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Bradley Blair Osteopath, Bradley Blair Osteopathy, Auckland (2026)

25/01/2026

Medial and Lateral Pectoral Nerves (C5–T1)

The medial and lateral pectoral nerves arise from the brachial plexus and provide motor innervation to the anterior chest wall musculature, principally the pectoralis major and pectoralis minor. Despite their names, their anatomical positions on the chest wall are counterintuitive, as the medial pectoral nerve typically lies lateral to the lateral pectoral nerve. Their nomenclature reflects their cord of origin within the brachial plexus rather than their surface anatomy.

The lateral pectoral nerve most commonly originates from the lateral cord of the brachial plexus and carries fibres from C5 to C7, with C5 contributing in approximately half of cases. Variations exist in which it may arise directly from the anterior divisions of the upper and middle trunks. After crossing anterior to the axillary vessels, it pierces the clavipectoral fascia and enters the deep surface of pectoralis major. Within the muscle, it divides into multiple branches, typically four to seven, supplying the clavicular and upper sternal portions of pectoralis major.

The medial pectoral nerve arises from the medial cord of the brachial plexus, carrying fibres predominantly from C8 and T1, although it may originate directly from the anterior division of the inferior trunk. It usually courses posterior to the axillary artery and travels between the axillary artery and vein. In the majority of individuals, the nerve pierces pectoralis minor before continuing to supply the lower and medial portions of pectoralis major. In the remaining cases, it passes around the lateral border of pectoralis minor rather than perforating it.

A key anatomical feature is the ansa pectoralis, a neural loop formed by a communicating branch between the medial and lateral pectoral nerves. Through this loop, fibres from the lateral pectoral nerve may contribute to innervation of pectoralis minor, reinforcing the concept that both nerves participate in coordinated control of the anterior chest wall rather than functioning in isolation.

Functionally, the lateral pectoral nerve primarily supplies the proximal and clavicular regions of pectoralis major, contributing to shoulder flexion, horizontal adduction, and internal rotation. The medial pectoral nerve supplies pectoralis minor and the sternal portion of pectoralis major, with an important role in movements such as shoulder extension from a flexed position and stabilisation of the scapula via pectoralis minor.

From a clinical perspective, these nerves are highly relevant in breast and axillary surgery. During procedures such as modified radical mastectomy or axillary lymph node dissection, injury to the medial pectoral nerve can lead to partial denervation and visible wasting of the lower portions of pectoralis major. Combined injury to both medial and lateral pectoral nerves may result in complete denervation of pectoralis major, producing marked atrophy and functional loss. Surgeons must therefore take care around the apex of the axilla, where the medial pectoral nerve and branches of the thoracoacromial vessels are particularly vulnerable.

Injury to the medial pectoral nerve may present as difficulty elevating or controlling the shoulder girdle, whereas lateral pectoral nerve injury often manifests as anterior chest wall asymmetry, weakness of shoulder adduction, and visible pectoralis major atrophy, sometimes accompanied by pain. These nerves are also targets for regional anaesthesia, with ultrasound-guided pectoral nerve blocks commonly used to reduce perioperative pain in breast and thoracic procedures.

A final point worth reinforcing is the naming convention: the medial and lateral pectoral nerves are named according to their origin from the medial and lateral cords of the brachial plexus, not their position on the chest wall. This distinction is a frequent source of confusion but is essential for accurate anatomical understanding and surgical safety.

25/01/2026

Gift vouchers: I used to do them years ago at a clinic in the UK, and I stopped because they brought me nothing but grief.

I’d set them for six months and people would try to book in ten months later. I’d shorten it to three months and people would still turn up long after it expired, acting like the expiry date was optional. I even had someone find one after two years and try the full emotional-blackmail routine, followed by the “I’ll put you on Facebook” threat. My answer was simple: do whatever you want. I’m not honouring something that expired ages ago because you’ve decided it suits you now.

Here’s the bigger issue: the people using vouchers are rarely people who were going to book in properly anyway. It’s usually a well-meaning relative buying it for someone who didn’t ask for it. Because it was “free” to them, it gets treated like it has no value, and it sits in a drawer until they remember it… conveniently after it’s expired.

So my honest advice is don’t do them. If you insist on offering vouchers, you need a very clear policy that you stick to every single time. Clear expiry. Clear terms. No extensions. No exceptions. Because the moment you bend once, you’ll be expected to bend forever.

24/01/2026

Tarsals – a set of seven irregularly shaped bones. They are situated proximally in the foot in the ankle area.

24/01/2026

When you’re a new grad, don’t fall into the trap of thinking you have to change who you are just to keep every patient comfortable. Yes, you can accommodate and modify where it makes sense, but if you’re going completely against what you’ve been trained to do just to manage someone’s anxiety or expectations, don’t do it. You’ll end up giving a watered-down treatment that you don’t believe in, the patient still won’t be happy, and you’ll walk away frustrated and doubting yourself. Making yourself unhappy to keep other people happy is a guaranteed way to burn out. Some people are simply not the right fit for your approach, and that’s fine. You’re allowed to say, respectfully, that you can’t help them and they’d be better off with someone else.

