Holistic Thorax Examination and Treatment

During one of our internal training sessions at BodyLab Osteopathy and Physiotherapy | Rehabilitation and Training in Zurich, we explored the topic of "holistic thorax examination and treatment."

A movement restriction or disorder in the thorax area can cause a variety of complaints that either create local issues or pain (e.g., in the thoracic spine area (TSP) or along the ribs) or cause radiations (e.g., to the arm, neck, and head area). This can occur due to the biomechanical connections of all these involved joints: For instance, during a head rotation, not only does the cervical spine (CSP) rotate, but the thoracic spine also rotates up to approximately the 4th thoracic vertebral body (T4) in the direction of the rotation.

Additionally, during maximal arm elevation, the last degrees of shoulder movement have to be achieved through extension in the TSP, as the shoulder joint alone cannot reach the full range of motion. If the spine or any involved joint does not assist supportively, it can lead to overloading of involved joints with pain and symptoms and/or movement restrictions.

Anatomical Characteristics

In theory, we reviewed the various components of the thorax and delved deeper into their functions. The thorax includes the thoracic spine (TSP), ribs, sternum, intrathoracic fasciae, and the diaphragm.

Thoracic Spine and Ribs

The TSP consists of 12 thoracic vertebrae and forms an anatomical kyphosis. The twelve ribs can be subdivided into 5-6 sternal ribs usually, which are directly attached to the sternum with cartilaginous connections, 4 asternal ribs which connect via cartilaginous joins with other ribs at the rib arch, and 2 free-floating ribs.

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

Although we need the ribs for every breath and they must move with thoracic spine movements, we are often unaware of how complex the whole system is and how many joints are involved. Anyone who has ever experienced a blocked, improperly functioning rib knows how disturbingly painful it can be!

Sternum and Manubrium

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

These components can be well observed on our skeletons, and they can also be palpated on oneself. The second rib is found at the transition from the manubrium to the corpus.

Diaphragm

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

It became once more clear how important and influential the diaphragm can be on the skeletal system, among other things. And how often the diaphragm, such an important muscle, is overlooked in therapy. There are a few regions and points where the diaphragm is quite accessible both directly and indirectly for manual therapeutic interventions!

Intrathoracic Fasciae

The most significant intrathoracic fasciae include the pleura and pericardium, which can be further anatomically divided and differentiated, and are anchored to the spine (pleura, C6/7), at the cervicothoracic junction (CTJ, vertebropericardial ligament of the pericardium), and at the manubrium or corpus sterni / diaphragm (superior and inferior sternopericardial ligaments). Through the fascial system, the structures of the thorax are connected, and it makes sense that tension and potential issues affecting the skeletal system can arise from this.

We immediately practiced palpating and exploring these structures on each other. It is always very exciting to switch roles and function as a "patient." One of the most important aspects of manual diagnostics from our perspective is feeling and interpreting the end-feels. End-feels provide crucial clues about which tissues are not moving and functioning properly.

We were able to take a lot of time, and with the support of our long-term therapists and osteopaths, we could practice on each other, palpating and comparing the end-feels of different people and their tensions.

Based on all these biomechanical relationships and the interplay of various body parts, organ fasciae and structures, it is possible that treatment is not done directly at the existing pain point but rather at another, distant location. It might happen that shoulder pain is treated at the front of the sternum, thereby reducing the pain in the shoulder. This requires, however, a profound knowledge of the body’s anatomy and is the art of diagnostic interpretation.

It became once more clear during this training that the whole body should always be considered. The connections very often explain why complaints can return if the underlying, actual causes are not treated and resolved. These training sessions also offer space for exciting discussions and exchanges of experiences, which we at BodyLab cherish and promote. It also provides space to get to know each other better in the team and under different circumstances. This furthers us as therapists, but also as a practice. Our patients and clients, of course, benefit from this. After such training sessions, one feels motivated to try and apply new techniques, skills, or perspectives. And as part of BodyLab, a shared dinner is an essential part after rigorous, intense training….

With various specialists, BodyLab is excellently equipped for any problem.

If you need us, we are gladly here for you!

Your BodyLab Team – Your specialists post-physical injuries

Osteopathy and Physiotherapy | Rehabilitation and Training

Zurich Altstetten

Title Image Credit

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