{"id":1757,"date":"2021-09-29T12:07:00","date_gmt":"2021-09-29T12:07:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1757"},"modified":"2025-10-01T11:42:38","modified_gmt":"2025-10-01T19:42:38","slug":"omm-question-of-the-day-thoracic-muscle-dysfunction","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction","title":{"rendered":"OMM Question of the Day: Thoracic Muscle Dysfunction"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#D_Stand_on_her_right_side_flex_at_T7_sidebend_her_right_and_rotate_her_right\" >D. Stand on her right side, flex at T7, sidebend her right and rotate her right<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#A_Stand_on_her_left_side_keep_her_neutral_at_T7_sidebend_her_right_and_rotate_her_right\" >A. Stand on her left side, keep her neutral at T7, sidebend her right and rotate her right<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#B_Stand_on_her_left_side_flex_at_T7_sidebend_her_left_and_rotate_her_left\" >B. Stand on her left side, flex at T7, sidebend her left and rotate her left<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#C_Stand_on_her_left_side_extend_at_T7_sidebend_her_left_and_rotate_her_left\" >C. Stand on her left side, extend at T7, sidebend her left and rotate her left<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#E_Stand_on_her_right_side_extend_at_T7_sidebend_her_left_and_rotate_her_left\" >E. Stand on her right side, extend at T7, sidebend her left and rotate her left<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\">A 60-year-old woman presents to the clinic with two weeks of mid-back pain. She was recently hospitalized for&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Acute_pancreatitis\" target=\"_blank\" rel=\"noreferrer noopener\">acute pancreatitis<\/a>&nbsp;and underwent a laparoscopic cholecystectomy. The back pain started during the hospitalization and is a dull ache that occurs intermittently throughout the day. Her past medical history includes&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism<\/a>&nbsp;for which she takes&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism_medications\" target=\"_blank\" rel=\"noreferrer noopener\">levothyroxine<\/a>&nbsp;50 mcg daily. Her vital signs are within normal limits. On physical examination her lungs are clear to auscultation. Her abdomen is scaphoid, she has normoactive bowel sounds and no abdominal tenderness to palpation. Examination of her thoracic spine shows the transverse process at T7 is more prominent on the left and evens out with the other transverse process when she extends her back. How should the physician position themself and the patient to treat her thoracic somatic dysfunction with muscle energy?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Stand on her left side, keep her neutral at T7, sidebend her right and rotate her right<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Stand on her left side, flex at T7, sidebend her left and rotate her left<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Stand on her left side, extend at T7, sidebend her left and rotate her left<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Stand on her right side, flex at T7, sidebend her right and rotate her right<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Stand on her right side, extend at T7, sidebend her left and rotate her left<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University of Otago in New Zealand\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Wp3qRm_3X0Q?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Stand_on_her_right_side_flex_at_T7_sidebend_her_right_and_rotate_her_right\"><\/span>D. Stand on her right side, flex at T7, sidebend her right and rotate her right<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s OMM Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Stand_on_her_left_side_keep_her_neutral_at_T7_sidebend_her_right_and_rotate_her_right\"><\/span>A. Stand on her left side, keep her neutral at T7, sidebend her right and rotate her right<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While the sidebending and rotation here are correctly taking her into her barrier, she should also be flexed to fully engage her barrier.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Stand_on_her_left_side_flex_at_T7_sidebend_her_left_and_rotate_her_left\"><\/span>B. Stand on her left side, flex at T7, sidebend her left and rotate her left<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While flexing her at T7 is moving her toward her barrier, left sidebending and left rotation are in her direction of ease.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Stand_on_her_left_side_extend_at_T7_sidebend_her_left_and_rotate_her_left\"><\/span>C. Stand on her left side, extend at T7, sidebend her left and rotate her left<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Positioning her in this way would be moving her further into her somatic dysfunction (motion of ease).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Stand_on_her_right_side_extend_at_T7_sidebend_her_left_and_rotate_her_left\"><\/span>E. Stand on her right side, extend at T7, sidebend her left and rotate her left<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Positioning her in this way would be moving her further into her somatic dysfunction (motion of ease).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Diagnosing_thoracic_spine_somatic_dysfunction\" target=\"_blank\" rel=\"noreferrer noopener\">Type 2 somatic dysfunctions at the thoracic spine<\/a>&nbsp;occur in flexion or extension, and rotation and sidebending are to the same side (e.g. T6 F S<strong><sub>R<\/sub><\/strong>&nbsp;R<strong><sub>R<\/sub><\/strong>). Depending on the patient\u2019s size and position, you can treat from either their left or right side. This patient\u2019s somatic dysfunction is T7 E S<strong><sub>L<\/sub><\/strong>&nbsp;R<strong><sub>L<\/sub><\/strong>, so whether you stand on her left or right side, you should be flexing her at T7, sidebending her right and rotating her right.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Position the patient into their barrier by moving exactly opposite of their somatic dysfunction. As you slowly engage the barrier for 3-5 seconds, instruct the patient to gently resist by returning their head toward neutral (i.e. moving it in the direction of their freedom of motion). After each time you engage their barrier, let them rest for a few seconds while you very slowly engage the next barrier.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Diagnosing_thoracic_spine_somatic_dysfunction\" target=\"_blank\" rel=\"noreferrer noopener\">Type 2 somatic dysfunctions<\/a>&nbsp;involve flexion or extension, and rotation and sidebending to the same side. In order to treat, stand on whichever side of the patient is more comfortable and move them toward their barrier.<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"994\" height=\"356\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_04dd2b.png?w=994\" alt=\"\" class=\"wp-image-1696\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_04dd2b.png 994w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_04dd2b.png?resize=300,107 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_04dd2b.png?resize=768,275 768w\" sizes=\"auto, (max-width: 994px) 100vw, 994px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><br><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?<\/strong><\/em><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>&nbsp;Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 60-year-old woman presents to the clinic with two weeks of mid-back pain. She was recently hospitalized for&nbsp;acute pancreatitis&nbsp;and underwent a laparoscopic cholecystectomy. The back pain started during the hospitalization and is a dull ache that occurs intermittently throughout the day. Her past medical history includes&nbsp;hypothyroidism&nbsp;for which she takes&nbsp;levothyroxine&nbsp;50 mcg daily. Her vital signs are [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1760,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,34,16],"tags":[],"class_list":["post-1757","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Thoracic Muscle Dysfunction - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-dysfunction\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Thoracic Muscle Dysfunction - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 60-year-old woman presents to the clinic with two weeks of mid-back pain. She was recently hospitalized for&nbsp;acute pancreatitis&nbsp;and underwent a laparoscopic cholecystectomy. The back pain started during the hospitalization and is a dull ache that occurs intermittently throughout the day. Her past medical history includes&nbsp;hypothyroidism&nbsp;for which she takes&nbsp;levothyroxine&nbsp;50 mcg daily. 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