Other thoracic spine treatments
Notes
Thoracic spine
Other thoracic spine treatments
Below are several techniques that are less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. These lists are not fully inclusive but are meant to highlight some of the most common or useful applications of each technique.
ARTICULATORY
Diagnosis: Side bending somatic dysfunction
- With the patient prone, stand at the side of their side bending restriction and instruct them to turn their head toward you
- Place both of your hands in opposite directions around the paravertebral musculature at the involved vertebra, with the fingers of the hand closer to you pointing caudad
- With both hands, gently press downward (toward the table) to engage the patient’s spinal motion
- With both hands, pull the tissues longitudinally (parallel to the spine) in the direction of your fingers to engage the side bending barrier
- Hold the patient in this barrier for about a second, then release the longitudinal force
- Repeat steps 4 and 5 until motion is normalized at the involved vertebra
BALANCED LIGAMENTOUS TENSION
Diagnosis: T1–T3 dysfunction
Example: T2 F SRRR
- With the patient supine, sit at the head of the table
- Place your palms under C2 or C3 and your fingertips bilaterally at the transverse process of T2 and T3
- Gently lift the T3 transverse processes to find a point of disengagement between flexion and extension
- Gently side bend and rotate T3 to the left while adding minimal rotation of T2 to the right, until a point of balanced tension is palpated
- Hold this position until a release is palpated
Diagnosis: T4–T12 dysfunction
Example: T8 N SLRR
- Stand behind the seated patient
- Place your left thumb at the transverse process of T8, and your right thumb at the transverse process of T9
- While monitoring the transverse processes, instruct the patient to lean forward and then backward until a balanced point between flexion and extension is palpated
- Instruct the patient to gently side bend to the left and rotate to the right until a balanced point between side bending and rotation is palpated
- You may instruct the patient to take several deep breaths or to hold their breath for 10–20 seconds to help facilitate tissue release
SOFT TISSUE
Unilateral prone pressure
- With the patient lying prone, stand at the side opposite of the area to be treated
- Place palms of both hands (with one slightly overlapping the other) on the patient’s hypertonic thoracic paravertebral musculature
- Exert a gentle force downward (into the table) to engage the tissues, and then laterally
- Hold the force for a few seconds, then repeat steps 2 and 3 in a gentle, kneading fashion
Bilateral prone pressure with counterpressure
- With the patient lying prone, stand on either side of the patient
- Place the hypothenar eminence of one hand and the thenar eminence of the other hand around the hypertonic thoracic paravertebral musculature (so fingers of one hand point cephalad while the others point caudad)
- Exert a gentle force downward (into the table) with both hands to engage the tissues, and then in the direction the fingers of each hand are pointing, creating distraction of the tissues
- Hold the force for a few seconds, then repeat steps 2 and 3 in a gentle, kneading fashion
Thoracic with shoulder block, lateral recumbent method
- With the patient in the lateral recumbent position with the side to be treated up, stand facing the patient’s chest
- Pass the caudad hand under the patient’s axilla with the fingertips on the medial aspect of the patient’s paravertebral muscles
- With the cephalad hand, contact the anterior portion of the shoulder to provide a counterforce
- Exert a downward force to engage the tissues with the caudad hand, and then a lateral force to create a perpendicular stretch
- Hold the stretch for a few seconds and repeat steps 2–4 in a gentle, kneading fashion
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