[

RESEARCH REPORT

JOHN D. BORSTAD, PT, PhD1

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Measurement of Pectoralis
Minor Muscle Length:
Validation and Clinical Application
ne of the fundamental procedures performed by clinicians who
provide rehabilitation services is the assessment of alignment
or posture.17 This assessment involves determining the position
of bony segments relative to either a prescribed standard or to
other bony segments. If postural or alignment deviations are noted in a
patient, an attempt to correct them may be part of an intervention strategy.

Based on the results of the postural

assessment, clinicians make inferences
about underlying adaptations around a
joint. Changes in muscle lengths, joint
congruency, and soft tissue exibility may
occur as a result of prolonged postural
deviation. These adaptations may lead to

abnormal movement or force distribution about a joint which may manifest as

pain, decreased range of motion, or impairment of muscle performance or motor function. Testing and measurement of
these potential adaptations are therefore
also included in the patient examination

T STUDY DESIGN: Clinical measurement validity

T RESULTS: In cadavers, a measurement using

study.

palpable landmarks was determined to be a valid

measure of the actual muscle length visualized
and measured following dissection. There was a
high intraclass correlation coefficient and a small
root-mean-square error between these 2 measures. High intraclass correlation coefficients
were also calculated in vivo when measurements
with the clinical instruments were compared with
the electromagnetic device measures.

T OBJECTIVES: To validate the measurement of

the pectoralis minor muscle length using palpable
landmarks and to explore the accuracy of the
measurement using a clinical instrument.

T BACKGROUND: The pectoralis minor is

believed to adaptively shorten. Individuals with
a relatively short pectoralis minor demonstrate
scapular kinematic alterations that have been
associated with shoulder impingement.

T CONCLUSION: A measurement using palpable

T METHODS AND MEASURES: A 3-dimensional

electromagnetic motion capture system was used
to calculate the length of the pectoralis minor in
11 cadavers, using 2 measurement techniques. In
addition, a measurement with the electromagnetic
system using palpable landmarks was compared
to a measurement with both a caliper and tape
measure in vivo.

landmarks for pectoralis minor length validly

represents the muscle length in cadavers. A caliper
or tape measure may be used clinically with high
accuracy and may help clinicians determine the
need for and the effectiveness of interventions
for lengthening this muscle. J Orthop Sports
Phys Ther 2008;38(4):169-174. doi:10.2519/
jospt.2008.2723

T KEY WORDS: posture, scapula, shoulder

and are essential to determining the most

effective interventions.
One of the more common postural
deviations seen clinically is the forward
shoulder.7,10 During a coronal plane assessment, the lobe of the ear, the body
of the seventh cervical vertebra, and the
greater trochanter of a patient with ideal
posture should be colinear. A patient is
considered to have a forward shoulder
if the acromion process is located anterior to this line.9 Pectoralis minor adaptive shortening has been implicated as
a mechanism for forward shoulder posture9 and for shoulder impingement.8,13
Healthy subjects with a relatively short
pectoralis minor have demonstrated limitations in scapular posterior tipping and
external rotation during arm elevation,3
which may minimize the subacromial
space,4,19 impinge the soft tissues, and
contribute to shoulder injury.
Borstad and Ludewig3 briey described the methods used to determine
the validity of measuring pectoralis minor length in cadavers using an electromagnetic motion capture system and
subsequently used the measurement
in vivo with a group of subjects free of
shoulder pathology to examine the effect
of pectoralis minor length on scapular
kinematics. However, to the authors
knowledge, a valid and practical clinical
measure of the length of the pectoralis
minor has not been reported, creating

Assistant Professor, Physical Therapy Division, The Ohio State University, Columbus, OH. Funded in part by an American Society of Biomechanics Graduate Student Grant-InAid. The Ohio State University Institutional Review Boards for Human Subjects Research approved this study. Address correspondence to Dr John D. Borstad, Physical Therapy
Division, The Ohio State University, 453 West Tenth Avenue, Columbus, OH 43210-1234. E-mail: borstad.1@osu.edu

