Physical Treatment of Thoracic Disorders

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.

Current trends in musculoskeletal therapy (that traditionally relied primarily on mobilisation, manipulation and other 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 mobilisation, and end-of-range passive stretching.

Passive accessory movements (vertebral and peripheral) still play a role in the management of neuromusculoskeletal disorders, but are implemented following the active component of the technique.  This method thus introduces a modified multimodal treatment approach with more active components than that found in traditional 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.

The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain.

Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain.