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

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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>
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>
=== Regions of the Thorax ===
* Verebromanubrial:
** Includes: T1 and T2, ribs 1 and 2, the manubrium and clavicle
* Vertebrosternal
** Includes: T3 to T7, true ribs 3 to 7 and sternum
* Vertebrochondral:
** Includes: T8 to 10 and false ribs 8 to 10
* Thoracolumbar
** Includes: T11 and T12, floating ribs 11 and 12<ref name=":0" />
==== Ribs ====
* Ribs 1, 11 and 12 articulate with the named vertebra (i.e. rib 1 articulates with T1)
* Ribs 2 to 10 articulate with the named vertebra, as well as the body above, the intervertebral disc and the anterior surface of the transverse process of the named vertebra
* More information on the ribs is available [[Ribs|here]]
==== The Thoracic Ring (T3-T9) ====
“The “thoracic ring” consists of two adjacent vertebrae and the related intervertebral disc, the right and left ribs (attached to the vertebra-disc-vertebra complex at the costovertebral joints), and the anterior attachments to the sternum/ manubrium and related cartilages.”<ref name=":1">Lee LJ. Thoracic ring approach. Available from: https://ljlee.ca/teaching-models/the-thoracic-ring-approach/ (accessed 28 August 2021).</ref>
There are 13 articulations per thoracic ring:<ref name=":0" /><ref name=":1" />
* Zygapophyseal / facet = 2
* Costovertebral = 4
* Intervertebral = 1
* Costotransverse = 2
* Costochondral = 2
* Sternocostal = 2
Because of the strong anatomical connections between the ribs and the thoracic spine, mobilising the rib laterally will cause motion at the vertebral segments of that thoracic ring, as well as the ribs on the opposite side of the body.<ref name=":0" />
=== Thoracic Function ===
Lee has described the thoracic spine as a “‘slinky’ or a shock-absorbing spring”.<ref name=":1" /> It consists of a dynamic stack of 10 thoracic rings<ref name=":1" /> and has the following functions:<ref name=":0" />
* Force transmission
** NB: many patients with chronic low back pain or cervical pain have a stiff thoracic spine
** Increasing thoracic mobility allows more even distribution of load through the spine with movement<ref>McConnell J. Recalcitrant chronic low back and leg pain--a new theory and different approach to management. Man Ther. 2002;7(4):183-92. </ref> <ref>Mohanty PP, Pattnaik M. Mobilisation of the thoracic spine in the management of spondylolisthesis. J Bodyw Mov Ther. 2016;20(3):598-603. </ref><ref>Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127-35. </ref>
* Central area for myofascial attachments
* Protects of heart, lungs, vessels, digestive tract<ref>Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical considerations for manual therapy. Man Ther. 1997;2(3):132-43. </ref>
* Aids optimal respiratory function
* Houses the autonomic nervous system
== References ==

Revision as of 02:42, 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
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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]

Regions of the Thorax[edit | edit source]

  • Verebromanubrial:
    • Includes: T1 and T2, ribs 1 and 2, the manubrium and clavicle
  • Vertebrosternal
    • Includes: T3 to T7, true ribs 3 to 7 and sternum
  • Vertebrochondral:
    • Includes: T8 to 10 and false ribs 8 to 10
  • Thoracolumbar
    • Includes: T11 and T12, floating ribs 11 and 12[3]

Ribs[edit | edit source]

  • Ribs 1, 11 and 12 articulate with the named vertebra (i.e. rib 1 articulates with T1)
  • Ribs 2 to 10 articulate with the named vertebra, as well as the body above, the intervertebral disc and the anterior surface of the transverse process of the named vertebra
  • More information on the ribs is available here

The Thoracic Ring (T3-T9)[edit | edit source]

“The “thoracic ring” consists of two adjacent vertebrae and the related intervertebral disc, the right and left ribs (attached to the vertebra-disc-vertebra complex at the costovertebral joints), and the anterior attachments to the sternum/ manubrium and related cartilages.”[9]

There are 13 articulations per thoracic ring:[3][9]

  • Zygapophyseal / facet = 2
  • Costovertebral = 4
  • Intervertebral = 1
  • Costotransverse = 2
  • Costochondral = 2
  • Sternocostal = 2

Because of the strong anatomical connections between the ribs and the thoracic spine, mobilising the rib laterally will cause motion at the vertebral segments of that thoracic ring, as well as the ribs on the opposite side of the body.[3]

Thoracic Function[edit | edit source]

Lee has described the thoracic spine as a “‘slinky’ or a shock-absorbing spring”.[9] It consists of a dynamic stack of 10 thoracic rings[9] and has the following functions:[3]

  • Force transmission
    • NB: many patients with chronic low back pain or cervical pain have a stiff thoracic spine
    • Increasing thoracic mobility allows more even distribution of load through the spine with movement[10] [11][12]
  • Central area for myofascial attachments
  • Protects of heart, lungs, vessels, digestive tract[13]
  • Aids optimal respiratory function
  • Houses the autonomic nervous system

References[edit | edit source]

  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 3.3 3.4 3.5 3.6 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.
  9. ↑ 9.0 9.1 9.2 9.3 Lee LJ. Thoracic ring approach. Available from: https://ljlee.ca/teaching-models/the-thoracic-ring-approach/ (accessed 28 August 2021).
  10. ↑ McConnell J. Recalcitrant chronic low back and leg pain--a new theory and different approach to management. Man Ther. 2002;7(4):183-92.
  11. ↑ Mohanty PP, Pattnaik M. Mobilisation of the thoracic spine in the management of spondylolisthesis. J Bodyw Mov Ther. 2016;20(3):598-603.
  12. ↑ Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127-35.
  13. ↑ Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical considerations for manual therapy. Man Ther. 1997;2(3):132-43.
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