Evaluation | Planning

Thoracic Spine – some ideas

a man touching his mid back with his right hand

Introduction

The thoracic spine has a significant influence on neck and upper extremity function.

The thoracic spine has less of an influence on lumbopelvic function, though it matters more in very active people. And there are some sports where poor lower thoracic function will really irritate the low back. For example, golf.

The thoracic spine has a particular set of ways in which it is influenced by, and influences, the health and vitality of the person. An example of this is the ‘rubbery’ quality of the lower thoracic erector spinae found in patients with inflammatory bowel disease.


What matters most?

What matters most is how well the thoracic spine rotates and how well it extends.

Failure to rotate and extend will affect a particular direction of neck rotation and side-bending.

For example, if some thoracic segments do not rotate well to the right, this will affect the way the neck rotates to the right.

For example, an inability of T4-5 to rotate to the right usually indicates stiffness on the left T4-5 segment, and vice versa.

This would also affect the ability of the right shoulder joint to abduct, explaining why treatment of any gleno-humeral pain and dysfunction must always include a particularly close look at this part of the thoracic spine.


Ribs and ‘rib pain’

Thoracic segment stiffness will warp and distort natural rib movement as the thoracic cage tries to flex and rotate.In some patients, particularly those with lax ligaments, this may cause anterior rib/sternal symptoms.

I’ve found that directly treating ribs and their myofascial components mostly isn’t necessary.

Even if there is true rib pain (and often it’s a mechanical consequence of problems with the supero-lateral vertebral segment) improving segment function seems to help enough.


Altered tissues

Raised muscle tone and pain generally develop on the opposite side to the stiffness. In other words, they occur on the same side as the difficulty rotating.

Stringy, thinner and less tender musculature generally occur on the same side as the stiffness.


Manipulation – which side?

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 ought to be directional. This is very much at odds with the way I was taught at undergraduate level (mid 1990s). Non-directional manipulation was considered sufficient.

Minimal amplitude techniques can do this in ways that do not discomfort the patient.

Manipulation is thus best performed on the non-tender side of the thoracic spine.

Although all manipulation should be carefully thought through, this is especially important if considering manipulating the same side and level as the patient’s pain.

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