Joint Manipulation: Thoracic Spine

Introduction

This course describes joint manipulation techniques for the thoracic spine (mid and upper back manipulation). Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion and specifically glide or slide). Research does imply that manipulations likely affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a relatively rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the thoracic spine (and cervicothoracic junction), improve spine range of motion (ROM), improve mobility of the rib cage, and potentially reduce scapular dyskinesis (altered shoulder blade motion) and upper extremity dysfunction. For example, research has demonstrated a correlation between thoracic kyphosis, excessive anterior tipping of the scapula, and shoulder impingement syndrome (SIS), and the addition of thoracic manipulations have resulted in improved short-term and long-term outcomes for SIS patients. These techniques may also be used in an integrated approach for cervicothoracic dysfunction and upper body dysfunction (UBD) including cervicogenic headache, shoulder instability, lateral epicondylitis (tennis elbow), chronic thoracic pain, T4 syndrome, chronic neck pain, and acromioclavicular dysfunction. Additionally, thoracic manipulations may be beneficial for individuals exhibiting postural dysfunctions including rounded shoulder posture, forward head posture, thoracic kyphosis, or an anterior pelvic tilt.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Cervicothoracic Junction Manipulation
• Thoracic Screw Manipulation
• Thoracic Pistol Manipulation

Related Courses

Additional Joint Mobilization Courses

• Joint Manipulation: Cervical Spine
• Joint Manipulation: Thoracic Spine
• Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis
• Joint Manipulation: Elbow (Radial Head) and Wrist
• Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