24/01/2026

Burners and Stingers Exercise

Hook your fingers above your collar bone, and gently rotate your neck to the same side, then extend your neck backwards. You should feel the stretch at the front of your neck under your fingers. This stretches the anterior scalene muscle.

A burner, also called a stinger, is a temporary nerve injury that usually happens when the neck and shoulder are forced suddenly in opposite directions, most commonly during contact sports. What actually gets irritated is either the upper part of the brachial plexus or the nerve roots coming from the neck, most often C5 and C6, which supply sensation and strength to the shoulder and upper arm.

People describe it as a sudden burning, sharp, or electric shock–type pain that shoots from the neck or shoulder down one arm. It can be accompanied by tingling, numbness, or a feeling of weakness in the arm. The key feature is that it is usually one-sided. Symptoms often settle within minutes, but in some cases they can last hours or days, and occasionally weakness can linger for longer.

It is considered a mild nerve injury, meaning the nerve has been stretched or compressed rather than torn. Because of that, most people recover fully. The issue is recurrence. Once someone has had a burner or stinger, they are more likely to get another one if the neck and shoulder are repeatedly exposed to the same loads and positions.

This is one exercise out of many that may be used for this condition. It may help some people and may not help others. This is general information only and not individual medical advice. If you are having any issues related to burners or stingers, or if symptoms persist or keep returning, please have it assessed in person by a licensed healthcare professional.

23/01/2026

This is a prone sacro-iliac articulation. Some people will recognise the set-up because it is often taught as a thrust technique, but I’m not thrusting here. I’m taking the joint to tension and articulating within that barrier. It’s a controlled, graded oscillation, not a high-velocity manoeuvre.

It tends to be more useful in people who are a bit “tight” through the hips and pelvis, because the tension builds more cleanly. It’s less useful if the hip is the main driver, or if lumbar extension is clearly not tolerated. In those cases, I either modify it or choose something else entirely. A pillow under the abdomen can help in patients who don’t love extension.

Before anyone starts with the “the SI joint doesn’t move” comment: it does move, just not a lot. Most research puts SI joint motion in the region of roughly 0.5 to 4 mm of translation and about 0.8 to 3 degrees of rotation, depending on how it’s measured and which direction you’re looking at. So no, it’s not some massive hinge joint, but it isn’t a welded brick either. Small movement is still movement, and in the right patient, small, specific input can be useful for symptoms and for getting things moving more comfortably.

As always, assessment comes first. I’m not randomly doing techniques for the sake of it, and this is not a one-size-fits-all approach for SI joint issues.

23/01/2026

Some of the questions I get asked are genuinely good. Some are… not.

A fair few of you already know the answer. You’re just outsourcing thinking to my comment section. If it’s something you could type into Google in 10 seconds, I’m probably not going to spend my time typing it out for you.

And yes, that may frustrate you. I’m fine with that.

I also want to be clear about something. Tone matters. If you ask a question in a rude, entitled way, don’t expect a warm reply. I’m not here to be spoken to like I’m your unpaid customer service department.

I know I can come across blunt. I’m aware. But I’d rather be direct than play nice while wasting time on questions that aren’t thought through.

So before you comment, take two seconds. Is it a genuine question? Is it something you could easily look up? Are you being respectful? If yes, ask away. If not, you might not get an answer.

23/01/2026

The axillary nerve arises from the posterior cord of the brachial plexus with contributions from C5 and C6. It runs posterior to the axillary artery, passes inferior to the glenohumeral joint capsule, and travels through the quadrangular space alongside the posterior humeral circumflex artery before dividing into anterior and posterior branches. This anatomical course explains why the nerve is particularly vulnerable during shoulder dislocation and fractures around the surgical neck of the humerus.

Motor innervation is provided to the deltoid and teres minor. The anterior division supplies the anterior and middle portions of the deltoid, while the posterior division supplies the posterior deltoid and teres minor. Sensory innervation is carried via the upper lateral cutaneous nerve of the arm, supplying the skin over the lower deltoid, commonly referred to as the regimental badge area. This sensory region is clinically useful when assessing suspected axillary nerve involvement.

Clinically, axillary nerve injury most often presents after anterior shoulder dislocation or proximal humeral trauma. Patients may report weakness with shoulder abduction and altered sensation over the lateral shoulder. External rotation weakness may also be present, although this can be less obvious due to contribution from infraspinatus. On examination, deltoid weakness or wasting and sensory change over the regimental badge area are key findings. Abduction may appear partially preserved due to supraspinatus contribution, which is why targeted testing of deltoid function is important.

Assessment tools such as the deltoid abduction lag test and abduction in internal rotation can help isolate deltoid function and reduce compensatory activity from surrounding muscles. When a significant injury is suspected, electrodiagnostic testing is used to confirm the diagnosis and monitor recovery, keeping in mind that denervation changes may not be evident in the first couple of weeks after injury.

