Improving Thoracic Mobility

Transcription

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 1

2 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 2

3 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 3

4 Upper quarter functioning The Thoracic Spine Thoracic Vertebrae 4

5 Anterior Myofascial Considerations Posterior Myofascial Considerations Contributions to Posture 5

6 Upper cross syndrome Manual therapy Treatment Approaches Self Stretching Posture Questions?? 6

7 Posture 3 Step 1 Roll pelvis forward 2 Step 2 Lift sternum bone 1 Step 3 Retract and relax neck Manual Therapy Techniques Clavicular Clearing 7

8 Pectoralis Bending Soft Tissue Mobilization Soft Tissue Mobilization Pectoralis Minor Pectoral Fascial Mobilization 8

9 8/16/2017 Inhibitive Distraction Subcranial Soft Tissue Mobilization Scalene Soft Tissue Mobilization 9

10 8/16/2017 Upper Trap Fascial Stretch Levator Soft Tissue Mobilization Sternocleidomastoid Fascial Mobilization 10

11 Rotational Thoracic Mobilization PA Accessory Oscillations Latissimus Dorsi Stretch 11

12 Pec Minor Stretch STM Pec Minor Self Mobilization Techniques 12

13 Scalene Self Stretch Suboccipitals Self Stretch Levator Self Stretch 13

14 Latissimus Self Stretch Upper Trap Self Stretch Pec Minor Self Stretch 14

15 Cat & Camel Exercise Upper Trunk Rotation through thoracic spine Lower Trunk Rotation through thoracic spine 15

16 Bringing it together Consider individual daily activities An eclectic approach Conclusion 16

17 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: Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 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: Bowling RW, Rocker PA, Erhard R 1986 Examination of the shoulder complex. Physical Therapy 66: 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: 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: 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: Crosbie J, Kilbreath SL, Hollmann L, York S. Scapulohumeral rhythm and associated spinal motion. Clin Biomech 2008;23: 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), 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: O Gorman H, Jull G. Thoracic Kyphosis and mobility: the effect of age. Physiotherapy Practice. 1987;3: 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: 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: Widhe T. Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. Eur Spine J. 2001;10: