Comparison of the Effectiveness of Different Myofascial Release Techniques for the Pectoralis Minor Muscle

Study Overview
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Brief Summary
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The aim of this study was to compare the effects of self-myofascial release, myofascial release with a physiotherapist and instrument assisted soft tissue mobilization (IASTM) techniques for the pectoralis minor muscle on pectoralis minor muscle length, rounded shoulder posture, glenohumeral joint total rotation range of motion (ROM) and skin temperature in asymptomatic individuals.

Detailed Description
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In the literature, the effects of myofascial release and instrument assisted soft tissue mobilization (IASTM) applications on individuals with pectoralis minor muscle are investigated, but the available evidence is insufficient. In a study conducted in asymptomatic individuals, self-myofascial release was found to be more effective than placebo application in increasing glenohumeral flexion joint range of motion (ROM), improving pectoralis minor length and advanced scapular posture. However, there was one study comparing the short-term effectiveness of the self-myofascial release method and IASTM methods on pectoralis minor length, glenohumeral total arch movement and skin temperature in individuals with short pectoralis minor, and the results of both applications were found to be similar. Despite these studies in the current literature, the amount of evidence examining the effectiveness of myofascial release technique performed under the guidance of a physiotherapist in individuals with short pectoralis minor is insufficient. However, the number of studies comparing the immediate and short-term effects of different myofascial release methods on the pectoralis minor muscle lengthening is few. Given the limited evidence available, different myofascial release methods may produce different short-term responses on the pectoralis minor muscle, with different results on muscle length, scapular position, glenohumeral total arch motion, and superficial skin temperature. Therefore, the aim of this study was to compare the effects of 3 different myofascial release techniques on pectoralis minor muscle length, rounded shoulder posture, glenohumeral joint total rotation ROM and skin temperature in asymptomatic individuals.

Official Title
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Comparison of the Effectiveness of Different Myofascial Release Techniques for the Pectoralis Minor Muscle

Conditions
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Pectoralis Minor Muscle Tension, Muscle Shortness, Mobility Limitation, Forward Scapular Posture, Rounded Shoulder Posture

Intervention / Treatment
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* Other: Self Myofascial Release
* Other: Myofascial Release
* Other: Instrument Assisted Soft Tissue Mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: between the ages of 18-35 Presence of pectoralis minor shortness Not having any upper extremity injury in the last 6 months Exclusion Criteria: Presence of upper extremity surgery in the last 12 months Presence of neurological disorder in the upper extremity Any sensory problems or open wounds around the shoulder

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Self Myofascial Release<br>Self Myofascial Release only | Other: Self Myofascial Release<br>* In the self-myofascial release technique, a tennis ball will be placed on the 4th rib on the shoulder side to be applied on the wall, and the participants will be asked to move the ball using their body along the pectoralis minor.<br>|
| Active Comparator: Myofascial Release<br>Myofascial Release with Physical Therapist Only | Other: Myofascial Release<br>* A slight caudal force will be applied by the physiotherapist until the pectoralis minor muscle meets the comfortable elastic limit of the soft tissue.<br>|
| Active Comparator: Instrument Assisted Soft Tissue Mobilization<br>Instrument Assisted Soft Tissue Mobilization Only | Other: Instrument Assisted Soft Tissue Mobilization<br>* Instrument-assisted soft tissue mobilization will be performed with the specified instruments for the pectoralis minor muscle.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pectoralis minor length | The length of the pectoralis minor muscle will be evaluated by the physiotherapist by calculating the pectoralis minor index (PMI), which is an objective evaluation method. In the calculation of PMI, the distance between the inferomedial of the coracoid process and the caudal edge of the 4th rib in the sternum will be evaluated with a tape measure to measure the length of the pectoralis minor muscle, and the values will be recorded in centimeters. Then, the measured pectoralis minor muscle length value will be calculated by dividing the participant's height in centimeters multiplied by 100. The reference value for PMI is 7.44%. | Baseline (first assessment) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pectoralis minor length | The length of the pectoralis minor muscle will be evaluated by the physiotherapist by calculating the pectoralis minor index (PMI), which is an objective evaluation method. In the calculation of PMI, the distance between the inferomedial of the coracoid process and the caudal edge of the 4th rib in the sternum will be evaluated with a tape measure to measure the length of the pectoralis minor muscle, and the values will be recorded in centimeters. Then, the measured pectoralis minor muscle length value will be calculated by dividing the participant's height in centimeters multiplied by 100. The reference value for PMI is 7.44%. | Immediately after the intervention (second assessment) | 
| rounded shoulder posture | The distance between the posterior border of the acromion and the table will be measured using a ruler while the patient is lying on her back, and the values will be recorded in cm | Baseline (first assessment) | 
| rounded shoulder posture | The distance between the posterior border of the acromion and the table will be measured using a ruler while the patient is lying on her back, and the values will be recorded in cm. | Immediately after the intervention (second assessment) | 
| glenohumeral joint total rotation ROM | The total value of the internal and external rotation angles of the glenohumeral joint will be measured with a digital inclinometer. After the inclinometer is placed on the patient's forearm, the glenohumeral joint total ROM will be recorded by passively externally and internally rotating the arms in the 90° flexion-90° abduction position. | Baseline (first assessment) | 
| glenohumeral joint total rotation ROM | The total value of the internal and external rotation angles of the glenohumeral joint will be measured with a digital inclinometer. After the inclinometer is placed on the patient's forearm, the glenohumeral joint total ROM will be recorded by passively externally and internally rotating the arms in the 90° flexion-90° abduction position. | Immediately after the intervention (second assessment) | 
| skin temperature | An infrared skin thermometer will be used to measure skin temperature. | Baseline (first assessment) | 
| skin temperature | An infrared skin thermometer will be used to measure skin temperature. | Immediately after the intervention (second assessment) | 
| number of trigger points | The presence of myofascial trigger points in the pectoralis minor muscle will be evaluated manually according to the Travel and Simons criteria. The total number will be recorded. | Baseline (first assessment) | 
| number of trigger points | The presence of myofascial trigger point (MTN) in the pectoralis minor muscle will be evaluated manually according to the Travel and Simons criteria. The total number will be recorded. | Immediately after the intervention (second assessment) | 
| pressure pain threshold | In order to evaluate the pain threshold of the pectoralis minor muscle, a pressure algometer (Baseline Push-Pull Force Gauge®, Fabrication Enterprises, Inc.) that can measure the pressure in pounds (Lb) and kilograms (kg), with a 1 cm diameter circular rubber disc attached to the piston at the end, will be used. Measurements will be recorded in kg/cm². | Baseline (first assessment) | 
| pressure pain threshold | In order to evaluate the pain threshold of the pectoralis minor muscle, a pressure algometer (Baseline Push-Pull Force Gauge®, Fabrication Enterprises, Inc.) that can measure the pressure in pounds (Lb) and kilograms (kg), with a 1 cm diameter circular rubber disc attached to the piston at the end, will be used. Measurements will be recorded in kg/cm². | Immediately after the intervention (second assessment) |