22/01/2026

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Focal Vibration Therapy (FVT) is a type of therapy that involves the use of high-frequency vibrations to treat muscle and joint pain, stiffness, and other musculoskeletal conditions. This therapy is typically performed using a device that generates vibrations, which are then applied directly to the affected area of the body.

The theory behind FVT is that the vibrations stimulate sensory receptors in the muscles, tendons, and joints, which can help to reduce pain and improve flexibility and range of motion.

To get your discount use this code: BradleyBlair_TEND

22/01/2026

There is no “best” treatment for chronic low back pain, and that is not a failure of research. It is an accurate reflection of how complex and variable persistent back pain actually is. Chronic low back pain is not a single diagnosis with a single mechanism, so expecting one treatment to outperform all others does not align with what we see clinically or in the literature.

High-quality clinical guidelines consistently show that many different treatments can help some people, but no single intervention shows clear superiority across populations. Exercise, manual therapy, psychological approaches, acupuncture, education, and multidisciplinary rehabilitation all demonstrate modest benefits on average, with large variation between individuals. Because comparative advantages are small or absent, guidelines repeatedly emphasise selecting treatments with lower risk and lower cost, rather than chasing a mythical “gold standard”.

Research also shows that outcomes are strongly influenced by individual factors such as symptom history, pain sensitivity, sleep, mood, expectations, work demands, previous experiences with care, and how confident the patient feels moving again. This explains why one person may respond well to exercise-based care, another to manual therapy combined with reassurance, and another to a broader multidisciplinary approach. It also explains why the same treatment can help one patient and do very little for the next.

Systematic reviews and guideline panels now consistently recommend individualised, flexible management rather than rigid protocols. The goal is not to find the perfect technique, but to help the patient improve function, reduce flare-ups, and regain confidence in daily activities using approaches that fit their circumstances and preferences. Chronic low back pain management is therefore a process, not a prescription.

This is general information only and not medical advice. Anyone with ongoing or concerning back pain should be assessed by a licensed healthcare professional.

22/01/2026

Being on social media means you’re opting into feedback from people who love what you do and people who can’t stand it, and that’s the deal. I get told, “If you don’t like people asking questions, you shouldn’t be on social media,” but that’s not what’s happening. The issue isn’t questions; it’s the lazy ones, the ones they already know the answer to, and the ones that are just a vehicle for being rude. I know full well some of my posts wind people up, and I’m fine with that, because I’m not here to be universally liked. I’m here to put out a message that helps the people it’s meant to help, and I’m not going to waste energy trying to convince people who are committed to misunderstanding me. If someone follows you just to dislike you, call you names, and keep showing up anyway, that’s their issue to manage. So if you’re thinking about putting yourself out there, do it. Say what you need to say, focus on what you’re trying to achieve, and accept that noise will come with the reach. If you can handle that, keep going—because the same visibility that attracts nonsense is also what allows your work to reach the people who actually need it.

22/01/2026

Discs Don’t “Slip”

The phrase “slipped disc” is anatomically incorrect. Intervertebral discs are firmly bound to the vertebral bodies above and below via cartilaginous endplates and reinforced by the annulus fibrosus. They cannot move, slide, or slip out of position.

What actually occurs is a disc herniation. This describes a situation where disc material, usually the nucleus pulposus, displaces through a defect or tear in the annulus fibrosus. The disc remains in its normal anatomical location; only internal material migrates beyond its usual boundaries.

An intervertebral disc is composed of a central nucleus pulposus, a surrounding annulus fibrosus made of concentric collagen lamellae, and cartilaginous endplates that anchor the disc to the vertebral bodies. These structures develop together and are mechanically integrated, which is why the idea of a disc “slipping” between bones is not biologically plausible.

Disc herniation is a process influenced by age-related changes, mechanical loading, and biochemical factors within the disc. Over time, the annulus fibrosus can develop fissures. When internal pressure rises, nucleus material may protrude or extrude through these fissures. Symptoms arise not because the disc has moved out of place, but because displaced disc material can irritate or compress nearby neural structures and provoke an inflammatory response.

Pain associated with disc herniation is driven by two main mechanisms. One is mechanical compression of nerve roots or the spinal cord. The other is chemical irritation, as nucleus pulposus material is biologically active and can sensitise adjacent neural tissue even without significant compression.

In clinical practice, accurate terminology matters. Saying “slipped disc” reinforces the idea that something is out of place and needs to be put back, which is misleading and often increases fear. Terms such as disc herniation, herniated disc, pr*****ed disc, or herniated nucleus pulposus accurately describe the pathology and align with modern anatomical and clinical understanding.

Bradley Blair Osteopath

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Monday	9am - 8pm
Tuesday	9am - 8pm
Wednesday	9am - 8pm
Thursday	9am - 8pm
Friday	9am - 8pm
Saturday	10am - 1pm