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[
difficulty in assessing pectoralis minor
length adaptations in patients with postural deviations or shoulder pathology.
The most common clinical method to
assess pectoralis minor length is to measure the distance from the posterolateral
angle of the scapula to the examination
table of a supine patient, with distances
greater than 2.54 cm (1 in) suggesting
pectoralis minor tightness.16 Measurements obtained with this method have
been shown to be poorly correlated with
a normalized measure of pectoralis minor length2 and to have poor diagnostic
accuracy,11 but have been demonstrated
to have excellent intrarater reliability.11
Measuring scapula resting position has
also been examined as an indirect indication of pectoralis minor length, but
poor to moderate reliability and validity have been reported.5,14,18 A direct and
practical measure of pectoralis minor
length will be valuable in identifying
those at risk for altered scapular motion and shoulder impingement. The
same measurement could also be used
to determine the effectiveness of treatment interventions aimed at correcting
shortened muscle length.
The purpose of this paper is to provide a complete description of the methods used to validate a pectoralis minor
length measurement using surface
palpation in cadavers,3 and to report
the results of a follow-up analysis on
the ability to measure pectoralis minor
length on human subjects using 2 clinical instruments.

METHODS
Instrumentation

or the in vitro validation using

cadavers, the Polhemus FASTRAK
electromagnetic motion capture
system (Polhemus, Inc, Colchester, VT)
was used to determine the position of 2
pectoralis minor landmarks relative to
each other. The clinical analysis used an
Ascension Technologies Flock of Birds
electromagnetic motion capture system
(Ascension Technology Corp, Burlington,

RESEARCH REPORT
VT), with MiniBIRD sensors to measure
the resting length of the pectoralis minor
muscle in healthy individuals. Both systems include a high-frequency magnetic
source transmitter, 3 receivers with embedded orthogonal axis systems, and a
fourth receiver located in a stylus for digitizing anatomical landmarks. An electric
signal output of 3-dimensional position
and orientation from each receiver is
generated by the magnetic pulses of the
transmitter. The reported root-meansquare (RMS) accuracy of the FASTRAK
system is 0.3 to 0.8 mm for position and
0.15 for orientation within a 76-cm
source-to-receiver distance, while the
Flock of Birds system has RMS accuracy
of 1.8 mm and 0.5. For the clinical analysis, a 30-cm metric Vernier caliper with
0.05-mm resolution (Westward Tools,
Edmonton, AB, Canada) and a standard
cloth tape measure with 1-mm resolution
were also used to measure the resting
length of the muscle.

Subjects and Procedures

Cadaver Analysis For the validation por-

tion of the study, 11 fresh cadavers with a

thoracic kyphosis angle of less than 30
between T1 and T126 were stabilized in
a sitting position using a custom-built
wooden frame and cloth transfer belts.
Once stabilized, surgical bone pins were
inserted into the thorax, humerus, and
scapula of the cadaver. A receiver was
then secured to each bone pin using a
manufactured jig and the transmitter was
mounted on the wooden frame at acromion level behind the cadaver. To capture
a resting position le, anatomical landmarks on each segment were palpated
and digitized with the stylus to create
anatomically based orthogonal axis systems on each segment.20 In addition to
the segment landmarks, 2 anatomical
landmarks representing the length of the
pectoralis minor were digitized. These 2
points were the medial-inferior angle of
the coracoid process and just lateral to
the sternocostal junction of the inferior
aspect of the fourth rib.
As the palpation and digitization of

FIGURE 1. Representation of pectoralis minor

and approximate landmarks used for in vivo
measurement.

the landmarks are critical to these measurements, they will be described in detail
here. Both of the landmarks were selected
based on pilot work with 2 fresh frozen
cadavers prior to the validation procedures. This pilot work conrmed that
the origin and insertion of the pectoralis
minor were on the proposed landmarks
and that the fourth rib landmark approximately bisected the distal attachment on
ribs 3, 4, and 5, thereby representing the
central line of the muscle with one vector.
The fourth rib landmark was dened as
the anterior-inferior edge of the rib 1 nger width lateral to the sternum (FIGURE
1). The junction between the bone and
cartilage, located approximately 3 nger
widths from the sternum, was a more easily palpable landmark, but the more medial site was chosen to avoid breast tissue
during in vivo measurements. The investigator located the landmark by initially
nding the inferior-medial aspect of the
rst rib at the sternum distal to the medial clavicle, and then counting down to
the fourth rib. The coracoid process landmark was dened as its medial-inferior
aspect and was located by palpating below the lateral concavity of the clavicle in
the deltopectoral groove (FIGURE 1).
Data were then collected with the arm
of the cadaver resting at its side. Following this data collection, the coracoid
process and the fourth rib were exposed
by a minimal incision through the skin
and subcutaneous tissue to allow visualization of the pectoralis minor origin

