west end physiotherapy Vancouver thoracic pain therapy
Thoracic Joint & Rib Dysfunctions

The thorax is the part of your body between your neck and lower back. Joints in this section, including the ribs, can get yanked out of alignment through sport, fall, seatbelts in an accident and at work. Mal-alignments are also caused by compressive forces through the arms and upper body as well as poor movement patterns and posture.

Case Study - Thoracic joint pain after trauma

  • 42-year-old female patient was complaining of left-sided pain in her thoracic spine at T 9 – 12.
  • She had injured herself 15 years ago riding a ski-doo when it hit a bump, flew up in the air and landed really hard.
  • The impact had injured the capsules (made up of ligaments to hold joints together) surrounding the facet joints between T9-10, T10-11 and T11-12 and led to shortening and scarring.
  • On examination, bending forward revealed limited forward and upward mobility of the left side of the vertebrae.  It was left behind compared to the right side.
  • Treatment consisted of deep friction massage, muscle energy techniques and stretches to the joint capsule to break up adhesions, restore normal forward and upward gliding and allow greater extensibility of the ligamentous joint capsule.
  • After 2 sessions, she reported it was the first time in 15 years that she woke up in the morning without pain.

Case study - Neck pain due to mal-aligned first rib

  • This was an interesting case of a 35-year-old female patient because the pain would only occur in the morning on waking.  During the day, the problem did not occur from working on the computer as is commonly seen.
  • When I assessed the joints of her neck and shoulder blade, things seem to be in good working order.  But then lying on her right side, the pain emerged in the right neck and upper shoulder blade area.

(The best way to find the culprit is to observe for mal-alignment, make a correction and wait for a relief of symptoms in the pain-producing position.)

  • Corrections in the neck did not make a difference, neither did shoulder blade re-positioning.
  • She mentioned that “it felt stuck”, so immediately I went to the first rib and its connection to T1 vertebra. When I corrected the position of the right first rib and tractioned the joint between T1, she immediately reported pain relief.
  • On closer examination, first rib was stuck in a position of expiration. After muscle energy techniques and soft tissue massage, it was back in its symmetrical alignment and able to fully reach its position of inspiration.
  • Re-testing in right side lying no longer reproduced pain.

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