The Effectiveness of Manual Therapies on the Thoracic Spine
The Thoracic Spine:[edit | edit source]
Anatomy:[edit | edit source]
- It is the longest portion of the spine, connecting to the Cervical Spine above and the Lumbar Spine below
- It comprises of 12 Vertebrae (T1-T12)
- The vertebrae bodies have a similar structure to that of the cervical spine.
- The spinous process increase in size the further down the thoracic spine.
- Each vertebrae sits above and below a IVD. [1](Palastanga and Field, 2014)
- T1-T11 articulate with the ribs to provide stability to the rib cage
Mobility:
- Least mobile portion of the spine
- T1-T8 = reduced flexion and extension, increased axial rotation
- T9-T12 = increased flexion and extension, reduced axial rotation. [1](Palastanga and Field, 2014)
Main Conditions:[edit | edit source]
- Osteoarthritis
- Osteoporosis
- Scoliosis
- Fracture
- Vertebral Body
- Facet joint
- Spinous Process
- Trauma
- Impact
- Myofascial pain
- Muscle Sprain/Strain
- Neurological Pain (combined with referred pain)
- Compression of nerve root
Contraindications to Manual Therapy:[edit | edit source]
Manual Therapies[edit | edit source]
The International Federation of Orthopaedic Manipulative Physical Therapists (http://www.ifompt.org) defines manual therapy techniques as:
"Any hands on treatment provided by the Physiotherapist; including joint mobilisation, manipulation or soft tissue therapy. With the aim to improve tissue extensibility; increase range of motion of the joint complex; mobilise or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction."
Mobilisations:[edit | edit source]
Sympo-excitatory response[edit | edit source]
Joint mobilisations have been defined by maitland as an externally imposed, small amplitude passive motion that is intended to produce gliding or traction at a joint[2].
They are often used in the Physiotherapy management in order to produce mechanical and neurophysiological effects[2]. It has been theorised by many authors that this is achieved when the sympathetic nervous system is excited following mobilisations, and thus the pain threshold increases. There have been several RCT's surrounding this area of interest so a systematic review was written by Kingston et al (2014) on the topic[3] and found that each study did demonstrate an sympo-excitatory response. Therefore following an acute injury, or where a patient is suffering from painful inflammation of the target area, it would be useful to treat them centrally, using mobilisations, away from the target area. This can be performed at any level of the spine, including the thoracic spine.
Pulmonary Function[edit | edit source]
Recent evidence has been published acknowledging the benefits of thoracic mobilisations on pulmonary function in patients. When combined with self stretching exercises on the pec minor and major muscle group along with the trapezius muscles, thoracic joint mobilisations have been shown to be statistically superior in improving FEV1, and PEF than self stretching alone. However, self stretching and thoracic mobilisations was statistically greater in improving FVC than thoracic joint mobilisations alone.[4]
Mobilisations are not limited to use in the solely MSK setting, they can also be used with patients who suffer neurological deficit. Stroke patients often suffer with limited thoracic movement[5] and impaired coughing ability leading to further respiratory complications[6]. Combined weekly thoracic and cervical joint mobilisations ( with movement) along with 30 minutes of exercise, 15 minutes of ergometer training and 15 minutes of functional electrical stimulation a week, has been shown to improve FEV1, FVC and coughing function greater than exercise, ergometer training and electrical stimulation alone[7].
Video:
Manipulations:[edit | edit source]
Video:
Soft Tissue (STT):[edit | edit source]
Video:
Summary:[edit | edit source]
References:[edit | edit source]
- ↑ 1.0 1.1 Palastanga, N. and Field, D. (2014). Anatomy and Human Movement. Kent: Elsevier Science.
- ↑ 2.0 2.1 3. Edmond S. Joint Mobilization/Manipulation - E-Book. 3rd ed. Elsevier Health Sciences.; 2016.
- ↑ 4. Kingston L, Claydon L, Tumilty S. The effects of spinal mobilizations on the sympathetic nervous system: A systematic review. Manual Therapy. 2014;19(4):281-287.
- ↑ 5. Hwangbo P, Hwangbo G, Park J, Lee S. The Effect of Thoracic Joint Mobilization and Self-stretching Exercise on Pulmonary Functions of Patients with Chronic Neck Pain. Journal of Physical Therapy Science. 2014;26(11):1783-1786.
- ↑ 7. Ogiwara S, Ogura K. Antero-Posterior Excursion of the Hemithorax in Hemiplegia. Journal of Physical Therapy Science. 2001;13(1):11-15.
- ↑ 8. Gauld L, Boynton A. Relationship between peak cough flow and spirometry in Duchenne muscular dystrophy. Pediatric Pulmonology. 2005;39(5):457-460.
- ↑ 6. Jang S, Bang H. Effect of thoracic and cervical joint mobilization on pulmonary function in stroke patients. Journal of Physical Therapy Science. 2016;28(1):257-260.