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and insertion.3 The previously described

digitization procedure was then repeated,
substituting the muscles actual origin
and insertion for the 2 skin-covered anatomical landmarks.
Human Subject Analysis The dominant
side pectoralis minor length of 26 subjects (11 male, 15 female) without a history of shoulder pathology was measured.
MiniBIRD receivers were taped to the
skin over the sternum and the acromion
process of each subject as they stood with
the transmitter behind them at acromion height. Segmental axis systems were
established using the same digitization
procedure as described above, and the
2 pectoralis minor landmarks were also
digitized. Two separate resting position
les were then collected approximately 1
minute apart. Data were collected for 1
second and subjects were told to stand
in your normal, relaxed posture during
data collection. Following this sequence,
the caliper arms were placed at the landmarks to capture the distance between
them (FIGURE 2), but the result was not recorded so that the rater remained blind.
A measurement using the cloth tape measure was then taken and recorded (FIGURE
3). The investigator recorded the caliper
measurement next, and then processed
the 2 resting position muscle length les
taken with the Flock of Birds motion
capture system. Using this sequence, the
investigator was blind to the 2 Flock of
Birds muscle length values during the
caliper measurement, and to all muscle
length values when using the tape measure. Prior to data collection, the study
was approved by The Ohio State University Institutional Review Boards for
Human Subjects Research. All subjects
provided informed consent to participate
in the study and the rights of human subjects were protected.

Data Reduction and Processing

To determine the in vitro pectoralis minor
muscle length, orthogonal anatomically
based axis systems for the 3 segments
were calculated, and the locations of the
2 digitized anatomical landmarks were

FIGURE 2. Measurement of pectoralis minor muscle

length taken with vernier caliper.

calculated relative to these anatomical

reference frames using a custom-written
software program for the FASTRAK system. The location of the coracoid process
landmark was calculated relative to the
reference frame of the scapula receiver, while the location of the fourth rib
landmark was calculated relative to the
trunk receiver. The 3-dimensional distances from each digitized landmark to
its receiver, which remain in a constant
location, were then calculated. With the
landmark-to-receiver distance known,
and the position and orientation of both
receivers in the transmitter reference
frame known, the 3-dimensional vector
lengths between the 2 digitized points
were then calculated using Excel (Microsoft Corporation, Redmond, WA). This
data processing sequence was repeated
with both the palpation measurement
and the measurement made using direct
visualization of the muscle insertions
using identical cadaver position data.
Using this method, only differences in
the location of the digitized landmarks
could produce differences in the muscle
length measurements between the 2
conditions.
The in vivo pectoralis minor length
was determined by calculating directly
the length between the coracoid process
and fourth rib landmarks relative to a
global reference system based on the
system transmitter using Motion Monitor software (Innovative Sports Technologies, Chicago, IL). This resulted in
2 electromagnetic measurements, both
determined following the same digiti-

FIGURE 3. Measurement of pectoralis minor muscle

length taken with tape measure.

zation procedure. Differences in these

2 measurements could therefore result
from slight changes in posture between
data collection times or from respiration, both of which could alter the actual
muscle length.

Analysis
The in vitro data were analyzed with 4
different methods: intraclass correlation coefficient (ICC), RMS error, linear
regression, and a paired t test with signicance set at P.05. The ICC3,1 was
calculated using mean-square values extracted from a mixed-model analysis of
variance (ANOVA), with subject as the
between-subject factor and trial as the
within-subject factor.
Four separate ICCs were calculated for
the in vivo data, each based on a mixedmodel ANOVA, with subject as the between-subject factor and instrument type
as the within-subject factor. Correlations
were determined between both Flock of
Birds resting le measures and the measurements with caliper and the tape measure. The ICC3,1 was used with the intent
to provide an estimate of the ability of a
single rater to consistently and accurately
measure the variable of interest.

