Thoracic Spine Treatment

Question 1

ME Type 2 Dysfunction Upper T-Spine (T1-4)

Answer 1

Patient seated
Doc at side
Monitor at spinous process for flexion/extension
Flex/extend head
Monitor at transverse process
Sidebend/rotate head
Patient tries to return head to neutral
Hold 3-5 secs
Relax

Question 2

ME Type 2 Dysfunction Middle/Lower T-Spine (T5-12)

Answer 2

Patient seated
Hand on side of PTP grasp neck, other hand grasp elbow
Doc behind patient opposite PTP
Monitor spinous and transverse process
Arm goes over both arms to grasp bicep on side of PTP
Flex/extend, sidebend, rotate into barrier
Patient tries to return to neutral
Hold 3-5 secs
Relax

Question 3

Supine HVLA “Kirksville Crunch”

Answer 3

Patient supine
Doc opposite PTP
Patient crosses arms over chest, arm of dysfunctional side on top, grasping shoulders
Doc rolls patient towards them
Place caudad thenar eminence on PTP
Flex patient’s shoulders so patients elbows are over PTP
Doc can place opposite hand around neck and cradle head and neck to flex neck and add tension OR place hands on patient’s elbows
Sidebend by moving thoracic region
Roll patient back on back slightly pass midline during exhalation, further engaging barriers
End of exhalation -> posterior thrust onto PTP into table

Question 4

Prone HVLA “Texas Twist”

Answer 4

Patient prone
Doc side opposite PTP
Place hands facing opposite directions on either side of PTP
As patient exhales further engage barriers
End of exhalation -> downward anterior thrust with counter balance pressure (twist) in direction of fingers
- force slightly greater on side of PTP, other hand = counterforce

Question 5

Supine (over-the-thigh) Upper/Middle T-Spine

Answer 5

Patient supine
Doc head of table
Knee on side of PTP on table with affected segment at knee
Patient clasp hands behind neck, elbows out
Doc’s arms go through holes made by arms and contact lateral aspect of thoracic cage
Patient exhales - pull patient’s chest downward into thigh while adding cephalad traction

Question 6

Seated HVLA

Answer 6

Patient seated
Doc standing behind
Foot on side of PTP up on table so knee contacts dysfunctional segment
Patient interlocks fingers behind neck with elbows out
Doc places arms under axilla, through holes created by arms, grasp dorsal aspect of patient’s wrist (full nelson)
Patient exhales - doc does upward cephalad force through patient’s axilla while rolling patient’s spine over knee

Question 7

Alternate Seated HVLA

Answer 7

Patient seated straddling table
Patient grasps neck with arm on side of PTP and grasp elbow with other arm
Doc behind patient opposite PTP
Thenar eminence on PTP
Other hand over both arms to grasp bicep of dysfunctional side
Go into flexion/extension and sidebending barrier
On exhalation - go into rotational barrier
End of exhalation - quickly and minimally pull patient through rotational barrier while other hand does slight thrust at PTP

Question 8

ME Type I Dysfunction

Answer 8

Patient seated, hand on side of PTP behind neck
Other hand grasp contralateral elbow
Doc behind patient opposite PTP
Monitor at apex of group curve
Arm goes under axilla and grasp bicep on side of PTP
Induce sidebending and rotation
Patient tries to return to neutral
Hold 3-5 secs
Relax