3 Strategies to Implement to Optimize Your Pec Stretch

Introduction:

The classic doorway stretch for the pecs can be seen in almost every physical therapy clinic across the country. Unfortunately, it's usually part of the randomly prescribed exercises to address a cluster of problems. Consider getting specific with these three strategies to take your pec stretch to the next level. 

• Respect Your Assessment
• Exhalation
• Inhalation

If you're a visual learner, click the video to watch the same concepts:

Respect Your Assessments: 

What does respecting your assessment genuinely mean?

Your assessments should guide your exercise programming and plan of care. Unfortunately, in most cases, the evaluation is performed, and the PT defaults back to their usual protocol for the condition they are treating. For example, if you have a patient dealing with shoulder pain, your default is a pre-determined set of exercises to improve "shoulder pain."

Conversely, when assessments are respected, they guide the perfect program and plan of care. Furthermore, the patients' specific limitations are the program's primary focus. 

Let's consider two examples relating to our pec stretch:

Example #1 - Not respecting the assessment:

You're assessing a patient with right shoulder pain. The shoulder flexion measures are as follows:

• Right Shoulder Flexion: 90°
• Left Shoulder Flexion: 160°

You decide that bilateral pec tightness is a contributor to their shoulder pain. So, you prescribe a bilateral doorway stretch to address their dysfunction. First, you coach the patient to place their left arm at approximately 130° of shoulder flexion and perform the stretch. Then, you repeated the same exercise at 130° of shoulder flexion on the right shoulder.

Do you see the problem? You've defaulted to your one-size-fits-all programming. 

Your assessment showed that the patient doesn't own their full shoulder flexion ROM. So, why place them in this vulnerable position? 

Example #2 - Respecting the Assessment:

Consider the same patient. This time, the left doorway stretch is at 130°, and the right is at 80°. You are now carrying through your assessment findings and working in your patient's range of motion. As a result, you'll be able to target the specific outcome you're looking for while minimizing the risk of pain.

Purposeful Breathing:

Breathing strategies while stretching is not a new concept, but putting intention behind it is. 

The usual process is the PT explaining to the patient to breathe while their stretching, and that's about it. But we can do better than this!

Before going into the specific strategies — let's first remember a couple of key concepts regarding respiration:

• Air moves from concentrations of high to low
• Air seeks the path of least resistance
• Exhalation increases compression
• Inhalation increases expansion

Purposeful Exhalation:

When your patient exhales correctly, the ribs compress down and in. If they don't exhale correctly, the rib cage doesn't move and remains stuck (part of their overall problem).

So, how can we strategically coach exhalation mechanics with a pec stretch?

Assume your patient has their left arm up to stretch their left pec. When they exhale correctly, we will coach them that they must feel their pec stretch increase. This happens only when the ribs move down, resulting in the pec origin moving further from the insertion. Additionally, to increase the stretch, we will coach them to turn towards the right (away from the pec that's being stretched). 

We are now maximizing their pec stretch through breathing and movement.

Purposeful Inhalation:

When your patient inhales correctly, they will expand the pump and bucket handle. If this doesn't occur, they'll resort to compensatory belly breathing.

So, how do we strategically couple our inhale with a good exhale?

Assume your patient is still stretching the left pec with their doorway stretch. They just finished an excellent exhale and turned into space while doing so. 

Now, we're going to coach them to inhale without returning to their previous position. If they perform this correctly, you'll observe the left anterior chest wall expand. This expansion will stretch their pec anterior-posteriorly and bias the pump handle expansion. Additionally, this space that's created from the inhale sets them up to then turn and move again on the exhale, thus a further stretch. When they follow this pattern, they'll be able to increase their stretch on every inhale and exhale.

Conclusion:

Understand that a pec stretch treats more of the symptoms than the underlying problem. However, if you can start to respect your assessment, get purposeful with your exhalation, and be intentional with your inhalation, you can produce beneficial outcomes with your pec stretch. 

As a result --> proper breathing + intention = optimized/successful pec stretch