Thoracic Manual Techniques and Exercises

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Original Editor - Lucinda hampton Top Contributors - Lucinda hampton, Jonathan Wong, Kim Jackson and Khloud Shreif

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Lucinda hampton, Jonathan Wong, Kim Jackson and Khloud Shreif  

Introduction

Physiotherapists often address movement disorders of the thoracic spine that respond well to manual techniques and/or exercise prescription to address joint restrictions or muscle weakness.

This page outlines some of the Manual Techniques and Exercises for the Thoracic Spine.

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.

• Restrictions in motion have the potential to impact performance and may manifest as local or distant musculoskeletal pathology.
• Movement of the thoracic spine is coupled with movement of the adjoining ribs. Thoracic extension involves concurrent posterior rotation (external torsion) and depression of the posterior ribs with elevation of the anterior ribs. Bending to the side is a combination of spinal segments side bending, ribs on the same come together while ribs on the opposite side separate. Inability to move well in all directions predisposes people to injury and pain.
• Motion restrictions may be due to contractile or non-contractile structures, and interventions to address each specific tissue restriction can vary depending on the source of the involved tissue.

1. Contractile restrictions - eg.muscle tightness, trigger points, may be addressed via muscle stretching or manual interventions such as soft-tissue mobilization or sustained pressure.
2. Non-contractile restrictions - eg hypermobile, or hypomobile joints

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. 

• Most interventions to address thoracic spine mobility are dependent on the clinician providing the intervention.
• The ability for the patient to incorporate self-mobilizations of the thoracic spine into therapeutic exercise programs may help maximize intervention outcomes.

Mobilisations

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.

This 4 minute video is a demonstration of a reverse NAG for thoracic spine using the Mulligan concept (MWM).

This video is of mid thoracic Maitland PA mobilisation (5 minutes).

Exercises

Exercises are beneficial in situations of hypomobility to increase movement and hypermobility and postural issues to increase strength. The are an essential part of physiotherapy

Manipulation

There is no much research literature on the safety of joint manipulation when applied to the thoracic spine. Thrust joint manipulation should never be performed when contraindications or precautions are present.

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