Thoracic Manipulation

Thoracic Manipulation Purpose: To treat pain from a variety of conditions. Step 1: 0:43 Start with the patient lying supine at the edge of the table closest to you. The table will need to be low (around knee height). Instruct the patient to “hug yourself tight”. Their hands should hold their scapulae and their elbows line up one on top of the other. If the patient has longer arms, you may need to have them hug a towel roll so that their elbows line up properly. Be sure they are hugging tight so that your force will transfer effectively. Step 2: 1:21 Have the patient flex the knee that is furthest from you, putting their foot flat on the table. Grip a cylindrical object such as a rolled up paper towel or chapstick in your 3rd-5th fingers as a buttress to protect your interphalangeal joints while using the “trigger finger” grip. Step 3: 1:52 Assist the patient to roll towards you. Palpate to find the segment you are targeting and apply the “trigger finger” grip. With the patient in this sidelying position, your finger should be pointing down towards the table so that your thenar eminence and middle phalange of your middle finger line up with the laminae of the targeted segment. Step 4: 2:41 Roll the patient back onto your hand (supine), checking to ensure that the patient is comfortable. Place your free hand on top of the patient’s elbows. You can use this hand to control the amount of flexion in their thoracic spine. Stay close to the patient and pivot your hips to face forward towards the head of the table. Your legs will end up scissored with your feet pointing forward in the same direction as your hips. Step 5: 3:10 Bring your chest down to meet your hand on top of the patient’s elbows. Using your bodyweight, exert a posterior force straight down through your hand, through the patient’s elbows into the table. Start slowly to take up the slack, then gently drop your body to apply a high velocity, low amplitude thrust straight down into the table. Be sure to explain the technique to your patient prior to administering it. Cite the evidence in terms of safety and efficacy. Explain that the patient may experience a “pop” due to cavitation, but that it is not necessary for the technique to be successful. Evidence: Childs, 2008. CPG pp. A20-21 Cleland et al., 2007 Gross et al. Manual Therapy, 2010 Leal and Dennison ISC 21.1.3 pp. 21-24