THORACIC SPINE – WHY MOBILITY MATTERS

Correct sitting posture, whether or not your work station is ergonomically sound, is a hard habit to maintain. Poor sitting habits, due to the repetition and/or duration, are considered a repetitive stress injury. Constant flexion to the spine causes deformation of the supportive anatomy that holds us upright. This phenomenon is known as creep, a condition where passive, supportive structures such as ligaments and joint structures are stretched. As a result, the mobility of our spine becomes limited and the supportive musculature cannot function properly. Compromised movement of the thoracic spine increases the stress to the adjacent joints and tissues.

Thoracic flexion should measure 20 – 45, extension 25 – 45 degrees, lateral flexion 20 – 40 degrees, and rotation 35 -50 degrees. Compared to other joints, this is a wide range for accepted movement, so moving towards the higher number is to our benefit.  From a chiropractic perspective, joint manipulation is very effective here, particularly at the cervicothoracic and thoracolumbar junction. Daily mobilization and stretching techniques are just as important and can easily be performed at home or in the gym.

Because shoulder mobility is closely tied to thoracic mobility, before we can consider the movement of the shoulder, we must look at the posture and movement of the thoracic spine. Patients with poor thoracic extension often present with impingement (secondary) issues. Therefore, improving thoracic spine mobility will also improve shoulder mechanics. For example, try flexing the shoulder while sitting in a slouched posture and you will experience limited motion and possibly discomfort or pain as you raise the arm. Conversely, forward shoulder flexion with an extended thoracic spine clears the subacromial space allowing the glenohumeral joint to move freely. Once this is established, we can move distal to the scapula stabilizers and the glenohumeral joint when considering movement dysfunctions and other pathologies.

Reiner D.C., Jennifer, Mobility Matters: DB Strength

Cook, Gray. Athletic Body in Balance. Champaign: Human Kinetics. 2003.

Cook, Gray. Movement. Lee Burton, Kyle Kiesel, Dr. Greg Rose, and Milo Bryant. Santa Cruz: On Target Publications. 2010.

Magee, David J. Orthopedic Physical Assessment. 4th Edition. Philidelphia: Saunders. 2002.

Reischl, Stephen F. Noceti-DeWit , Lisa M., Current Concepts of Orthopaedic Physical Therapy. The Foot and Ankle: Physical Therapy Patient Manageemnt Utilizing Current Evidence. Orthopaedic Section, APTA, Inc. 2006.

Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby. 2002.

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Thoracic outlet syndrome (TOS) is a set of symptoms due to compression and/or irritation of these vessels and nerves.  There is much controversy among physicians and diagnosing this syndrome is very difficult.  It is often confused with carpal tunnel syndrome, brachial plexus syndrome, rotator cuff syndrome and bursitis.

Causes:

1. Disc protrusion, herniation or degeneration causing nerve impingement
2. Brachial plexus entrapment or subclavian artery compression in the interscalene triangle (usually between anterior and medial scalene)
3. Impingement at the cervico-axillary canal or the costo-clavicular space (1st rib) -could be from carrying a heavy shoulder bag or bad posture
4. Fibrositis of the cervical and shoulder area (pectoralis major and minor, the posterior cervical triangle)
5. Cervical spondylosis -irritation or compression of the C3-C8 spinal nerves causing increased tension and spasm in anterior scalene muscles.
6. Extra first rib (cervical rib)
7. Bone spurs on cervical vertebrae (may be called extra first rib)
8. Trauma such as whiplash (hyperextension) or other injury to the neck that results in scar tissue formation in scalenes which lead to compression
9. Trauma to the shoulder
10. Old fractures of the clavicle that limit space for vessels.
11. Postural distortions caused by pec minor and minor, SCM, scalenes, trapezius, levator scapulae; forward head, rounded shoulders, scoliosis, kyphosis
12. Loss of curvature in the neck due to Longus coli shortening
13. Excessive exercise leading to shortening of the shoulder and neck muscles
14. Shallow breathing -hypertrophy of scalene muscles
15. Postural changes due to pregnancy
16. Anterior scalene tightness
17. Pectoralis minor tightness

Signs/Symptoms:

1. Paresthesia of the hand most commonly little finger, medial forearm and arm; Pins and needle feeling
2. Weakness in trapezius
3. Swelling or puffiness in arm or hand
4. Bluish color in hand, coldness in hand and fingers due to loss of circulation: insufficient blood supply due to compression of subclavian artery
5. Muscles in hand atrophy in chronic conditions
6. Edema/swelling in hand caused by compression of subclavian vein
7. Raynaud's phenomenon
8. Pain in neck
9. Weakness in hands and arms especially when raising overhead
10. Dull shooting pain down the arm
11. Feeling of heaviness in arms
12. Difficulties with fine motor skills of hands

Treatment Goals:

1. Release adhesions causing nerve entrapment, reduce muscle spasming or contractures causing nerve entrapment via manual therapy or instrument assisted soft tissue mobilization (Graston Technique).
2. Trigger point therapy for all muscles of the shoulder, neck and upper back: scalenes, trapezius, SCM, pectoralis major and minor, subclavius, rhomboids.
3. Correct postural deviations with orthopedic evaluation of how shoulders and neck are influenced by the mobility/lack of mobility of the scapulae and thoracic spine.
4. Re-educate and increase awareness of posture via basic principles of exercise rehab for scapula stabilizers including middle/lower trapezius and serratus anterior.
5. Daily stretching routine for the pectoralis minor and major, anterior and middle scalene and upper trapezius.

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The IntelliSkin shirt stimulates these nerve endings to send specific cues to the brain that cause your tight, over-used, under-stretched muscles to relax and the opposing under-used, under-toned muscles to simultaneously contract, tone and move to protect your body’s structure*. The constant flow of information back and forth from the nerve receptors in the skin to the brain provide subconscious “coaching,” instructing muscles to work together, function and protect more efficiently.

Muscle memory is created by maintaining improved posture and ergonomics during repetitive daily movements and activities such as training, driving, sitting at the computer and yard work.

* Sherrington’s Law of Reciprocal Inhibition

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