RESULTS

escriptive statistics for the in

vitro pectoralis minor lengths are
given in TABLE 1. The paired t test
comparing the 11 surface measurements
to the direct visualization measurements
of the 11 cadavers did not demonstrate

journal of orthopaedic & sports physical therapy | volume 38 | number 4 | april 2008 | 171

In Vitro Pectoralis Minor Vector

Length Measurements

TABLE 1
Cadaver

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RESEARCH REPORT

Surface Measure (cm)

Dissected Measure (cm)

14.3

14.0

12.2

11.1

12.5

12.6

8.9

9.8

12.8

12.8

11.0

10.2

12.6

13.1

12.5

13.0

14.7

15.9

10

11.8

12.2

11

13.0

13.4

Mean (SE)

12.4 (0.5)

12.6 (0.5)

Repeated-Measures ANOVA and ICC

Results for In Vitro Pectoralis Minor
Vector Resting Length Measurements

TABLE 2

Factor

df

Mean Square

Subject

10

5.20034

Trial

0.14209

Error

10

0.22819

Total

21

f Ratio

Probability Level

ICC

0.62

0.45

0.96

Abbreviations: ANOVA, analysis of variance; df, degrees of freedom; ICC, intraclass correlation
coefficient.

statistical difference (t = 0.79; P = .45).

The ANOVA output and ICC calculation
are given in TABLE 2. RMS error was calculated at 0.66 cm, while the linear regression analysis resulted in a slope of 1.02
and an r2 value of 0.85.
The mean in vivo pectoralis minor
length measurements are provided in
TABLE 3, and the ICCs are given in TABLE
4. The in vivo ICC results range from
0.82 to 0.87, indicating very good agreement between the measurements made
with the Flock of Birds and the 2 clinical
instruments.

DISCUSSION

his in vitro analysis demonstrated that a pectoralis minor length

measurement using palpable origin
and insertion estimates is a valid representation of a measurement made with

direct visualization of the actual muscle

in fresh cadavers. ICC values above 0.90
are considered to indicate reasonable
validity and support the generalizability
theory, recognizing that measurement
differences result from a variety of factors, not only the true variance and error.15 In this analysis, the palpation skills
of the examiner, a change in position of
the cadaver, and the amount of subcutaneous tissue over the landmarks are all
possible sources of error. The ICC value
of 0.96 establishes the criterion validity
of the palpation skill and consistency of
the investigator and indicates that the
electromagnetic system can be used to
measure the resting length of the pectoralis minor muscle in vivo. In support of
the ICC, the regression analysis, RMS error, and paired t test all indicate strong
consistency between the landmark palpation measurement and the direct visu-

]
alization measurement using cadavers.
Based on this outcome, researchers may
condently use an electromagnetic motion capture system to measure pectoralis
minor length in vivo.
The results from the in vivo analysis
indicate that clinicians may also accurately measure pectoralis minor length using
less-expensive instruments. The calculated ICCs comparing these clinical measurements to the electromagnetic system
measurements indicate good concurrent
validity for measuring the distance between the anatomical landmarks selected to represent pectoralis minor muscle
length for this analysis. This nding may
be useful because stretching of the pectoralis minor has been used as an intervention for individuals with shoulder pain in
several studies.1,12,21 Bang and Deyle1 analyzed an exercise group and an exercise
plus manual therapy group to compare
the effect of these intervention programs
on shoulder pain. Specic manual therapy techniques, including pectoralis minor
stretching and soft tissue mobilization,
were given when indicated, based on the
examination of each patient. Wang et al21
tested the 3-dimensional kinematics of a
group of individuals with forward shoulder posture before and after a 6-week
home exercise program. The exercise program included a self-stretch for the pectoralis minor as 1 of 6 exercises. Ludewig
and Borstad12 compared symptoms and
function between a group with shoulder
impingement and a nonpainful group of
construction workers before and after an
8-week home exercise program. A pectoralis minor stretch was included as 1 of
5 exercises. The validity of using surface
landmarks and readily available clinical
instruments to measure the pectoralis
minor length established in the present
analysis creates the opportunity to examine muscle length change as a potential
mechanism for the effectiveness of an intervention at the shoulder.
Both of these clinical measurements
should be normalized to patient height to
determine the relative length of pectoralis minor. A pectoralis minor length index

