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Improving Thoracic Mobility

By

William J. Hanney DPT, PhD, ATC, CSCS

Course Description A lack of thoracic mobility can have broad clinical implications and evidence suggests addressing mobility in this region may be beneficial for those with shoulder, neck and lower back pain. However, this region can be challenging to treat. Enhancing mobility can be difficulty due to the intimate architecture of the anatomy. Also, improving mobility for patients can require awkward positions that may be challenging to assume. This course will discuss the anatomy and basic mechanics of the thoracic region and review current evidence for interventions targeting this region. Finally, practical manual therapy and self-mobilization concepts will be covered so the participant can take this information and apply it in practical way. Upon conclusion of this webinar the attendee will have a better understanding of how thoracic mobility can have a broach influence on many different patient cases and new ideas on how to address it clinically.

Objectives

• Identify three primary causes for decreased thoracic mobility

• Identify four conditions associated with a lack of thoracic mobility

• Describe 3 manual therapy techniques to address poor thoracic mobility

• Describe 4 self-mobilization techniques to promote patient self-care to improve thoracic mobility

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Course Outline

• Anatomy and basic mechanics

• Associated impairments and conditions

• Treatment approaches to improve thoracic mobility

• Manual therapy techniques to improve thoracic mobility

• Self-mobilization techniques to improve thoracic mobility

Why improve thoracic mobility?

• Societal postures

• Aging

• Regional Interdependence

Poor Posture

• Increasing challenges with functional transitions

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Neck Pain

• Biomechanical considerations

• Postural implications

• Direct associations have been found with thoracic mobility and neck pain (Norlander et al 1997)

Shoulder Pain

• Posture and scapular position

• Reduced subacromial space (Bowling et al 1986)

• Limited functional upper extremity movements

Low Back Pain

• Associated kypholordotic posture

• Accentuated mobility in the lumbar spine and SI

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Upper quarter functioning

The Thoracic Spine

Thoracic Vertebrae

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Anterior Myofascial Considerations

Posterior Myofascial Considerations

Contributions to Posture

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Upper cross syndrome

Treatment Approaches

Manual therapy

Posture Self

Stretching

Questions??

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Posture

Step 1 – Roll pelvis forward Step 2 – Lift sternum bone Step 3 – Retract and relax neck

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2

3

Manual Therapy Techniques

Clavicular Clearing

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Pectoralis Bending Soft Tissue Mobilization

Soft Tissue Mobilization Pectoralis Minor

Pectoral Fascial Mobilization

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Inhibitive Distraction

Subcranial Soft Tissue Mobilization

Scalene Soft Tissue Mobilization

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Upper Trap Fascial Stretch

Levator Soft Tissue Mobilization

Sternocleidomastoid Fascial Mobilization

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Rotational Thoracic Mobilization

PA Accessory Oscillations

Latissimus Dorsi Stretch

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Pec Minor Stretch

STM Pec Minor

Self Mobilization Techniques

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Scalene Self Stretch

Suboccipitals Self Stretch

Levator Self Stretch

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Latissimus Self Stretch

Upper Trap Self Stretch

Pec Minor Self Stretch

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Cat & Camel Exercise

Upper Trunk Rotation through thoracic spine

Lower Trunk Rotation through thoracic spine

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Bringing it together

• Consider individual daily activities

• An eclectic approach

Conclusion

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Questions?

References

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• Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 1866-1877

• Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther 2000;30:126–37

• Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 1866-1877

• Bergman GJ, Winters JC, Groenier KH, Meyboom-de Jong B, Postema K, van der Heijden GJ. Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial. J Manipulative Physiol Ther 2010;33:96–101

• Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther 2009;14:375–80

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• Falla, D., O'Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Man Ther, 12(2), 139-143.

• Norlander S, Nordgren B. Clinical symptoms related to musculoskeletal neck-shoulder pain and mobility in the cervico-thoracic spine. Scand J Rehabil Med. 1998;30:243-251

• O’Gorman H, Jull G. Thoracic Kyphosis and mobility: the effect of age. Physiotherapy Practice. 1987;3:154-162

• Twomey L, Taylor J. Sagittal and horizontal plane movement of the human lumbar vertebral column in cadavers and in the living. Rheumatology and Rehabilitation. 1980;19:223-232

• Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther 2007;37:658–60

• Widhe T. Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. Eur Spine J. 2001;10:118-123