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This case report describes an indirect approach incorporating diaphragmatic breathing, imagery, role rehearsal and surface electromyographic (SEMG) feedback to successfully reduce pain and increase left shoulder mobility in a 23 year old woman with a left pectoralis muscle injury from a skiing accident. It demonstrates how direct biofeedback or therapeutic interventions may be counterproductive and indirect approaches guided by SEMG activity may facilitate clinical success. It is offered as a model to increase therapeutic efficacy when an initial biofeedback intervention appears not to work.