Thoracic Spine

Diagnosis, Mobilisation and Motor Control Retraining of the Thoracic Spine and Ribs

Thoracic spine and rib pain associated with trunk movement, static postures and respiratory function can be difficult to treat. This course demonstrates innovative techniques to assess and mobilise thoracic and rib restrictions and then details the strategies to control the compensatory uncontrolled movements.

Course Outline

The pain in this region is also related to costo-vertebral, cervico-thoracic, scapulo-thoracic and thoraco-lumbar dysfunction. Assessing the inter relationships between articular and myofascial restrictions and their corresponding compensations Uncontrolled Movements (UCM) in these four regions is very complex.

This two-day course reviews the functional anatomy of the thorax. Functional classification of thoracic musculature is outlined with local and global stability systems identified. Based upon a systematic assessment and diagnosis of spinal movement dysfunction, an integrated treatment approach for mechanical dysfunction is presented. It details the retraining of stability function at local and global levels for the thoracic spine and ribcage and emphasises rehabilitation strategies based on a clinical reasoning framework. This course is orientated to a ‘hands on’ practical application of dysfunction assessment and stability retraining using patient examples where possible.

Key Features

• Positional diagnosis of thoracic and rib compensations for restrictions in the thorax.
• The anatomy and functional classification of thoracic musculature is outlined with local and global stability systems identified.
• The application of manual mobilisation (muscle energy based) techniques to mobilise the restrictions
• Based upon a systematic and logical assessment of spinal movement dysfunction, an integrated treatment approach is presented.
• The stabilisation of the compensatory movement is detailed at 3 levels
  
  1. Dissociation of the site and direction of uncontrolled movement
  2. Local stabilisation of uncontrolled thoracic or rib translation
  3. Influence of recruitment imbalance between 1 joint stabilisers and 2 joint mobilisers in the thorax
• The course details the rehabilitation of the stability system at local and global levels for the thoracic spine and emphasises rehabilitation strategies for appropriate clinical decision making.

Learning Outcomes

At the end of this course the participant should be able to:

• Understand the development of movement and stability dysfunction
• Analyse the inter-relationship between restriction and compensation in articular and myofascial tissues
• Demonstrate the ability to palpate the thoracic spine and rib cage to make a positional diagnosis of thoracic and rib compensation for restriction
• Manual techniques to mobilise thoracic and rib restrictions
• Clinically assess hip motor control strategies to identify and diagnose the site and direction of stability dysfunction and retrain direction specific dysfunction in the thorax
• Assess and rehab local stabiliser function in the thoracic spine
• Discuss the influence of global imbalance in stabiliser - mobiliser function

The participant should demonstrate the ability to apply principles of assessment and motor control retraining to:

• Develop an evidence based management plan to improve functional control
• Use clinical reasoning to prioritize initial management and plan a progression of rehab
• Apply rehabilitation strategies to manage stability dysfunction
• Use re-assessment tools to guide the rate of progression of an individual patient through their rehab programme

Programme Outline

• Uncontrolled Movement Theory

• Palpation & mobilisation of thoracic & rib restrictions

• Palpation of ribs dysfunctions

• Structural rib treatment

• Thoracic control of direction

• Thoracic control of translation (in neutral)

• Thoracic control of global imbalance