Podcast
Questions and Answers
Which of the following is the PRIMARY goal of thoracic joint mobilization techniques as presented?
Which of the following is the PRIMARY goal of thoracic joint mobilization techniques as presented?
- To create structural changes in the thoracic vertebrae
- To induce a state of hypermobility for increased flexibility
- To modulate pain, improve joint movement, and address hypomobility (correct)
- To directly address muscle strength deficits in the thoracic region
Thoracic spine high-velocity, low-amplitude thrust (HVLAT) manipulation is CONTRAINDICATED in patients with which condition?
Thoracic spine high-velocity, low-amplitude thrust (HVLAT) manipulation is CONTRAINDICATED in patients with which condition?
- Muscle strains
- Osteoporosis (correct)
- Facet joint sprain
- Disc herniation
In a seated lateral glide mobilization of the thoracic spine, where should the therapist ideally position themselves relative to the patient and the side of restricted sidebending?
In a seated lateral glide mobilization of the thoracic spine, where should the therapist ideally position themselves relative to the patient and the side of restricted sidebending?
- Standing directly in front of the patient
- Standing on the contralateral side to the restriction
- Standing on the ipsilateral side to the restriction (correct)
- Standing behind the patient
During a seated lateral glide mobilization, the therapist's mobilizing hand should make contact with which anatomical landmark to induce lateral flexion?
During a seated lateral glide mobilization, the therapist's mobilizing hand should make contact with which anatomical landmark to induce lateral flexion?
In a seated central posterior-anterior (PA) mobilization, what is the recommended position for the patient's arms and forehead?
In a seated central posterior-anterior (PA) mobilization, what is the recommended position for the patient's arms and forehead?
Which part of the therapist's hand is typically used to apply pressure on the spinous process during a seated central PA mobilization?
Which part of the therapist's hand is typically used to apply pressure on the spinous process during a seated central PA mobilization?
What is the direction of force application during a prone central PA mobilization of the thoracic spine?
What is the direction of force application during a prone central PA mobilization of the thoracic spine?
For a prone unilateral PA mobilization, which hand contact options are appropriate for applying pressure?
For a prone unilateral PA mobilization, which hand contact options are appropriate for applying pressure?
During a 1st rib inferior mobilization, what is the purpose of inducing slight ipsilateral lateral flexion of the patient's neck?
During a 1st rib inferior mobilization, what is the purpose of inducing slight ipsilateral lateral flexion of the patient's neck?
In a 1st rib inferior mobilization, where should the lateral aspect of the 2nd metacarpophalangeal (MCP) joint of the mobilizing hand be positioned?
In a 1st rib inferior mobilization, where should the lateral aspect of the 2nd metacarpophalangeal (MCP) joint of the mobilizing hand be positioned?
Which of the following is considered a CONTRAINDICATION for thoracic HVLAT manipulation?
Which of the following is considered a CONTRAINDICATION for thoracic HVLAT manipulation?
For a prone HVLAT manipulation, at what height should the bed be ideally positioned relative to the therapist?
For a prone HVLAT manipulation, at what height should the bed be ideally positioned relative to the therapist?
During a prone HVLAT manipulation, where should the therapist's hypothenar eminences be placed to contact the facet joints?
During a prone HVLAT manipulation, where should the therapist's hypothenar eminences be placed to contact the facet joints?
In a prone HVLAT manipulation set-up, what is the purpose of 'taking up skin slack' by shearing hands in opposite directions?
In a prone HVLAT manipulation set-up, what is the purpose of 'taking up skin slack' by shearing hands in opposite directions?
For which region of the thoracic spine is prone HVLAT manipulation considered to be BEST suited?
For which region of the thoracic spine is prone HVLAT manipulation considered to be BEST suited?
In a supine HVLAT manipulation, what should the patient be instructed to do with their arms?
In a supine HVLAT manipulation, what should the patient be instructed to do with their arms?
During a supine HVLAT manipulation, where is the contact hand (using a firm but flat fist) typically placed to induce a posterior force?
During a supine HVLAT manipulation, where is the contact hand (using a firm but flat fist) typically placed to induce a posterior force?
In a seated HVLAT manipulation, what action does the therapist take with the patient's elbows to apply a posterior and superior force?
In a seated HVLAT manipulation, what action does the therapist take with the patient's elbows to apply a posterior and superior force?
What is the potential outcome for the patient during a seated HVLAT manipulation due to the rapid force application?
What is the potential outcome for the patient during a seated HVLAT manipulation due to the rapid force application?
Which of the following is NOT a primary category of therapeutic exercise interventions for the thoracic spine as presented?
Which of the following is NOT a primary category of therapeutic exercise interventions for the thoracic spine as presented?
Self soft tissue mobilization using a massage ball is categorized under which type of thoracic exercise intervention?
