, and most importantly resets the soft tissue et al that MET assist in lengthening the pectoralis minor,
proprioceptive sensory mechanism. This latter factor but this increased resting length was sustained for at least
reprograms the centralnervous system, enabling a normal 48 hours after the final application. Muscle length change
functional range of motion without eliciting the old pain greater than 1 cm is needed to identify a real change in
pattern. ”Paul J et al”, explained that MFR improves the pectoralis minor length at baseline and at the 6th week24. The
vertical alignment and lengthens the body providing more change in resting PML index showed a clinical significance
space for proper functioning of osseous structures, nerves, in group B. Thus, MET should be considered when increased
muscles, blood vessels and organs which improves the muscle length is desired for an extended period of time.
function17,18. Furthermore, because tightness of the pectoralis minor has
been associated with the development of shoulder pain, this
“Barnes MF” claimed that as a result of MFR, there is technique may assist in decreasing the prevalence of shoulder
change in the viscosity of the ground substance of the muscle pain among subjects with overhead activities. However,
and fascia which can restore proper alignment of the muscle further research is necessary to confirm this hypothesis25.
fiber and increase the joint mobility. He explained that MFR
made the fascia elongated, softened and more pliable thereby, Sturyf et al reported that a 6-week program involving
helping to restore the normal length of the fascia. Thus, it can Scapular focused strengthening of the Rotator cuff muscles
be helpful to increase the flexibility and joint ROM. The will improve scapular dynamics. Due to the association
resultant muscle relaxation may encourage a copious return between scapular orientation and shoulder pain, the MET
of blood and oxygen, which dramatically elevates pain technique we used may also assist in decreasing the risk of
threshold and encourage healthy, compliant tissue. This shoulder injury26. Die drichsen et al suggested that
promotes healing, reduces pain and pressure in the fibrous Strengthening Exercises should be a part of conventional
band of connective tissue or fascia by breaking up the physiotherapy for SIS and are efficient in improving the
adhesions19. muscular imbalance, correcting scapular alignment in
subjects with shoulder impingement27,28. Insufficient scapular
According to "Kidd," MFR is inherently not evidence- positioning can lead to decreased glenohumeral rotation
based medicine. Kidd argued that because the application of strength, altered neuromuscular-activation patterns, an
MFR relies on clinician-patient interaction, it cannot be a increased risk of developing subacromial and internal
neutral treatment; therefore, the subjectivity of the interaction impingement syndrome. Such that Strengthening of
cannot be removed when we try to determine its outcome22. weakened muscles leads to biomechanical movement and
Our results are supported by Kidd indicated that much of the obtaining appropriate direction of abnormal parts. Stretching
effect of MFR relies on the skill of the clinician and his or her the shortened muscle mutually with strengthening the
ability to sense the changes in the tissue. In addition, weaken muscles has considerable influence on improving the
biological effects of touch can change the effectiveness of the abnormal scapular kinematic29,30.
treatment, depending on the state of either the clinician or the
patient20. The study shows that Shortening of Pectoralis Minor
length is one of the potential contributer for abnormal
According to "Greenman" Muscle energy technique is scapulohumeral dynamics in shoulder impingement
an active method of voluntary contraction of muscle against syndrome. In the present study, both MFR and MET are
the counterforce of the movement. Mechanism of the MET’s individually proven to be effective in pre-test to post-test
on pain reduction and activity improvement are clearly comparison on increasing Pectoralis Minor length, reducing
unknown, but various hypothesis suggests that muscle and pain and improving function in subjects with Shoulder
joint mechanoreceptors which involve centrally mediated impingement syndrome. But in between the group
pathways including periaqueductal gray matter in midbrain comparison MET with conventional physiotherapy have
and noradrenergic plays a major role in descending inhibitory proven to be highly significant in improving pain and
pathways. MET increases range of motion since the muscle function, increasing the length of Pectoralis Minor.
extensibility is increased in around shoulder pain and there is
a reflex relaxation and viscoelastic changes which could
cause change in the stretch tolerance. The reduction in pain

