Thoracic Spine and Ribcage Management

Question 1

What assumptions must be met before developing your treatment plan?

Answer 1

• thorough patient interview and physical exam
• ruled out red flags and yellow flags are managed
• contraindications and precautions for chosen treatment have been reviewed
• asterisks and outcomes are set to be measured

Question 2

What is thoracic joint dysfunction?

What are common symptoms?

Answer 2

painful joint disorder at the facet, costotransverse or costovertebral joint-“locking”

• unilateral pain
• cervical/thoracic movements into joint restriction or deep breathing into restriction aggravate symptoms
• positions or motions away from joint restrictions ease symptoms

usually there are no neuro signs

Question 3

What is considered a “closing restriction”?

Answer 3

-pain and limited ROM with EXT and SB into restriction

Question 4

What is considered a “opening restriction”?

Answer 4

-pain and limited ROM with FLEX and SB away from the restriction

Question 5

What may torsional rib dysfunctions affect?

Answer 5

proper breathing due to external and/or internal rib torsion

Question 6

What may cause a costochondral/sternocostal dysfunction?

What aggravates this dysfunction?

Answer 6

• trauma (direct blow such as from a seat belt injury or sports injury)
• +/- instability
• reactive arthritis or an autoimmune disorder

Agg: thoracic, shoulder motion; deep breath, cough, or sneeze

Question 7

What are common treatments for 1st and 2nd rib disorders?

Answer 7

• manual therapy
• stretch scalenes
• deep neck flexors and postural muscle retraining/education

Question 8

What should strength programs focus on for thoracic pain management?

Answer 8

• scapulothoracic stabilization
• cervicothoracic stabilization (DNFs and Deep extensors)
• Lumbopelvic stability
• Upper extremity conditioning
• endurance for ADLs/work/leisure activities