Introduction[edit | edit source]Physiotherapists often address movement disorders of the thoracic region that respond well to manual techniques and/or exercise prescription to address joint restrictions or muscle weakness. Show
Range of motion (ROM) in the thoracic region is necessary for a number of daily activities and sporting tasks such as golf, throwing sports, tennis, and rowing. Dysfunction of the thoracic spine can also play a role in breathing difficulties and may be linked to postural issues in the later stages of life. Additionally getting more ROM through the thoracic spine has impact on areas upstream and downstream the body.
Joint hypermobility is usually addressed with therapeutic exercise to improve neuromuscular control Joint hypomobility may be addressed with manual interventions including joint mobilization and manipulation. Hypomobility of vertebral and costovertebral joints in the thoracic spine may prevent the patient from attaining full motion of the thorax.
Range of Options - Manual Therapy Thoracic Spine[edit | edit source]As therapists we are trained in a multitude of techniques - chooseing the appropriate ones are usually to do with your expertise and choice. The following have great site links for detailed information.
Mobilisations[edit | edit source]
These videos demonstrate 3 common mobilisation styles. This first 2 minute video shows a good upper thoracic function mobilisation for extension, and extension combined with rotation. [6] This 4 minute video is a demonstration of a reverse NAG for thoracic spine using the Mulligan concept (MWM). [7] This video is of mid thoracic Maitland PA mobilisation (5 minutes). [8] Manipulation
Exercises[edit | edit source]Exercises are beneficial in situations of hypomobility to increase movement and hypermobility and postural issues to increase strength.
The first video (6 minutes) gives a good range of exercises for hypomobile joints [10] The next video is of exercises for eg Scheuermann's Kyphosis Exercises - home exercise program[edit | edit source]A good way to help clients to combat a painful/stiff upper back is to make an appropriate home exercise program (HEP) ie the right stretching and strengthening routine. Be sure to read this link to help get better adherence to a HEP Stretching and Strengthening of the thoracic extensor muscles can be achieved by following exercises: Cow -Cat stretch To perform: Begin in quadruped (hands and knees) with knees under hips and hands under shoulders. Inhale as you move your sit bones up towards the ceiling, arching the back and pressing the chest towards the floor as you lift the head up. Relaxing the shoulder blades behind you. From there, inhale as you move from this “cow” position to an angry “cat” position, rounding out your back and pushing shoulder blades away from you as your spine forms a “C” curve in the opposite direction. Go through this cycle 10 times. Open Book This stretch is a great way to improve rotation in the thoracic spine. Begin by lying on your left side with knees bent and arms straight out in front of you, palms touching. Gently lift your right hand straight up off of the left hand, opening up the arm like it’s a book or door while following the top hand with your head and eyes until your right hand is on the other side of your body, palm up, with your head and eyes turned towards the right. Hold this stretch for a few breaths before returning to the starting position with palms facing each other. Repeat up to 10 times on each side. Thoracic extension over Foam Roller If using a foam roller, place the foam roller perpendicular to torso. Sit in front of the foam roller, and gently hammock the head with your hands, interlocking the fingers and supporting the weight of your head without pulling it. Lean backwards so that your upper back is reaching backwards over the foam roller. Gently allow your shoulders to reach towards the floor while the foam roller supports your upper back. Carefully lift the hips to roll up and down the muscles of the upper back or move the foam roller up and inch after each stretch, leaning backwards over the roller until a gentle stretch is felt. Repeat several times, without forcing your body into discomfort. This stretch can be very intense, so start with small movement and don’t spend more than a couple minutes in this position. Doorway Stretch (Pec stretch) Use the walls of a standard doorway to stretch out the pecs. Bring each forearm up against one side of the doorway. Gently lean forward through the doorway keeping the arms on one side to stretch out the chest. Hold for 30 seconds.[11] Occiput to wall [4] Stretching the Extensor Muscles and strengthening the Anterior Neck Flexors: The patient stands with his back against the wall and retracts the chin. There will be an upper cervical spine flexion and lower cervical spine extension. Hold this position for 15 seconds. [4] Education - Postural training and Body mechanics[edit | edit source]
Postural awareness training steps:
The training of all the postural muscles is important to assure the stability of the spine. Training of the postural muscles can be achieved by eg.balance training
see also: Thoracic Hyperkyphosis, Sway Back Posture, Posture; Forward Head Posture. [edit | edit source]Because pain in the thoracic region is often caused by muscle tension and poor posture, initial treatment efforts focus on relieving the tension with
2. Over-the-counter medications such as acetaminophen or ibuprofen. The majority of clients usually will improve with these measures References[edit | edit source]
Which position should a client be in to perform the cervical flexion and extension test?The test is performed by having the seated client rotate the neck and head to one side and then drop the head and neck back on the opposite shoulder (rotation to one side, lateral flexion to the opposite side, and extension); the client should then be asked to pick a point and visually focus on it.
What position is recommended for the testing leg during the hip abduction and external rotation test?The patient is positioned in supine. The leg is placed in a figure-4 position (hip flexed and abducted with the lateral ankle resting on the contralateral thigh proximal to the knee.
What position is recommended for the testing leg during the hip abduction and external rotation test quizlet?Hip Flexion, Abduction and External Rotation with knee flexion tests which muscle(s)? Position of Patient: Short sitting with thighs supported on table and legs hanging over side. Arms may be used for support.
What is considered normal mobility during the first MTP extension test?What is considered normal mobility during the 1st MTP extension test? The great toe is above other toes. The great toe is inline with other toes.
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