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Thoracic Spine Biomechanics & Therapy
Transcript of Thoracic Spine Biomechanics & Therapy
Senior Physiotherapist Back to Basics Movement Load Bearing
Biomechanics Thoracic Discs Thoracic spine thrust mobilization/manipulation
has significantly greater short-term reductions in pain and disability
Cleland et al 2007 Most Common Search Results Anatomic & Functional Difference 2 common patterns of clinical disorders: Posture, loading
Movement impairment Biomechanics & Implications 47% BW 9% BW ↑Vertebral body size
↑End-plate cross-sectional area
Bone content Ability to sustain increasing load Singer et al 1995 Failure load Lower Tx Mid Tx When Loadbearing fails Additionally, Mid-Thoracic Loading Mid Thoracic Loading Preferential loading thr anterior structures
Higher incidence of disc and vertebral body changes
≠ pain but it gives us an idea of the loading factor Corresponds to attachment of UL
(arms outstretched / do things),
increase load to Mid-Tx Intra-Discal Pressure
@ Different Postures Mid-Tx discs undergo greater deformation & creep
in response to a specific load than those in lower Tx & upp Lx
Koeller et al 1984 Min discal pressure Max Discal pressure 1.5-3x more pressure w load Abnormalities detected with MRI in 70% of normal adult population
Annular tear 58%
Cord compression 29%
End-plate irregulariteis 38%
Wood et al (1995) “Normal” Thoracic Discs MRI findings must be correlated to clinical presentation Implications Load tf thr posterior column formed by interlocking laminae and articular facets Lower Tx-Loading Shape of Vert Body & Disc LOG & resting m tone Posture No change to Tx kyphosis despite linear increase in EMG activity of ES.
Rather note non-linear increase in ab m
Hence optimal response is to maintain neutral curvature Response to loading Implication Why is he so hunched??? Ribcage provides additional stability
Enhanced further by an increase in intra-thoracic pressure (diaphragm, abs, intercostals)
Individual Tx vert is firmly attached
Req complete resection of ligaments/cv jt, disc/rib head resection Mechanical Stability of the Thoracic Spine
Fl / Ext
Anterior / Posterior Rib rotation
coupled w ipsilateral posterior rib rotation
Coupled w ipsilateral anterior rib rotation
Rotation coupled w contralateral SF Associated Mvt/Coupling Kinematics Contributes to normal Cx function & functional movt of Tx.
? Pain / restriction EOR Cx ROM
Reduced mobility of Cx Rot/SF
a/w lower cervical extension and posterior translation
& reduced kyphosis Upper Thoracic Region Limited mid tx mvt Large influence due to rib attachment Consider upp Tx mobility / rib mobility with limited EOR Cx ROM
Overhead activities & Shoulder pain?
R/v Tx / ribs Implication – Upp Tx Full arm elevation – link w Tx/Lx extension
Most of the rotation happens in Mid Tx
So if limited Mid-Tx mvt – elevate arm Tx rot will be limited and reproduce pain Ax Mid-Tx vs Lower Tx Rotation Apex of kyphosis
Anterior elements subjected to high compressive loads
May have progressive wedge deformity
Reduced mobility of mid-thoracic spinal & rib mvt
Esp rotation & extension
May have anterior osteophytic growth
Resulting in reduced mobility Age changes Mid-Tx Facet orientation change from coronal to sagittal
Dirn of Uni-lateral PA Implication Lower Tx Natural Kyphosis Polga et al 2004
Load in Ax and Rx Spinal Adaptation Regional Differences