Self soft tissue mobilization using a massage ball is categorized under which type of thoracic exercise intervention?
Exercises like 'bow and arrow', 'thread the needle', and 'cat-cow/camel stretch' are primarily aimed at improving what aspect of thoracic function?
Exercises like 'bow and arrow', 'thread the needle', and 'cat-cow/camel stretch' are primarily aimed at improving what aspect of thoracic function?
Quadruped band-assisted rotation is an example of which type of thoracic exercise intervention?
Quadruped band-assisted rotation is an example of which type of thoracic exercise intervention?
Exercises like 'Rows', 'Ts and Ys', and 'Lat pull-downs' are primarily used for improving what aspect of thoracic function?
Exercises like 'Rows', 'Ts and Ys', and 'Lat pull-downs' are primarily used for improving what aspect of thoracic function?
A 43-year-old desk worker with mid-thoracic pain (T6), limited rotation, extension, and lateral flexion, and tender middle trapezius and rhomboids, would MOST likely benefit from which initial intervention strategy?
A 43-year-old desk worker with mid-thoracic pain (T6), limited rotation, extension, and lateral flexion, and tender middle trapezius and rhomboids, would MOST likely benefit from which initial intervention strategy?
In the presented patient case example, which specific mobility exercise is recommended as part of the intervention plan?
In the presented patient case example, which specific mobility exercise is recommended as part of the intervention plan?
For the 'Thera-band snow angels' exercise in the patient case, what repetition range is suggested, aiming to maintain some reserve capacity?
For the 'Thera-band snow angels' exercise in the patient case, what repetition range is suggested, aiming to maintain some reserve capacity?
After applying thoracic manipulation and mobility exercises, what is the NEXT recommended step in managing the patient in the case example?
After applying thoracic manipulation and mobility exercises, what is the NEXT recommended step in managing the patient in the case example?
Which of the following best describes the force application for seated thoracic extension manipulation?
Which of the following best describes the force application for seated thoracic extension manipulation?
In the context of thoracic interventions, 'graded exposure' is MOST relevant to which category of exercises?
In the context of thoracic interventions, 'graded exposure' is MOST relevant to which category of exercises?
What is a common indication for utilizing thoracic mobility exercises?
What is a common indication for utilizing thoracic mobility exercises?
When performing a prone HVLAT, why are elbows kept locked during the thrust?
When performing a prone HVLAT, why are elbows kept locked during the thrust?
Which patient position is shared between prone central PA mobilization and prone central PA assessment?
Which patient position is shared between prone central PA mobilization and prone central PA assessment?
What is the primary focus of 'motor control' exercises for the thoracic spine?
What is the primary focus of 'motor control' exercises for the thoracic spine?
For effective 1st rib mobilization, in which direction is the downward force applied through the 1st rib?
For effective 1st rib mobilization, in which direction is the downward force applied through the 1st rib?
What is the recommended number of repetitions for seated thoracic extension with a rolled towel in the patient case example?
What is the recommended number of repetitions for seated thoracic extension with a rolled towel in the patient case example?
Which of the following is an example of a 'strengthening' exercise specifically targeting the scapulothoracic region?
Which of the following is an example of a 'strengthening' exercise specifically targeting the scapulothoracic region?
What is the primary indication for using thoracic HVLAT manipulation?
What is the primary indication for using thoracic HVLAT manipulation?
Flashcards
Thoracic Mobilization
Thoracic Mobilization
Restore joint motion and decrease pain in the thoracic spine through manual techniques.
Thoracic HVLAT Manipulation
Thoracic HVLAT Manipulation
A high-velocity, low-amplitude thrust technique to address joint restrictions.
Thoracic Exercise
Thoracic Exercise
Exercises aimed at improving mobility, motor control, and strength in the thoracic spine.
