Thoracic spine – some ideas

  • The thoracic spine has a significant influence on the way the neck works, even in not very active people, and has a massive impact on upper extremity function.
  • The thoracic spine does not have such a significant influence on lumbo-pelvic function, except in very active people or in people whose lumbar spine is only just coping.
  • The thoracic spine has a particular set of ways in which it is influenced by, and influences, the health and vitality of the person.
  • The critical mechanical focus of the thoracic spine is a) how well does it rotate and b) how well does it extend?
  • Failure to rotate and extend will affect a particular direction of neck rotation and (less so) side-bending. E.g. if some thoracic segments do not rotate well to the right, they will affect – mainly through myofascial effects – the way the neck moves to the right. This will affect the ability of the right shoulder joint to rise to 180 flexion.
  • Failure to rotate in a particular direction of one, or more, segments generally indicates stiffness of the opposite side – for example, if analysis shows that T3-5 does not rotate well to the right, then it is T3-5 on the left that is likely to be stiff and dysfunctional.
Medical illustration of the thoracic spine
  • One-sided restrictions as in the example above are more common than ‘neutral’ bilateral stiffness at a particular level, particularly in young and middle-aged people.
  • Thoracic vertebral segment ‘stiffness’ will warp and distort natural rib movement as the thoracic cage flexes and rotates – in some patients this may result in anterior rib / sternal area discomfort.
  • Abnormal muscle tone and pain generally develops on the opposite side to the stiffness – in other words, they occur on the same side as the difficulty turning.
  • Stringy, thinner (less muscle mass) and less tender segment musculature generally develop on the same side as the stiffness.
  • The role of manipulation is to release this stiffness by restoring the failed rotation and extension at the segment in a particular direction – in other words, manipulation must be directional in its purpose.
  • Regarding the actual manipulative technique, this is achieved by manipulative approaches that aim to challenge the inability of the segment to rotate in the desired direction – minimal amplitude techniques can do this in ways that do not discomfort the patient.
  • Finally, manipulation is thus generally performed on the non-tender side of the thoracic spine – in the case of a patient who has thoracic pain, a higher level of thinking should be done if one is tempted to manipulate the same side and same level as the pain.

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