The Thoracic Spine

As with neck pain and low back pain, it is frequently difficult for the clinician to make a precise diagnosis in patients with pain in the region of the thoracic spine given the interplay between the thorax, upper limb, neck, low back, and the cardiorespiratory and visceral systems. The most common musculoskeletal problems are disorders of the thoracic imervertebral joints and the numerous rib articulations as this region of the spine contributes stability to the axial skeleton. The thorax never sleeps as, even at rest, this complex interplay of joints, ligaments and muscles moves with respiration.

This online course will cover the following topics:

• Assessment of thoracic pain

• Thoracic intervertebral joint disorders

• Costovertebral-costotransverese joint disorders

• Scheurmann's disease

• T4 syndrome

• Chest pain

• Rib trauma

• Side strain

Current trends in musculoskeletal therapy that rely on hands-on modalities, are moving away from passive techniques to a more active approach which includes greater participation by the patient.  Drawing on research and clinical experience, the author has developed a more dynamic manual therapy technique that utilises a combination of isometric exercise (resisted muscle contraction), active physiological oscillatory techniques, and end-of-range passive stretching.

This method thus introduces a modified multimodal treatment approach with more active components than that found in traditional passive manual therapy models.  Therapeutic patient education including psychosocial input and exercise therapy are adjusted in line with the patient’s individual needs.  All components of this method combine to produce an analgesic effect and may also help to boost the neuroimmune system.

Thoracic outlet syndrome (TOS) is a challenging condition to diagnose correctly and manage appropriately. This is the result of a number of factors including the multifaceted contribution to the syndrome; the limitations of current clinical diagnostic tests; the insufficient recognition of the sub-types of TOS; and the dearth of research into the optimal treatment approach. 

This master class identifies the subtypes of TOS, highlights the possible factors that contribute to the condition and outlines the clinical examination required to diagnose the presence of TOS.

Thoracic outlet syndrome (TOS) is a challenging condition to diagnose correctly and manage appropriately. This is the result of a number of factors including the multifaceted contribution to the syndrome; the limitations of current clinical diagnostic tests; the insufficient recognition of the sub-types of TOS; and the dearth of research into the optimal treatment approach.

This master class identifies the subtypes of TOS, highlights the possible factors that contribute to the condition and outlines the clinical examination required to diagnose the presence of TOS.

Thoracic outlet syndrome (TOS) is attributed to compression of the nerves and vessels as they exit the thoracic outlet. Classified into several sub-types, conservative management is generally recommended as the first stage treatment in favour of surgical intervention. In cases where postural deviations contribute substantially to compression of the thoracic outlet, the rehabilitation approach outlined in this master class will provide the clinician with appropriate management strategies to help decompress the outlet.

The main component of the rehabilitation programme is the graded restoration of scapula control, movement, and positioning at rest and through movement. Adjunctive strategies include restoration of humeral head control, isolated strengthening of weak shoulder muscles, taping, and other manual therapy techniques. The rehabilitation outlined in this paper also serves as a model for the management of any shoulder condition where scapula dysfunction is the major contributing factor.

Thoracic outlet syndrome (TOS) is attributed to compression of the nerves and vessels as they exit the thoracic outlet. Classified into several sub-types, conservative management is generally recommended as the first stage treatment in favour of surgical intervention. In cases where postural deviations contribute substantially to compression of the thoracic outlet, the rehabilitation approach outlined in this master class will provide the clinician with appropriate management strategies to help decompress the outlet.

The main component of the rehabilitation programme is the graded restoration of scapula control, movement, and positioning at rest and through movement. Adjunctive strategies include restoration of humeral head control, isolated strengthening of weak shoulder muscles, taping, and other manual therapy techniques. The rehabilitation outlined in this paper also serves as a model for the management of any shoulder condition where scapula dysfunction is the major contributing factor.

This is a comprehensive 15-page manual which includes nine figures of practical demonstration on examination and treatment techniques.

The examination of any patient suffering with symptoms of neuromusculoskeletal dysfunction consists of two main parts:  

• a questioning/interview section, including inquiry about both the symptoms present and their history; and
• a physical examination section, in which the structures implicated during the interview are examined.  

There is substantial evidence in the literature that the musculoskeletal system is capable of producing abdominal symptoms. Most authors agree that the vast majority of cases of abdominal pain have a visceral origin and, in the first instance, visceral pathology which must be excluded. However, when routine visceral screening investigations are negative, clinicians should consider the musculoskeletal system as a potential cause of symptoms. 

The viscera are known for their capacity to present misleading symptoms and have been described as the ‘great deceivers’ in terms of the patterns of pain presentation.

Correct interpretation of the symptoms through a careful history and physical examination is important for an accurate diagnosis and treatment.  Given the incidence of patients with abdominal pain that remains unexplained following gastroenterological investigations, it is vital to investigate the musculoskeletal system and, where appropriate, treat accordingly.

Successful management of any thoracic syndrome is contingent upon the therapist’s ability to constantly assess and interpret the history, clinical signs and symptoms of the disorder, along with the skill of administering therapeutic techniques. 

Part 1 of this correspondence course covers the manual therapy and exercise for the treatment of common thoracic conditions such as thoracic outlet syndrome and first rib as well as T4 syndrome.  It includes a detailed case report and eight illustrations describing manual therapy techniques. Also described are the most common running-related injuries including patellofemoral pain and iliotibial band syndromes and their biomechanics and prevention. 

Part 2 of this course covers the treatment of postural stabilizing syndromes for the upper, mid and lower thorax and the thoracic nerve root syndrome.  It also includes detailed case studies, four illustrations demonstrating manual techniques and four illustrations of exercises for the treatment of the above mentioned conditions.

Successful management of any thoracic syndrome is contingent upon the therapist’s ability to constantly assess and interpret the history, clinical signs and symptoms of the disorder, along with the skill of administering therapeutic techniques. 

Part 1 of this correspondence course covers the manual therapy and exercise for the treatment of common thoracic conditions such as thoracic outlet syndrome and first rib as well as T4 syndrome.  It includes a detailed case report and eight illustrations describing manual therapy techniques. Also described are the most common running-related injuries including patellofemoral pain and iliotibial band syndromes and their biomechanics and prevention.   

Part 2 of this course covers the treatment of postural stabilizing syndromes for the upper, mid and lower thorax and the thoracic nerve root syndrome.  It also includes detailed case studies, four illustrations demonstrating manual techniques and four illustrations of exercises for the treatment of the above-mentioned conditions.