Holistic Thorax Examination and Treatment

During one of our internal continuing education sessions at BodyLab osteopathy and Physiotherapy | Rehabilitation and Training in Zurich, we focused on the topic of "holistic thoracic examination and treatment."

A restriction of movement or dysfunction in the thoracic area can cause a wide variety of Conditions, which either cause local problems or pain (e.g., in the area of the thoracic spine (T-spine) or along the ribs) or trigger radiating sensations (e.g., in the arm, neck, and head area). This can sometimes happen due to the biomechanical connections between all of these involved joints: For example, when you turn your head, not only does your cervical spine (C-spine) rotate, but your thoracic spine down to about the 4th thoracic vertebra (T4) also moves along in the direction of the rotation.

And even when you raise your arm fully, the last degrees of shoulder movement must come from an extension in the thoracic spine, because the shoulder joint alone couldn't achieve the full range of motion. If, for instance, your spine or an involved joint doesn't move supportively, this can lead to an overload of the joints involved along with pain and symptoms and/or movement restrictions.

Anatomical Conditions

In theory, we first took a closer, more in-depth look at the various components of the thorax and their functions. The thorax includes the thoracic spine (T-spine), the ribs, the sternum, the intrathoracic fasciae, and the diaphragm.

Thoracic spine and ribs

The thoracic spine consists of 12 thoracic vertebrae and forms an anatomical kyphosis. The twelve ribs can be divided into usually 5–6 true (sternal) ribs, which are directly attached to the breastbone (sternum) via cartilaginous connections, 4 false (asternal) ribs that are attached to the costal arch via cartilage connections with the other ribs, and 2 floating ribs.

Each rib is connected to the thoracic spine via 2 different synovial joints (depending on the level, with a single vertebral body or with two different vertebral bodies and the intervertebral disc between them) as well as to the transverse process (P. transversus) of a thoracic vertebra.

Although you use your ribs with every breath and they must move along with movements of your thoracic spine, few people realize just how complex this entire system is and how many joints are involved. However, anyone who has ever had a locked, restricted rib knows just how uncomfortably painful it can be!

Sternum and manubrium

The sternum consists of three important parts: the manubrium sterni, the corpus sterni, and the xiphoid process (diaphragm).

You can observe this clearly on our skeleton, and you can also easily palpate it on yourself. You'll find the second rib at the junction between the manubrium and the body (corpus).

Diaphragm

The diaphragm, a muscle, stretches across the lower costal arch (arcus costae) and is also attached to the spine.

It became clear to us once again how important the diaphragm is and what a major influence it can have on the skeletal system, among other things. And how often this vital muscle is forgotten in therapy. Yet there are several regions and spots where the diaphragm is easily accessible and reachable for manual therapy interventions, both directly and indirectly! 

Intrathoracic fasciae

The most important intrathoracic fasciae include the pleura and the pericardium, which can be further anatomically subdivided and differentiated, attaching to the spine (pleura, C6/7), the cervicothoracic junction (CTJ, lig. vertebropericardiaca of the pericardium), and the manubrium or sternal body / diaphragm (lig. sternopericardiaca sup. and inf.). The structures of the thorax are connected to one another via the fascial system, and it makes sense that tension and potential problems can be transmitted through it to the skeletal system.

We immediately practiced palpating and feeling these structures on one another. It's always very exciting to switch roles and act as the "patient." In our view, one of the most important aspects of manual diagnostics is sensing and interpreting the end-feels. The end-feels provide important clues about which tissues aren't moving and functioning properly.

We took plenty of time, and with the support of our experienced therapists and osteopaths, we practiced on one another and were able to palpate, feel, and compare the end-feels and tensions of different individuals.

Because of all these biomechanical connections and the interplay between different parts of the body, organ fasciae, and structures, treatment might not take place directly at your current pain point, but rather at another, more distant location. It could be that your shoulder pain is treated at the front near the sternum (breastbone), thereby minimizing the pain in your shoulder. However, this requires an in-depth knowledge of body anatomy and represents the fine art of diagnostic interpretation.

This training made it clear to us once again that you should always look at the whole body. These interconnected systems very often explain why Conditions can return if the underlying, root causes haven't been treated and resolved. These workshops also offer room for engaging discussions and sharing experiences, something we foster and value at BodyLab. It also gives us space to get to know one another better within the team and in different settings. This helps us grow as therapists and as a practice, which naturally benefits our patients and clients as well. After training like this, you feel inspired and motivated to try out and apply new techniques, skills, or perspectives. And just like always at BodyLab, an intense, demanding training session wraps up with dinner together….

Thanks to our diverse specialists, BodyLab is ideally equipped for any problem.

Whenever you need us, we're here for you!

Your BodyLab team, your specialists for a freely moving rib cage

osteopathy and Physiotherapy | Rehabilitation and Training

Zurich Altstetten

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Cover image credit

anonymous, Vesalius 164frc, marked as public domain, details on Wikimedia Commons