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Thoracic spine stiffness
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Thoracic spine stiffness - October 5, 2004 3:09:00 AM
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fantast
Posts: 8
Joined: June 17, 2003
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hi everybody
I have a patient coming with a diagnosis of C6-7 disc problem complaining of lower neck pain radiating up to the left middle and index finger
On examination there was no significant pain with Cx ROM
But when applying PA over upper thoracic spine I found it to be very stiff and reproducing patient's symptoms
Also I found a rhomboid trigger point which increases fingers numbness
So I've started central PA mob's for T1-6 and trigger point therapy
And instructed the patient to use cat position thoracic flex/ext and extension using the back of the chair
So I'm asking for a suggestion to effectively mobile this stiff area
waiting for your help
regards
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Re: Thoracic spine stiffness - October 5, 2004 4:31:00 AM
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Shill
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From: Madison WI USA
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No pain with neck ROM at all? Including overpressure, spurlings and seated and supine extension with retraction? If none of these cause pain, then your indirect approach will be fine for gradual reduction in symptoms. One of the things I always look for is a way for the patient to bring about pain reduction through repeated movements, and usually we can find a direction that causes some pain during, but decreases pain as a result. It typically is either retraction and extension using the hands at the base of the c-spine to stabilize below the painful level.
The PA glides to T spine likely reproduce sx because of the c6/7 actually moving when you do this, based on the path of least resistance theory.
Good luck,
Steve
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Steve Hill PT
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Re: Thoracic spine stiffness - October 5, 2004 5:26:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Hi. I think I would try a flexion opening manipulation to the t-spine. I have had some good outcomes by treating the t-spine in addition to the cervical spine. It is amazing to see how much improvment you can get in the cervical spine by moving the segments below it. Good luck,
Army
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Thoracic spine stiffness - October 5, 2004 10:21:00 AM
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steve
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From: Canada
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Just to further Army's point, the cervical spine and thoracic spine work in conjunction with the cervical spine being the obviously more mobile of the two. Stiffness in the thoracic spine causes greater stress in the cervical spine. Manipulation work fantastically for increasing mobility in the thoracic spine but I find the results are temporary unless followed with self mobilization (Rolled up towel with back extensions and 2 tennis balls in a sock work well) and stability/postural exercise.
Steve
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Re: Thoracic spine stiffness - October 5, 2004 6:14:00 PM
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eam
Posts: 290
Joined: February 5, 2004
From: New York, NY 10028
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In addition to the above, did you check the sit/slump position with overpressure via neck flexion? I had a similiar patient recently, and had good success with mobilizing the thoracic spine and neural mobs. Also, did you check the 1st rib?
Good luck!
Erica
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Re: Thoracic spine stiffness - October 6, 2004 1:05:00 AM
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fantast
Posts: 8
Joined: June 17, 2003
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Hi everyone
And thank you all for your suggestions
Shill, as I said neck ROM is not producing the patient symptoms, I even tried compression test in ext, ext. + LF bilaterally with no complain
And for the retraction and extension, that's what I'm doing right now and I totally agree with you for the PA glides to T spine
Army, unfortunately I haven't yet had a manipulation course, but your view looks logical and I'll try to ask someone help who's well experienced with cervical and thoracic manipulation
Eam, thank you for your addition and I'll check sit/slump test next time, but I'm wondering what's the reason to check the 1st rib?
Further more, I have checked the median nerve tension test which increased the numbness of the middle and index finger . . . so, is it advised to stretch the median nerve as the test position?
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Re: Thoracic spine stiffness - October 6, 2004 5:18:00 AM
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eam
Posts: 290
Joined: February 5, 2004
From: New York, NY 10028
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In my experience, mobilizing the nerve with an acute disk problem usually exacerbates the symptoms. I learned that one the hard way!
As far as the 1st rib goes-if there are some triggers in the scalenes, which attach to the 1st rib (anterior/middle scalene) they will pull on that 1st rib, perhaps causing sx's and refer pain to the vertebral border of the scapula as well as down the arm. if you have access to Travell and Simons Myofascial Pain and Dysfunction book, you can take a look. Just a thought. Good luck!
Erica
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Re: Thoracic spine stiffness - October 6, 2004 5:58:00 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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One could always consider T4 syndrome...often discussed and argued over, but present in some cases (in my humble opinion)
The interscapular trigger point, often in the rhomboid, but sometimes in the infraspinatus muscle belly, can reproduce these symptoms.
I have posted on this site, my own, and even NOIgroup.com, looking for answers with regards to these points and their ability to reproduce arm symptoms, when the actual cervical spine is not moved/touched.
A stiff T-spine often means more C-spine movement required, thus more stress and wear. I like to tape two raquet balls together for self mobilization.....the point between the two accomodates the spinous process, and the apex of each ball just about perfectly hits the transverse process/costovertbral joint. A great way to self mobilize and even perform some accupressure to the trigger points!
Duffy
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Thoracic spine stiffness - October 9, 2004 4:25:00 AM
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fantast
Posts: 8
Joined: June 17, 2003
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Thank you eam for the clarification as your idea looks logical, so I'll try to take care of that
Duffy I completely agree with you on the interscapular trigger points, in this patient I only found the rhomboid to produce sx's . . . but in other patient I found also the upper trapezuis and the infraspinatus muscle belly points existing
For me, trigger point therapy is a new trend and still I don't know that much about it, so I don't understand completely the mechanism of symptoms production when the spine is not touched !!
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Re: Thoracic spine stiffness - October 9, 2004 4:32:00 AM
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modegard
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Joined: August 30, 2004
From: central wisconsin
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I have found that mobilization with overpressure into throacic extension improves the carry over. Also, I teach my patients how to functionally incorporate thoracic extension with UE overhead ROM to maintain their new mobility and improve quality of motion.
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Re: Thoracic spine stiffness - October 11, 2004 4:20:00 AM
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fantast
Posts: 8
Joined: June 17, 2003
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hi every 1
eam, I've checked the sitting slump test which was neg.
I've seen a back extension ex's which is performed this way:
i)Stand with back against the wall, heels approx. 20cm from wall, feet shoulder width apart, knees slightly flexed.
ii) Flatten the lumbar lordosis into the wall (i.e. perform a posterior pelvic tilt)…this is essential.
iii) Abduct the shoulder to 90° and try to maintain the forearms against the wall.
iv) If possible lift the arms up overhead, touching the wall and while keeping the lumbar spine flat against the wall.
v) Go up as far as possible…always respecting pain…hold 5 seconds, repeat 5 times.
did anyone try this ex's with good outcomes . . . because I've tried it myself and found it to be effective and planning to use it with my patient
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