Thoracic spine manipulation made easy

Posted: April 27, 2013 in Uncategorized

This will be another quick video blog explaining the thoracic spine manipulation roll down technique  Personally I really enjoy this technique because if done on the appropriate patient, almost immediate relief can be obtained. I will stop right now and say only those who have spinal manipulation within their scope of practice should be attempting this. You must also be very confident in knowing who to and more importantly, who NOT to do this technique with. Here are a list of some contraindications for spinal manipulation (reasons why it should not be done)

  • Recent spinal fracture (duh)
  • Bilatareal/Quadralateral numbness/tingling
  • Constant pain/night pain
  • Osteoporosis
  • Lack of consent (you would be surprised how many times I’v heard patient stories of a practitioner just manipulating away without even telling the patient what they are about to do)
  • Pain in the premanipulative hold
  • This is a personal contraindication…I do NOT manipulate children under 13 and adults over 65

Here are some reason why I would choose to do a Thoracic manip

  • Chronic loss of thoracic spine mobility…could be a stability issue though, so that should be rulled out too
  • Pain with inspiration
  • Chronic loss of shoulder mobility/ROM (please see JOSPT ‘The Effects of Thoracic Spine Manipulation in Subjects with Signs of Rotator Cuff Tendinopathy for more information
  • Cervical spine pain/headaches/Stiffness (please see The Journal of Manual & Manipulative Therapy, 2008: 16(2): 93-99. “The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial” for more information

Keep in mind that I am still new to the video blog entries and as such, I need to practice my camera angles/mic control. I know it’s pretty small but now I know to film horizontal with my iPhone and not vertically…I will get better, not to worry 🙂

Importance of thoracic spine extension in shoulder elevation

A great patient buy-in outcome measure I like to do pre and post manip is bilateral arm elevation. If the client is restricted with upper thoracic extension they will have difficulty getting those last few degrees of bilateral shoulder flexion because a lot of the end range shoulder flexion comes from the spine going into extension. Have the patient raise their arms over their head, note restriction and pain levels, do manip and then re-test. If this helps, the patient will notice right away and…bam, instant credibility

Explaining the technique on a spine model:

Demonstrating the technique on a real person (the film got turned off too fast and I was about to say that after the manip is done I always check patient response to see if they are feeling good.

Thank you for reading and if you have any pointers, questions or comments I’m always happy to answer

  1. Jesse,
    Nice elaboration and references for your content. Keep up the good work!

  2. Carol Marcus says:

    Jesse, I had a total right knee replacement in Scottsdale Sept 5, 2013. I will be in Toronto for 2 weeks Oct 22 to Nov 4 and don’t know where you are now. Please send contact info. I was impressed with your treatments following my rotator cuff surgery a year ago. Carol

  3. Jen says:

    My PT just performed thoracic spine manipulation on me Thursday. Today I have had pain in my chest and upper middle back – it hurts to breathe deep and cough. Is this normal?

  4. Private says:

    Dangerous technique which caused me injury and constant pain. Pure quackery.

    • Bruce G says:

      Private, can you elaborate please. I am an Australian physiotherapist, and this technique is considered the least risky of all spinal manipulations. Jesse has explained very well when and when not to use it.

  5. jessephysio says:

    I’m sorry you had a bad result with this manipulation. There is no evidence that i know of that demonstrates a quantifiable risk to utilizing this technique on the right person. A prudent therapist would first have both the technical and theoretical knowledge about how to perform the manip, but also know the contraindications for it. There is good evidence that this manip can help with neck and shoulder pain, along with decreased paraspinal muscle tone (transient, albeit).

    Please let me know if you have any questions about this or any other technique or treatment,

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