IJISRT21NOV350 www.ijisrt.com 781

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
This study proved that MET along with Conventional management." Physical Therapy in Sport 17 (2016): 1-
Physiotherapy were effective in increasing the Pectoralis. 13.
Minor length, reducing pain and in improving the function in [11]. Gurudut, Peeyoosha, Aarti Welling, and Gayatri
subjects with shoulder impingement syndrome than MFR Kudchadkar. "Combined Effect of Gross and Focused
along with Conventional physiotherapy Myofascial Release Technique on Trigger Points and
Mobility in Subjects with Frozen Shoulder-A Pilot
Hence, we can conclude that subjects with Shoulder Study.
Impingement Syndrome can achievesignificant results using [12]. Başkurt, Zeliha, et al. "The effectiveness of scapular
MET along with Conventional physiotherapy. stabilization exercise in the patients with subacromial
impingement syndrome." Journal of back and
V. CONCLUSION musculoskeletal rehabilitation 24.3 (2011): 173-179.
[13]. Kaur, Paramdeep, and G. Jayaraman. "To Compare the
The present study concluded that six weeks of Effectiveness of Myofascial Release (MFR) with
Interventions of Myofascial Release along with Conventional Strengthening and Stretching with Strengthening to
Physiotherapy and Muscle Energy Technique along with Improve the Rounded Shoulder Posture." Indian
Conventional Physiotherapy were shown statistically Journal of Physiotherapy & Occupational Therapy 13.2
significant difference in increasing muscle length reducing (2019).
Pain and improving Function. However more percentage of [14]. Bohunicky, Sarah. "Myofascial release of the pectoral
improvement was found in subjects received Muscle Energy fascia: Effect on shoulder posture, pectoral length,
Technique along with Conventional Physiotherapy when muscle activity, and movement performance." (2021).
compared to Myofascial Release along with Conventional [15]. Borstad JD.Measurement of pectoralis minor muscle
Physiotherapy. length: validation and clinical application journal of
orthopaedic and sports physical therapy.2008
From the findings of the current study, it is Apr;38(4):169-74.
recommended the Muscle Energy Technique along with [16]. Erika jaci Richards, Relationship between pectoralis
Conventional Physiotherapy protocol may be opted as a minor length, subacromial space, and pain in swimmers
treatment of choice for increasing muscle length, reduction of and overhead athlets. Department of exercise science,
Pain and improvement in function. Brigham young university.2017
[17]. Morais and Cruz, The pectoralis minor muscle and
REFERENCES shoulder movement related impairment and pain:
Rationale, Assesment and management.oct 2015.
[1]. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. [18]. Alex Urfer Physical therapy management of an elite
Impingement syndrome of the shoulder. Deutsches rock climbers with subacromial impingement
Ärzteblatt International. 2017 Nov;114(45):765. syndrome. Idaho state university, Department of
[2]. Singh B, Bakti N, Gulihar A. Current concepts in the physical and occupational therapy.29- Apr -2018.
diagnosis and treatment of shoulder impingement. [19]. Dayana P.Rosa, john D. Borstad & Paula R. Camargo,
Indian journal of orthopaedics. 2017 Oct;51(5):516-23. UNIMEP, Brazil. Reliability of measuring pectoralis
[3]. Singh S, Gill S, Mohammad F, Kumar S, Kumar D, minor muscle length in subjects with and without signs
Kumar S. Prevalence of shoulder disorders in tertiary of shoulder impingement, 2015 Oct 1.
care centre. Int J Res Med Sci. 2015 Mar;3(4):917-20. [20]. Green, Sally, Rachelle Buchbinder, and Sarah E.
[4]. Creech JA, Silver S. Shoulder impingement syndrome. Hetrick. "Physiotherapy interventions for shoulder
StatPearls [Internet]. 2020 May pain." Cochrane database of systematic reviews 2
[5]. Umer M, Qadir I, Azam M. Subacromial impingement (2003).
syndrome. Orthopedic reviews. 2012 May 9;4(2). [21]. Turgut, Elif, Irem Duzgun, and Gul Baltaci. "Effects of
[6]. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. scapular stabilization exercise training on scapular
Impingement syndrome of the shoulder. Deutsches kinematics, disability, and pain in subacromial
Ärzteblatt International. 2017 Nov;114(45):765. impingement: a randomized controlled trial." Archives
[7]. Creech JA, Silver S. Shoulder impingement syndrome. of physical medicine and rehabilitation 98.10 (2017):
StatPearls [Internet]. 2020 May 7. 1915-1923.
[8]. Morais N, Cruz J. The pectoralis minor muscle and [22]. Wang, Che-Hsiang, et al. "Stretching and strengthening
shoulder movement-related impairments and pain: exercises: their effect on three-dimensional scapular
Rationale, assessment and management. Physical kinematics." Archives of physical medicine and
Therapy in Sport. 2016 Jan 1;17:1-3. rehabilitation 80.8 (1999): 923-929.
[9]. Richards, Erika Jaci. Relationship between Pectoralis [23]. Van de Velde, Annemie, et al. "Scapular-muscle
Minor Length, Subacromial Space, and Pain in performance: two training programs in adolescent
Swimmers and Overhead Athletes. Brigham Young swimmers." Journal of athletic training 46.2 (2011):
University, 2017. 160-167.
[10]. Morais, Nuno, and Joana Cruz. "The pectoralis [24]. Morais and Cruz, The pectoralis minor muscle and
minor muscle and shoulder movement-related shoulder movement related impairment and pain:
impairments and pain: Rationale, assessment and Rationale, Assesment and management.oct 2015.

IJISRT21NOV350 www.ijisrt.com 782

Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
[25]. Alex Urfer Physical therapy management of an elite
rock climbers with subacromial impingement
syndrome. Idaho state university, Department of
physical and occupational therapy.29- Apr -2018.
[26]. Dayana P.Rosa, john D. Borstad & Paula R. Camargo,
UNIMEP, Brazil. Reliability of measuring pectoralis
minor muscle length in subjects with and without signs
of shoulder impingement, 2015 Oct 1.
[27]. Green, Sally, Rachelle Buchbinder, and Sarah E.
Hetrick. "Physiotherapy interventions for shoulder
pain." Cochrane database of systematic reviews 2
(2003).
[28]. Turgut, Elif, Irem Duzgun, and Gul Baltaci. "Effects of
scapular stabilization exercise training on scapular
kinematics, disability, and pain in subacromial
impingement: a randomized controlled trial." Archives
of physical medicine and rehabilitation 98.10 (2017):
1915-1923.
[29]. Wang, Che-Hsiang, et al. "Stretching and strengthening
exercises: their effect on three-dimensional scapular
kinematics." Archives of physical medicine and
rehabilitation 80.8 (1999): 923-929.
[30]. Van de Velde, Annemie, et al. "Scapular-muscle
performance: two training programs in adolescent
swimmers." Journal of athletic training 46.2 (2011):
160-167.

IJISRT21NOV350 www.ijisrt.com 783