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5. THE THORACIC SPINE AND RIBS (Tl on T2 through T12 on LI)

5.1. Therapy Guide

5.1.1. Examination

The upper extremities, the cervical spine and the thoracic spine and ribs interact in most upper body movements. A shortened muscle or a dysfunction in any of these areas may greatly affect total function. Therefore, all examinations of dysfunc-tions of the thoracic spine and ribs should also include examinations of the cervical spine and the upper extremities.

Pain and/or reduced mobility in the thoracic spine may be a secondary symptom of internal organ pathology or malfunction, which may cause changes in the skin, subcutaneus tissue, fasciae, muscles and tendons or joints. For example, a healed pleurisy may cause residual pain in the thorax or thoracic spine with hyperaesthesia and reduced mobility in the relevant segments. This pain may disappear when the mobility of the thoracic spine and ribs is normalized.

5.1.2. Treatment Guidelines

Caution is the watchword in treating the spine. Therefore, in treating any restriction, perform the non-specific techniąues first. Perform specific tech-niąues only if the non-specific techniąues elicit no contraindications to further therapy.

The therapist may instruct or direct patient eye movements and respiration to aid therapy.

Eye movements evoke reflex responses, such as “leading” movements of the head. Directing eye movement then gives the therapist control over patient head movement.

Respiration: Normal breathing, particularly ex-haling, promotes relaxation, while inhaling or holding the breath are often naturally evoked when producing muscular force. Therefore, in-structing the patient to exhale aids relaxation during stretching, while breathing normally promotes relaxation during sustained stretching (two minutes or morę). Inhaling helps the patient contract against the therapist’s resistance, such as during the stimulation of antagonists phase of treatment.

Many of the following therapy techniąues for treating the thoracic spine and ribs may be performed with the patient either sitting or lying on the couch. The choice between the two alternative treatment positions depends both on comfort and convenience for both the patient and the therapist.

For example, some patients may not be able to tolerate a sitting position when being treated, and therefore must be treated lying down. Likewise, a smaller therapist may find treatment of a large patient in a prone or supine position to be far easier than the equivalent treatment of a sitting patient.

5.1.3. Movement Patterns and Locking

Movement patterns and locking are discussed in Part 2, pp. 14-25. The following is a short summary review for the thoracic spine and ribs.

First, although the thoracic spine and its mobile segments are anatomically well defined (in the cranial to caudal direction, as starting at Tl on T2 and ending with the T12 on LI segment), the therapeutic definition is not so rigid. In many cases, the transition from typical cervical spine segment behavior to typical thoracic spine segment behavior is not abrupt at the C7-T1 segment, but rather morę gradual. This means that cervical spine may extend caudally into the upper thoracic spine. So therapeutically the upper thoracic spine should always be regarded as possibly behaving as if it were a part of the cervical spine. Whenever “cervical behavior” is noted in the upper thorac spine, it must be treated accordingly.

As can be seen from the schematic representa-tion of Fig. 7, p. 18, in ventral flexion the cervical and thoracic spines behave similarly. However, in dorsal flexion, they differ. The movement pattern of the thoracic spine is mirror symmetric with respect to a coronal piane. That is, in ventral flexion, lateral flexion and rotation to the same side are “physiological” movements, while in dorsal flexion, lateral flexion and rotation to opposite sides are “physiological.” The pattern for “physiological” movement in dorsal flexion appears to be the mirror image of the pattern in ventral flexion.

Segments adjacent to those treated should be stabilized so they do not follow the movement induced to effect treatment. Stabilization always reąuires inflection, or changes of flexion, either in the sagittal or the frontal planes. Basic stabilization of the thoracic spine involves changing flexion from ventral to dorsal or vice versa. For instance, treatment of a segment in ventral flexion is most effective if its adjacent (superior or inferior) segments are placed in dorsal flexion.

However, when rotation and/or lateral flexion are restricted in ventral or dorsal flexion, it is possible and necessary to lock the segments above and/or below morę securely than is possible by inflection in the sagittal piane alone. Locking is then attained by changing flexion and/or rotation in the frontal piane. This type of locking, most often used in non-specific techniąues, in-volves retaining ventral/dorsal flexion but changing to the opposite lateral flexion and rotation to effect the lock. End feel indicates when locking is