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Continuing Education2 Credits

Joint Manipulation: Thoracic Spine

Joint manipulations for the thoracic spine. Types of manipulations, manipulations vs. mobilizations of the spine and thoracic spine. Optimal intervention for cervical pain, CTJ, shoulder pain, TMJ, elbow pain, thoracic spine pain, forward head, arms fall, scapula elevates, and epicondylitis (epicondylalgia). The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of thoracic spine manips.

Brent Brookbush

Brent Brookbush


Course Description: Thoracic Spine Manipulation


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:

Sample Intervention (Cervicothoracic Junction Pain)

Additional Joint Mobilization Courses

For an introduction to joint mobilizations and manipulations:


Research Summary

Research Corner: Cervical Spine

3 sub-categories

Research Corner: Thoracic Spine

6 sub-categories

Comparing Mobilizations and Manipulations

Systemic Response

Risk of Adverse Events

Video Demonstration

3 sub-categoriesvideo


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