172 | april 2008 | volume 38 | number 4 | journal of orthopaedic & sports physical therapy

Mean (SE) Pectoralis Minor

Length (cm) In Vivo

TABLE 3
Flock of Birds 1

Flock of Birds 2

Caliper

Tape Measure

Male (n = 11)

15.6 (0.3)

15.5 (0.3)

16.4 (0.3)

16.8 (0.3)

Female (n = 15)

14.6 (0.4)

14.7 (0.4)

15.0 (0.4)

15.5 (0.3)

All (n = 26)

15.0 (0.3)

15.1 (0.3)

15.6 (0.3)

16.1 (0.3)

TABLE 4

ICC Results for In Vivo Pectoralis

Minor Measurements

Instrument/Comparison Instrument

ICC3,1

cal use. Measurement of other muscle

lengths in vivo may also be possible using an electromagnetic system. Clinically, either a caliper or a tape measure
may be used to measure pectoralis minor
muscle length using the coracoid process
and fourth rib near the sternum as landmarks. The generalizability of these ndings should be examined in controlled
studies before widespread use of these
instruments to measure pectoralis minor
length is adopted for research and clinical
applications. T

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Vernier Caliper
Flock of Birds 1

0.87

Flock of Birds 2

0.83

Tape Measure
Flock of Birds 1

0.86

Flock of Birds 2

0.82

Abbreviation: ICC, intraclass correlation coefficient.

(PMI) has been previously reported and is

calculated by dividing the resting length
of the muscle in centimeters by subject
height in centimeters, and multiplying by
100.3 From a sample of 82 subjects using
this method, the mean PMI was calculated as 8.24, with a standard deviation of
0.80. Patients with a PMI lower than 7.44
(mean PMI 1 SD) could be considered to
have a relatively short pectoralis minor.
Two potential limitations of the in
vivo analysis are that only 1 rater took
the measurements, and subjects may
have altered their posture during the
measurements. Because only 1 rater took
the measurements, the generalizability
of the results to the population of therapists that may use these measurements
has not been established. An analysis using multiple raters is being considered
in an effort to determine the validity
and reliability of these measurements as
taken by other clinicians. The possibility that subjects changed their standing
posture during the measurements will be
more problematic when these measurements are made longitudinally to assess
change in pectoralis minor length due to
an intervention. For the current analysis,
changing posture would have resulted in
greater error and subsequently lower ICC

values, but the results appear to indicate

that this was not the case. Probably the
greatest source of error was soft tissue
contour when measuring with the tape
measure, and the ICC values appear to
support this likelihood.
Another important consideration regarding the validity of the clinical measurements is the ability to accurately
transfer palpation skills from cadavers to
live subjects. Under both conditions, the
landmarks representing pectoralis minor were considered easy to locate. The
amount of subcutaneous tissue over the
landmarks likely represented the largest
source of palpation error and this varied across both cadaver and live subject
samples. The perception that these landmarks are easily located under both in
vivo and in vitro conditions could also be
examined by analyzing the ability of other
raters to make these measurements.

CONCLUSION

he palpation and digitization

method using an electromagnetic
motion capture system is a valid
measurement of the pectoralis minor
muscle length. This nding has application to both in vivo research and clini-

KEY POINTS
FINDINGS: The resting length of the pec-

toralis minor can be validly measured

using palpable landmarks and can be
reliably measured with a caliper or cloth
tape measure.
IMPLICATION: The clinical measurement of
the pectoralis minor resting length may
assist in treatment planning and in assessing intervention effectiveness.
CAUTION: Because the measurements
were made by only 1 rater, the generalizability to other raters is limited.
ACKNOWLEDGEMENTS: The cadaveric data

from this analysis were collected and

analyzed as part of the authors dissertation at the University of Minnesota.
The author gratefully acknowledges the
contributions of Paula Ludewig, PT, PhD,
Associate Professor, Program in Physical
Therapy at the University of Minnesota,
who served as his academic advisor.