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    • Cervicothoracic Junction
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    • Shoulder Pain and Dysfunction
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    • TMJ and Thoracic Manipulation (21 - 23)
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    • Thoracic Spine Pain and Thoracic Manipulation
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    • Lateral Epicondylagia and Thoracic Manipulation
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    • Thoracic Manipulation and Low Back Pain
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    • Comparing Techniques
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    • Comparing Thoracic Manipulations
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    • Mobilization versus Manipulation
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    • Analgesia
85. Martínez-Segura, R., De-la-Llave-Rincón, A. I., Ortega-Santiago, R., Cleland, J. A., & Fernandez-De-Las-Penas, C. (2012). Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 42(9), 806-814.
86. Terrett, A. C., & Vernon, H. (1984). Manipulation and pain tolerance. A controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels. American journal of physical medicine, 63(5), 217-225.
87. Bishop, M. D., Beneciuk, J. M., & George, S. Z. (2011). Immediate reduction in temporal sensory summation after thoracic spinal manipulation. The Spine Journal, 11(5), 440-446.
88. McIver, S. (2003). The effect of manipulation on pressure pain thresholds in the thoracic spine (Doctoral dissertation, Victoria University).
89. Sparks, C., Cleland, J. A., Elliott, J. M., Zagardo, M., & Liu, W. C. (2013). Using functional magnetic resonance imaging to determine if cerebral hemodynamic responses to pain change following thoracic spine thrust manipulation in healthy individuals. journal of orthopaedic & sports physical therapy, 43(5), 340-348.
90. Jordon, M. K., Beattie, P. F., D’Urso, S., & Scriven, S. (2017). Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 25(4), 172-181.
91. de Araujo, F. X., Schell, M. S., Ferreira, G. E., Pessoa, M. D. V., de Oliveira, L. R., Borges, B. G., … & Silva, M. F. (2018). Autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: A randomized controlled trial. Journal of bodywork and movement therapies, 22(2), 313-320.
92. O’Neill, S., Ødegaard-Olsen, Ø., & Søvde, B. (2015). The effect of spinal manipulation on deep experimental muscle pain in healthy volunteers. Chiropractic & manual therapies, 23(1), 25.
    • Sympathoexcitatory
93. Minarini, G., Ford, M., & Esteves, J. (2018). Immediate effect of T2, T5, T11 thoracic spine manipulation of asymptomatic patient on autonomic nervous system response: Single-blind, parallel-arm controlled-group experiment. International Journal of Osteopathic Medicine, 30, 12-17.
94. Budgell, B., & Polus, B. (2006). The effects of thoracic manipulation on heart rate variability: a controlled crossover trial. Journal of manipulative and physiological therapeutics, 29(8), 603-610.
95. Ward, J., Coats, J., Tyer, K., Weigand, S., & Williams, G. (2013). Immediate effects of anterior upper thoracic spine manipulation on cardiovascular response. Journal of manipulative and physiological therapeutics, 36(2), 101-110.
96. Sampath, K. K., Botnmark, E., Mani, R., Cotter, J. D., Katare, R., Munasinghe, P. E., & Tumilty, S. (2017). Neuroendocrine response following a thoracic spinal manipulation in healthy men. journal of orthopaedic & sports physical therapy, 47(9), 617-627.
97. Ward, J., Tyer, K., Coats, J., Williams, G., & Kulcak, K. (2015). Immediate effects of upper thoracic spine manipulation on hypertensive individuals. Journal of Manual & Manipulative Therapy, 23(1), 43-50.
98. Plaugher, G., Long, C. R., Alcantara, J., Silveus, A. D., Wood, H., Lotun, K., … & Rowe, S. H. (2002). Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study. Journal of manipulative and physiological therapeutics, 25(4), 221-239.
99. da Silva, A. C., de Godoy Marques, C. M., & Marques, J. L. B. (2018). Influence of Spinal Manipulation on Autonomic Modulation and Heart Rate in Patients With Rotator Cuff Tendinopathy. Journal of chiropractic medicine, 17(2), 82-89.
100. Packer, A. C., Dibai-Filho, A. V., Costa, A. C. D. S., Macedo, A. B., Bortolazzo, G. L., & Rodrigues-Bigaton, D. (2015). Immediate effects of upper thoracic manipulation on the skin surface temperature of the vertebral region in healthy women. Fisioterapia e Pesquisa, 22(1), 54-60.
101. Sillevis, R., Cleland, J., Hellman, M., & Beekhuizen, K. (2010). Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 18(4), 181-190.
102. Welch, A., & Boone, R. (2008). Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. Journal of chiropractic medicine, 7(3), 86-93.
     • Systemic Response - Endocrine
103. Brennan, P. C., Kokjohn, K., Kaltinger, C. J., Lohr, G. E., Glendening, C., Hondras, M. A., … & Triano, J. J. (1991). Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. Journal of manipulative and physiological therapeutics, 14(7), 399-408.
