The regions that need to be addressed are the contracted tissues that perpetuate the forward flexion of his upper thoracic spine and rib cage. This includes the coracobrachialis and pectoralis group. Stretching, wet heat and postural correction exercises are important. This patient was given specific stretches and postural exercises to retract his shoulders and bring extension and lift to his upper thoracic spine. He was instructed to bring in his guitar so his posture during playing the guitar can be evaluated. Suggestions were made to prevent forward flexion while playing his guitar. A different seat was suggested, and accommodation was made to the length of his guitar strap.

Spinal manipulative therapeutics were made to correct the fixations to his thoracic and cervical spine and rib cage. Corrections were made to his scapulae fixations and malpositions. 

The myofasciitis was treated with trigger point ultrasound to his upper trapezius and anterior shoulder where the pectoralis minor attaches. This is a combination of pulsed ultrasound and EMS. The EMS acts diagnostically to locate trigger points in the soft tissue, the pulsed ultrasound remains on the located trigger point for about 15 seconds to help dissolve the adhesions in the soft tissues.

Trigger point ultrasound cannot be performed over the vital organs so the coracobrachialis and pectoralis major needed to be treated with manual methods, not modalities. The manual method applied was post isometric relaxation to the coracobrachialis and pectoralis major. This technique stretches as well as releases trigger points in soft tissues. Also applied was Strain Counterstrain for the release of contracted soft tissues. This technique is great for chronic and acute conditions. This patient did well under care and is currently a maintenance patient.

Recommended courses for reference:

Soft Tissue Injury 103: Comprehensive Introduction to Soft tissue Injury and Treatment

Soft Tissue Injury 108: Thoracic Spine and Rib Cage: Biomechanics, Pathology and Soft Tissue Treatment

Soft Tissue Injury 112: Strain/Counterstrain: Theory, Technique and Treatment

Soft Tissue Injury 113: Therapeutic Stretching and Exercise Rehabilitation

Soft Tissue Injury 114: Deep Tissue and Muscle Fascial Release

Soft Tissue Injury 115: Active Myofascial Rehabilitation

Soft Tissue Injury 120: Modalities - Theories, Application and Treatment

Soft Tissue Injury 121: Posture; Normal Biomechanics, Pathology and Treatment for Scoliosis and Spinal Distortion Syndromes.