REFERENCES
1. Bang MD, Deyle GD. Comparison of supervised
exercise with and without manual physical
therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther.
2000;30:126-137.
2. Borstad JD. Resting position variables at the
shoulder: evidence to support a posture-impairment association. Phys Ther. 2006;86:549-557.
3. Borstad JD, Ludewig PM. The effect of long
versus short pectoralis minor resting length on
scapular kinematics in healthy individuals. J
Orthop Sports Phys Ther. 2005;35:227-238.
4. Flatow EL, Soslowsky LJ, Ticker JB, et al. Excur-

journal of orthopaedic & sports physical therapy | volume 38 | number 4 | april 2008 | 173

[
5.

6.

7.

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8.

9.

10.

sion of the rotator cuff under the acromion. Patterns of subacromial contact. Am J Sports Med.
1994;22:779-788.
Gibson MH, Goebel GV, Jordan TM, Kegerreis S, Worrell TW. A reliability study of
measurement techniques to determine static
scapular position. J Orthop Sports Phys Ther.
1995;21:100-106.
Greeneld B, Catlin PA, Coats PW, Green E,
McDonald JJ, North C. Posture in patients with
shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther. 1995;21:287-295.
Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis
CA. Incidence of common postural abnormalities
in the cervical, shoulder, and thoracic regions
and their association with pain in two age groups
of healthy subjects. Phys Ther. 1992;72:425-431.
Hebert LJ, Moffet H, McFadyen BJ, Dionne CE.
Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil. 2002;83:60-69.
Kendall FP, McCreary EK, Provance PG. Muscles:
Testing and Function. 4th ed. Baltimore, MD:
Williams & Wilkins; 1993.
Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med.
1998;26:325-337.

RESEARCH REPORT

11. Lewis JS, Valentine RE. The pectoralis minor

length test: a study of the intrarater reliability and diagnostic accuracy in subjects
with and without shoulder symptoms. BMC
Musculoskelet Disord. 2007;8:64. http://dx.doi.
org/10.1186/1471-2474-8-64
12. Ludewig PM, Borstad JD. Effects of a home
exercise programme on shoulder pain and
functional status in construction workers. Occup
Environ Med. 2003;60:841-849.
13. Ludewig PM, Cook TM. Alterations in shoulder
kinematics and associated muscle activity in
people with symptoms of shoulder impingement. Phys Ther. 2000;80:276-291.
14. Peterson DE, Blankenship KR, Robb JB, et al.
Investigation of the validity and reliability of four
objective techniques for measuring forward
shoulder posture. J Orthop Sports Phys Ther.
1997;25:34-42.
15. Portney LG, Watkins MP. Foundations of Clinical
Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000.
16. Sahrmann SA. Diagnosis and Treatment of
Movement Impairment Syndromes. St Louis,
MO: Mosby; 2002.
17. Sahrmann SA. Does postural assessment con-

174 | april 2008 | volume 38 | number 4 | journal of orthopaedic & sports physical therapy

18.

19.

20.

21.

tribute to patient care? J Orthop Sports Phys

Ther. 2002;32:376-379.
Sobush DC, Simoneau GG, Dietz KE, Levene JA,
Grossman RE, Smith WB. The lennie test for
measuring scapular position in healthy young
adult females: a reliability and validity study. J
Orthop Sports Phys Ther. 1996;23:39-50.
Solem-Bertoft E, Thuomas KA, Westerberg CE.
The inuence of scapular retraction and protraction on the width of the subacromial space. An
MRI study. Clin Orthop Relat Res. 1993;99-103.
Veeger HE, van der Helm FC, Chadwick EK, Magermans D. Toward standardized procedures for
recording and describing 3-D shoulder movements. Behav Res Methods Instrum Comput.
2003;35:440-446.
Wang CH, McClure P, Pratt NE, Nobilini R.
Stretching and strengthening exercises: their effect on three-dimensional scapular kinematics.
Arch Phys Med Rehabil. 1999;80:923-929.

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