104. Brennan, P. C., Triano, J. J., McGregor, M., Kokjohn, K., Hondras, M. A., & Brennan, D. C. (1992). Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. Journal of manipulative and physiological therapeutics, 15(2), 83-89.
105. Puhl, A. A., & Injeyan, H. S. (2012). Short-term effects of manipulation to the upper thoracic spine of asymptomatic subjects on plasma concentrations of epinephrine and norepinephrine—a randomized and controlled observational study. Journal of manipulative and physiological therapeutics, 35(3), 209-215.
     • Muscle Activity
106. Colloca, C. J., & Keller, T. S. (2001). Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain. Journal of manipulative and physiological therapeutics, 24(8), 489-500.
107. Herzog, W., Conway, P. J., Zhang, Y. T., Gal, J., & Guimaraes, A. C. (1995). Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study. Journal of manipulative and physiological therapeutics, 18(4), 233-236.
108. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. Journal of manipulative and physiological therapeutics, 28(7), 465-471.
109. Herzog, W., Scheele, D., & Conway, P. J. (1999). Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. Spine, 24(2), 146-152.
110. Nougarou, F., Pagé, I., Loranger, M., Dugas, C., & Descarreaux, M. (2016). Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application. BMC complementary and alternative medicine, 16(1), 161.
111. Sueki, D., Almaria, S., Bender, M., & McConnell, B. (2018). The immediate and 1-week effects of mid-thoracic thrust manipulation on lower extremity passive range of motion. Physiotherapy theory and practice, 1-11.
112. Pires, P. F., Packer, A. C., Dibai-Filho, A. V., & Rodrigues-Bigaton, D. (2015). Immediate and short-term effects of upper thoracic manipulation on myoelectric activity of sternocleidomastoid muscles in young women with chronic neck pain: A Randomized Blind Clinical Trial. Journal of manipulative and physiological therapeutics, 38(8), 555-563.
113. Cleland, J., Selleck, B., Stowell, T., Browne, L., Alberini, S., St. Cyr, H., & Caron, T. (2004). Short-term effects of thoracic manipulation on lower trapezius muscle strength. Journal of Manual & Manipulative Therapy, 12(2), 82-90.
     • Pulmonary function
114. Shin, D. C., & Lee, Y. W. (2016). The immediate effects of spinal thoracic manipulation on respiratory functions. Journal of physical therapy science, 28(9), 2547-2549.
115. da Silva, P. H. L., de Ré, D., Behne, G. R., Vazatta, M. P., & de Carvalho, A. R. (2013). Maximum respiratory pressure alterations after spinal manipulation. The European Journal of Physiotherapy, 15(2), 64-69.
116. Jung, J. H., & Moon, D. C. (2015). The effect of thoracic region self-mobilization on chest expansion and pulmonary function. Journal of physical therapy science, 27(9), 2779-2781.
117. Joo, S., Lee, Y., & Song, C. H. (2018). Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study. Journal of manipulative and physiological therapeutics, 41(7), 602-608.
     • Adverse Reactions
118. Rydell, N., & Räf, L. (1999). Spinal manipulation--treatment associated with a high risk of complications. Lakartidningen, 96(34), 3536-3540.
119. Puentedura, E. J., & O'Grady, W. H. (2015). Safety of thrust joint manipulation in the thoracic spine: a systematic review. Journal of Manual & Manipulative Therapy, 23(3), 154-161.
120. Ruelle, A., Datti, R., & Pisani, R. (1999). Thoracic epidural hematoma after spinal manipulation therapy. Journal of spinal disorders, 12(6), 534-536.
121. Hdeib, A., Goodwin, C. R., Sciubba, D., Bydon, A., Wolinsky, J. P., Witham, T., & Gokaslan, Z. L. (2016). Hemorrhagic thoracic schwannoma presenting with intradural hematoma and acute paraplegia after spinal manipulation therapy. International journal of spine surgery, 10, 42.
122. Senstad, O., Leboeuf-Yde, C., & Borchgrevink, C. (1996). Predictors of side effects to spinal manipulative therapy. Journal of manipulative and physiological therapeutics, 19(7), 441-445.
123. Sran, M. M., Khan, K. M., Zhu, Q., McKay, H. A., & Oxland, T. R. (2004). Failure characteristics of the thoracic spine with a posteroanterior load: investigating the safety of spinal mobilization. Spine, 29(21), 2382-2388.
124. Stemper, B. D., Hallman, J. J., & Peterson, B. M. (2011). An experimental study of chest compression during chiropractic manipulation of the thoracic spine using an anthropomorphic test device. Journal of manipulative and physiological therapeutics, 34(5), 290-296.
     • Additional Research
125. Fernández-De-Las-Peñas, C., Cleland, J. A., Huijbregts, P., Palomeque-del-Cerro, L., & González-Iglesias, J. (2009). Repeated applications of thoracic spine thrust manipulation do not lead to tolerance in patients presenting with acute mechanical neck pain: a secondary analysis. Journal of Manual & Manipulative Therapy, 17(3), 154-162.
126. Yang J, Lee B, Kim C. Changes in proprioception and pain in patients with neck pain after upper thoracic manipulation. J Phys Ther Sci. 2015;27(3):795-8.
127. Sung, Y. B., Lee, J. H., & Park, Y. H. (2014). Effects of thoracic mobilization and manipulation on function and mental state in chronic lower back pain. Journal of physical therapy science, 26(11), 1711-1714.