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8/16/2017
1
Improving Thoracic Mobility
By
William J. Hanney DPT, PhD, ATC, CSCS
Course Description A lack of thoracic mobility can have broad clinical implications and evidence suggests addressing mobility in this region may be beneficial for those with shoulder, neck and lower back pain. However, this region can be challenging to treat. Enhancing mobility can be difficulty due to the intimate architecture of the anatomy. Also, improving mobility for patients can require awkward positions that may be challenging to assume. This course will discuss the anatomy and basic mechanics of the thoracic region and review current evidence for interventions targeting this region. Finally, practical manual therapy and self-mobilization concepts will be covered so the participant can take this information and apply it in practical way. Upon conclusion of this webinar the attendee will have a better understanding of how thoracic mobility can have a broach influence on many different patient cases and new ideas on how to address it clinically.
Objectives
• Identify three primary causes for decreased thoracic mobility
• Identify four conditions associated with a lack of thoracic mobility
• Describe 3 manual therapy techniques to address poor thoracic mobility
• Describe 4 self-mobilization techniques to promote patient self-care to improve thoracic mobility
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Course Outline
• Anatomy and basic mechanics
• Associated impairments and conditions
• Treatment approaches to improve thoracic mobility
• Manual therapy techniques to improve thoracic mobility
• Self-mobilization techniques to improve thoracic mobility
Why improve thoracic mobility?
• Societal postures
• Aging
• Regional Interdependence
Poor Posture
• Increasing challenges with functional transitions
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Neck Pain
• Biomechanical considerations
• Postural implications
• Direct associations have been found with thoracic mobility and neck pain (Norlander et al 1997)
Shoulder Pain
• Posture and scapular position
• Reduced subacromial space (Bowling et al 1986)
• Limited functional upper extremity movements
Low Back Pain
• Associated kypholordotic posture
• Accentuated mobility in the lumbar spine and SI
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Upper quarter functioning
The Thoracic Spine
Thoracic Vertebrae
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Anterior Myofascial Considerations
Posterior Myofascial Considerations
Contributions to Posture
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Upper cross syndrome
Treatment Approaches
Manual therapy
Posture Self
Stretching
Questions??
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Posture
Step 1 – Roll pelvis forward Step 2 – Lift sternum bone Step 3 – Retract and relax neck
1
2
3
Manual Therapy Techniques
Clavicular Clearing
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Pectoralis Bending Soft Tissue Mobilization
Soft Tissue Mobilization Pectoralis Minor
Pectoral Fascial Mobilization
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Inhibitive Distraction
Subcranial Soft Tissue Mobilization
Scalene Soft Tissue Mobilization
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Upper Trap Fascial Stretch
Levator Soft Tissue Mobilization
Sternocleidomastoid Fascial Mobilization
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Rotational Thoracic Mobilization
PA Accessory Oscillations
Latissimus Dorsi Stretch
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Pec Minor Stretch
STM Pec Minor
Self Mobilization Techniques
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Scalene Self Stretch
Suboccipitals Self Stretch
Levator Self Stretch
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Latissimus Self Stretch
Upper Trap Self Stretch
Pec Minor Self Stretch
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Cat & Camel Exercise
Upper Trunk Rotation through thoracic spine
Lower Trunk Rotation through thoracic spine
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Bringing it together
• Consider individual daily activities
• An eclectic approach
Conclusion
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Questions?
References
• Adams G, Sim J. A survey of UK manual therapists’ practice of and attitudes towards manipulation and its complications. Physiother Res Int. 1998;3:206-227
• Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 1866-1877
• Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther 2000;30:126–37
• Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 1866-1877
• Bergman GJ, Winters JC, Groenier KH, Meyboom-de Jong B, Postema K, van der Heijden GJ. Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial. J Manipulative Physiol Ther 2010;33:96–101
• Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther 2009;14:375–80
• Cleland J, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007;87(1):9-23
• Cleland J, et al. Short-term effects of thoracic manipulation on lower trapezius muscle strength. The Journal of Manual & Manipulative Therapy. 2004;12(2):82-90
• Crawford H, Jull G. The influence of thoracic posture and movement on range of arm elevation. Physiother Theory Pract. 1993;9: 143–8.
• Crosbie J, Kilbreath SL, Hollmann L, York S. Scapulohumeral rhythm and associated spinal motion. Clin Biomech 2008;23:184–92
• Falla, D., O'Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Man Ther, 12(2), 139-143.
• Norlander S, Nordgren B. Clinical symptoms related to musculoskeletal neck-shoulder pain and mobility in the cervico-thoracic spine. Scand J Rehabil Med. 1998;30:243-251
• O’Gorman H, Jull G. Thoracic Kyphosis and mobility: the effect of age. Physiotherapy Practice. 1987;3:154-162
• Twomey L, Taylor J. Sagittal and horizontal plane movement of the human lumbar vertebral column in cadavers and in the living. Rheumatology and Rehabilitation. 1980;19:223-232
• Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther 2007;37:658–60
• Widhe T. Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. Eur Spine J. 2001;10:118-123