Thoracic spine - some ideas

  1. The thoracic spine has a major influence on the way the neck works, even in not very active people, and has a massive influence on upper extremity function.
  2. The thoracic spine does not have such a big influence on lumbo-pelvic function, except in very active people or in people whose lumbar spine is only just coping.
  3. The thoracic spine has a particular set of ways in which it is influenced by, and influences, the health and vitality of the person.
  4. The key mechanical focus of the thoracic spine is a) how well does it rotate? and b) how well does it extend?
  5. Failure to rotate and extend will affect a particular direction of neck rotation and (less so) side-bending (i.e. if some thoracic segments will not rotate well to the right, they will affect - mainly through myofascial effects - the ability of the neck to move to the right), and will affect the ability of the shoulder joint to rise to true 180 flexion.
  6. Failure to rotate in a particular direction of one, or more, segments generally indicates stiffness of the opposite side of the segment - for example, if analysis shows that T3-5 does not rotate well to the right, then it is T3-5 on the left that are likely to be stiff and dysfunctional.
  7. One-sided restrictions as in the example above are more common than 'neutral' bilateral stiffness at a particular level, particular in young and middle aged people.
  8. Abnormal muscle tone and pain generally develops on the opposite side to the stiffness (in other words, they develop on the same side as the difficulty turning.
  9. Stringy, thinner (less muscle mass) and less tender segment musculature generally develop on the same side as the stiffness.
  10. The role of manipulation is to release the stiffness identified in point (6), to restore the failed rotation and extension at the segment in a particular direction - in other words, manipulation must be directional in its purpose.
  11. In terms of the actual manipulative technique, this is achieved by manipulative techniques that aim to challenge the inability of the segment to rotate in the desired direction - minimal amplitude techniques can do this in ways that do not discomfort the patient.
  12. Finally, manipulation is thus generally performed on the non-tender side of the thoracic spine - in the case of a patient who has thoracic pain, a higher level of thinking should be done if one is tempted to manipulate the same side as the pain.