Anatomy, Biomechanics and Regional Interdependence of the Thorax: Difference between revisions

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== Introduction ==
== Introduction ==
The thorax is an area
The thorax is an area of the spine that has, historically, been under-explored. It can, however, be a silent contributor to many presentations in clinical practice.
 
One cross-sectional survey in Denmark looked at the prevalence of spinal pain. It found that in one year:<ref>Leboeuf-Yde C, Nielsen J, Kyvik KO, Fejer R, Hartvigsen J. [https://link.springer.com/article/10.1186/1471-2474-10-39 Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age]. ''BMC Musculoskelet Disord''. 2009;10(39).</ref>
 
* 13 percent of respondents had thoracic pain
* 43 percent had low back pain
* 44 percent had neck pain
 
However, 36 to 41 percent of individuals have thoracic pain which co-exists with neck or back pain.<ref>Roquelaure Y, Bodin J, Ha C, Le Marec F, Fouquet N, Ramond-Roquin A et al. Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study. Arthritis Care Res (Hoboken). 2014;66(11):1695-702. </ref> Thus, four in ten patients will have an associated thoracic spine condition. This is, therefore, a region that should not be ignored in physiotherapy practice.<ref name=":0">Bell-Jenje T. The Thorax Simplified - Anatomy, Biomechanics and Regional Interdependence Course. Physioplus, 2021.</ref>
 
== Anatomy ==
The [[Thoracic Anatomy|thoracic spine]] includes 136 joints and 112 muscle attachments. The orientation of the thoracic joints and ribs limit flexion, extension and lateral flexion, but facilitate rotation.<ref name=":0" />
 
=== Range of Motion ===
The total rotation available in the thoracic spine is 85 degrees (+/- 14.8 degrees).<ref>Heneghan NR, Hall A, Hollands M, Balanos GM. Stability and intra-tester reliability of an in vivo measurement of thoracic axial rotation using an innovative methodology. Manual Therapy. 2009; 14(4):452-5.</ref> It contributes 80 percent of the total range of axial trunk rotation.<ref>Fujii R, Sakaura H, Mukai Y, Hosono N, Ishii T, Iwasaki M et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223353/ Kinematics of the lumbar spine in trunk rotation: in vivo three-dimensional analysis using magnetic resonance imaging]. ''Eur Spine J''. 2007;16(11):1867-74. </ref> Each thoracic segment rotates between 6 and 8 degrees. This is significantly more than each lumbar segment, which only has 2 to 3 degrees of rotation.<ref name=":0" />
 
Thoracic movement is critical for optimal performance in rotational sports and kinematically links the upper and lower quarters.<ref>Heneghan NR, Lokhaug SM, Tyros I, Longvastøl S, Rushton A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173996/ Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis]. BMJ Open Sport Exerc Med. 2020;6(1):e000713. </ref><ref>Heneghan NR. Webb K, Mahoney T, Rushton A.  [https://www.researchgate.net/publication/334720891_Thoracic_spine_mobility_an_essential_link_in_upper_limb_kinetic_chains_in_athletes_A_systematic_review Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review]. ''Transl Sports Med''.  2019;2:301-15.</ref> It also contributes 55 percent to total force during a throw.<ref>Kaczmarek PK, Lubiatowski P, Cisowski P, Grygorowicz M, Łepski M, Długosz J et al. [https://www.researchgate.net/publication/263207986_Shoulder_problems_in_overhead_sports_Part_I_-_biomechanics_of_throwing Shoulder problems in overhead sports. Part I - biomechanics of throwing]. Pol Orthop Traumatol. 2014;79:50-8. </ref>

Revision as of 02:20, 28 August 2021

Original Editor - Jess Bell based on the course by Tanja Bell-Jenje
Top Contributors - Jess Bell, Lucinda hampton, Kim Jackson, Olajumoke Ogunleye, Merinda Rodseth and Robin Tacchetti
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (28/08/2021)

Introduction[edit | edit source]

The thorax is an area of the spine that has, historically, been under-explored. It can, however, be a silent contributor to many presentations in clinical practice.

One cross-sectional survey in Denmark looked at the prevalence of spinal pain. It found that in one year:[1]

  • 13 percent of respondents had thoracic pain
  • 43 percent had low back pain
  • 44 percent had neck pain

However, 36 to 41 percent of individuals have thoracic pain which co-exists with neck or back pain.[2] Thus, four in ten patients will have an associated thoracic spine condition. This is, therefore, a region that should not be ignored in physiotherapy practice.[3]

Anatomy[edit | edit source]

The thoracic spine includes 136 joints and 112 muscle attachments. The orientation of the thoracic joints and ribs limit flexion, extension and lateral flexion, but facilitate rotation.[3]

Range of Motion[edit | edit source]

The total rotation available in the thoracic spine is 85 degrees (+/- 14.8 degrees).[4] It contributes 80 percent of the total range of axial trunk rotation.[5] Each thoracic segment rotates between 6 and 8 degrees. This is significantly more than each lumbar segment, which only has 2 to 3 degrees of rotation.[3]

Thoracic movement is critical for optimal performance in rotational sports and kinematically links the upper and lower quarters.[6][7] It also contributes 55 percent to total force during a throw.[8]

  1. ↑ Leboeuf-Yde C, Nielsen J, Kyvik KO, Fejer R, Hartvigsen J. Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskelet Disord. 2009;10(39).
  2. ↑ Roquelaure Y, Bodin J, Ha C, Le Marec F, Fouquet N, Ramond-Roquin A et al. Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study. Arthritis Care Res (Hoboken). 2014;66(11):1695-702.
  3. ↑ 3.0 3.1 3.2 Bell-Jenje T. The Thorax Simplified - Anatomy, Biomechanics and Regional Interdependence Course. Physioplus, 2021.
  4. ↑ Heneghan NR, Hall A, Hollands M, Balanos GM. Stability and intra-tester reliability of an in vivo measurement of thoracic axial rotation using an innovative methodology. Manual Therapy. 2009; 14(4):452-5.
  5. ↑ Fujii R, Sakaura H, Mukai Y, Hosono N, Ishii T, Iwasaki M et al. Kinematics of the lumbar spine in trunk rotation: in vivo three-dimensional analysis using magnetic resonance imaging. Eur Spine J. 2007;16(11):1867-74.
  6. ↑ Heneghan NR, Lokhaug SM, Tyros I, Longvastøl S, Rushton A. Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ Open Sport Exerc Med. 2020;6(1):e000713.
  7. ↑ Heneghan NR. Webb K, Mahoney T, Rushton A.  Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review. Transl Sports Med.  2019;2:301-15.
  8. ↑ Kaczmarek PK, Lubiatowski P, Cisowski P, Grygorowicz M, Łepski M, Długosz J et al. Shoulder problems in overhead sports. Part I - biomechanics of throwing. Pol Orthop Traumatol. 2014;79:50-8.
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