week 10 notes

Question 1

c7 - T4 mobility restricitons

Answer 1

The head cannot move fully in the presence of

hypomobility in the upper thoracic region

Question 2

T4 - 8

bilateral arm elevation

Answer 2

=15˚ thoracic ext
- restriction of rib movement can restrict
segmental movement
- utilize breathing pattern when treating
rib dysfunction

Question 3

• T8-L1

Answer 3

• transitional area- behaves a bit more like lumbar

- note rotary instability

Question 4

rib mvmt

Answer 4

Th Flexion: anterior rib rotation
Th LF (R): anterior rotation (R) rib
Th Extension: posterior rib rotation
Th Rot (R): posterior rotation (R) rib

Question 5

unilateral PA directions

Answer 5

In Csp: unilateral PA’s can be performed with a medial directed glide to encourage the “down slope” mvmt of
the superior facet to help restore LF, Rot and Ext
In Tsp: use a ceph and caud direction
for Flex and Ext respectively

Question 6

inspir vs exp

Answer 6

ER - inhalation - caudad

IR = exhale - cephald

Question 7

High velocity manipulation (HVT)

Indications:

Answer 7

 When subtle spasm is not allowing movement of a joint
and mobilisation is aggravating pain
 Residual hypomobility not responding to mobilisation
 Some thoracic areas become hypersensitive, too much
local discomfort with mobilisation

Question 8

Contraindications to manipulation

Answer 8

• Non-musculoskeletal causes of pain
• Systemic/inflammatory disease
– e.g. RA, ankylosing spondylitis
• Neoplasms, metastatic disease
• Spinal cord, cauda equina compromise
• Pregnancy
• Osteoporosis, or treatment likely to cause eg long term steroids,
anticoagulants
• Severe nerve root pain
• Fractures
• Vertebral or internal carotid artery compromise

Question 9

Precautions with manipulation

Answer 9

MANIPS IS SPEED NOT FORCE
• Pregnancy, post-partum period
• Adolescents or children
• Muscle spasm or pain positioning
• Patient unable to understand
• Patient not relaxed
• Recent trauma
• Older patients

Question 10

Thoracic MOBS W/ MWM

Answer 10

1. Th - with active rotation = USE A TRANSVERSE GLIDE
   - PROGRESSION OF TRANSVERSE FLIDES
   - HYPO THENAR
2. Th = with active extension - CAUDAD
   BTWN THENAR/HYPER THENAR

Question 11

THORACIC EXERCISES TO INC./MAINTAIN RANGE

Answer 11

• Thoracic extension overroller
• Yoga poses
• Adding resistance with theraband, weights
• Sport specific training

Question 12

THORACIC SPINE ROTATION MOBILITY

Answer 12

Thread the needle
Bow and arrow
Cat/cow