Thursday, April 15, 2010

Thoracic Anteriority/Rib Pain

Many times patients that are experiencing mid thoracic pain are given a diagnosis of a thoracic anteriority. This is then corrected by a common manipulative procedure where the patient is lying on their back and the doctor places his hand around the patient to the involved thoracic vertebra, then with his weight on the rib cage, a downward thrust is made. Some may tolerate the procedure but due to the lack of specificity and risk of rib injury, it is not the best way to correct a thoracic subluxation. The Gonstead system provides a much safer approach to correcting these types of problems.

When looking at the morphology of the thoracic spine it becomes clear that in order for a segment to move anterior with respect to the segment below there would have to be significant pathology. This is due to the coronal angle of the facet joints. Most of the time when you see a dishing of the thoracic spine it is due to extension compensation from a lower spinal segment. Another cause can be the imbrication of the long spinous processes in the mid thoracic region. Compensatory areas are often associated with tight and rope like musculature where the level of the problem will be edematous and flaccid on palpation. The best way to correct an intersegmental dysfunction of the thoracic spine is through careful analysis and specificity of the contact point. This can best be done with the patient in the prone position. Depending on the intersegmental relationships the contact point would be on either the spinous process or the transverse process of the involved segment. The line of drive would be through the disc plane line in a high velocity low amplitude type of thrust.

Patients sometimes will report that they have a rib out. Again the majority of the time it is due to the rotational component of a thoracic subluxation. By correcting the thoracic intersegmental dysfunction the rib pain will disappear. A good indicator that a rib has actually slipped posterior is acute pain on inhalation. If they do not have pain with breathing it usually is the thoracic segment. 

Please feel free to contact us if you have any questions.

Be Well
Scott Conklin DC