Thoracic mobilization

1- Anterior directed central gliding This widely used extension technique is suitable for midline or bilateral pain. Position of the patient: The patient lies prone and relaxed. If possible the top of the couch should be lowered so that partial forward flexion of the thoracic spine can be achieved. The arms should lie over the side of the couch or abducted with the hands resting at the head of the couch or under the patient's head. Position of the therapist: - The therapist stands by the patient's side and places the pisiform prominence or lateral border of the bone of the fifth metacarpal over the spinous process. also, the pads of the thumbs may be used. - It is important to be well above the patient so that the arms are straight and the therapist shoulders directly above the spine of the patient. Method: A firm controlled oscillatory pressure is applied by transmitting the body weight through the arms to the hands. Time span The mobilization should be applied for approximately 30 to 60 seconds, with two or three repeats in one treatment session. 2. Anterior directed unilateral gliding: The technique is similar to that of the central method but is used for unilateral pain where the painful lesion is located lateral to the spinous process. It is usually directed to a painful apophyseal joint which is 2-3cm from the midline. 3. Transverse directed rotational gliding: This method is used for unilateral pain and produces a rotational mobilization via pressure applied to the side of the spinous process at the affected vertebral level. The direction of the pressure should always be towards the painful side.