Indications for Thoracic Mobilization
Indications for Thoracic Mobilization
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Seated Lateral Glide
Seated Lateral Glide
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Seated Central PA
Seated Central PA
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Prone Central PA
Prone Central PA
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Prone Unilateral PA
Prone Unilateral PA
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1st Rib Inferior Mobilization
1st Rib Inferior Mobilization
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Indications for Thoracic Manipulation
Indications for Thoracic Manipulation
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Contraindications for Thoracic Manipulation
Contraindications for Thoracic Manipulation
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Prone HVLAT Manipulation
Prone HVLAT Manipulation
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Supine HVLAT Manipulation
Supine HVLAT Manipulation
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Seated HVLAT Manipulation
Seated HVLAT Manipulation
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Thoracic Exercise Goal
Thoracic Exercise Goal
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Self Soft Tissue Mobilization
Self Soft Tissue Mobilization
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Mobility exercises for thoracic spine
Mobility exercises for thoracic spine
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Graded Exposure
Graded Exposure
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Scapulothoracic Strengthening
Scapulothoracic Strengthening
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Patient Case Example Intervention
Patient Case Example Intervention
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Study Notes
Objectives of Thoracic Spine Interventions
- Understanding and demonstrating thoracic spine joint mobilizations is key
- It's important to grasp and show high-velocity, low-amplitude thrust manipulations
- Coaching exercise interventions for the thoracic spine is a crucial skill
Overview of Thoracic Spine Interventions
- Thoracic mobilization
- HVLAT manipulation aids recovery
- Therapeutic exercise improves outcomes encompassing mobility, motor control/graded exposure, and strengthening
Mobilization Overview
- Pain modulation, hypomobility, and limited ROM are key indications
- Seated techniques include lateral glide and PA (posterior-anterior) extension
- Prone techniques include CPA (central posterior-anterior) and UPA (unilateral posterior-anterior) techniques
- 1st Rib Mobilization adresses specific restrictions
Seated Lateral Glide
- The patient sits with legs straddling the plinth, positioned at the edge
- The therapist stands on the same side as the restriction
- To enhance right sidebending, mobilize the right side
- Reach over the patient's shoulder to the opposite scapula
- The mobilizing hand contacts the spinous process on the affected side
- A lateral force goes through the mobilizing hand and into sidebend via the shoulder
Seated Central PA
- The patient is seated, facing a chair or plinth
- The therapist stands at the patient's side
- The patient crosses arms, resting their forehead on their forearms, with arms supported
- Contact is made at the spinous process using the hypothenar eminence
- Apply a force anteriorly while extending via the opposite arm
Prone Central PA
- Setup mirrors CPA assessment
- Contact is through the hypothenar eminence or using a "peace sign" hand position
- Apply force directly anterior
Prone Unilateral PA
- This setup aligns with UPA assessment
- Use either a dummy thumb or hyopthenar eminence for contact
- Apply force directly anterior
1st Rib Inferior Mobilization
- The patient is seated while the therapist stands behind
- Forearm contact induces slight ipsilateral lateral flexion to ease soft tissue tension
- The lateral 2nd MCP of the mobilizing hand is placed anterior to the upper trapezius
- Drag the upper trapezius back while applying a downward force
Manipulation Overview
- This aims to provide pain modulation, hypomobility, and ROM issues
- Contraindications include osteoporosis and fractures
- Techniques: Prone HVLAT, Supine HVLAT, Seated HVLAT
Prone HVLAT Manipulation
- The patient lies prone while the therapist stands perpendicular to the patient
- The bed should be at knee height or lower
- Contact is made at the facet joints with the hypothenar eminence, fingers pointing in opposite directions
- Apply skin slack
- Keep elbows locked and sink down to take up joint slack
- Utilize rapid force directly anterior, best applied for mid-thoracic issues
Supine HVLAT Manipulation
- The patient is supine, hugging their chest or a rolled towel, with the therapist to one side
- Ensure the opposite arm is on top
- Roll patient to the side and place contact hand with a firm fist
- The spinous process should be between fingers and the thenar eminence for TLJ manipulation
- Tuck patient elbows to your stomach and deliver force directly posterior into the table
- Best for the upper thoracic spine, but can target the mid-thoracic area as well
Seated HVLAT Manipulation
- The patient is seated, hugging their chest while the therapist stands behind
- A rolled towel can localize forces
- The therapist grabs the patient’s elbows to apply rapid force
- Apply a rapid posterior and superior force through the arms
- The patient may come off the table slightly
Exercise Overview
- Aims to treat pain modulation, limited ROM, weakness, and endurance deficits
- Components include: mobility, motor control/graded exposure, scapulothoracic and general strengthening
Mobility Exercises
- Self soft tissue mobilization/trigger point release improves mobility
- Dynamic stretches like bow and arrow, thread the needle, extension exercises and cat-cow stretch enhance range of motion
Motor Control/Graded Exposure Exercises
- Quadruped band assisted and resisted rotation
- Resisted bow and arrow
- Banded wall slide with lift-off increases control
Strengthening Exercises
- Scapulothoracic exercises strengthen
- Use rows, T's and Y's, snow angels, or Lat pull downs
Patient Case Example: Presentation
- A 43-year-old reports mid-thoracic pain at T6
- Exercises 3x/week (CrossFit)
- Limited rotation, extension, lateral flexion is present
- TTP in middle trapezius and rhomboids
- Experiences strong, painful muscle testing and end-of-workday pain that exercise alleviates
Patient Case Example: Interventions
- Thoracic HVLAT manipulation (prone or supine)
- Seated thoracic extension with rolled towel (10 reps at lower, mid, upper thoracic)
- Side-lying bow and arrow stretch (15 reps each side)
- Thera-band snow angels (3x8-12 reps with 2-3 reps in reserve)
- Retest limited motions after manipulation and mobility exercises
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