Thoracic Pain

[Sal703]

Hi All,

I have a patient for 4 weeks now for neck muscle spasms and headache which he's had for about 10 years. He saw chiro for who knows how long and he said they did a lot thoracic and cervical manipulations.. which did not help. I gave him some exercises, changed his pillow and the headache is gone as well as the neck pain. However, there is still constant pain on C7-T1 level, the spinous processes are very tender to touch. Pain with full cervical extension. I've done some prone thoracic mob, s/cs of the thoracic spine, upper back stretches and strengthening which did not help. The only thing that helps is isometric of the cervical spine in extension which gave some temporary relief. X-ray seems normal.

So do you have any ideas/suggestions/techniques to help the symptoms? i also wonder what is the effect of repetitive manipulation of the spine in terms of long term damage..(e.g scarring, arthritis.. )

Similar Threads:

• Lower Thoracic Pain
• Thoracic Pain
• HELP! 30yr Nurse; return of Lumbar/Thoracic pain & ongoing pain in buttock radiating front thigh
• Thoracic Back Pain. Please help me.
• Thoracic referred pain

[HercPehl]

Have you tried some facet joint tissue techniques? for the headache try the following releases: Superior oblique, both rectus capitis, oblique capitis and SCM. If those dont relieve the headache then assess the ROM of same side big toe for extension if ROM there is limited then there is you problem.
Also check pelvis in anterior pelvic tilt the SCM tends to stiffen up to balance C spine and head allignment.
Check ROM for rotation at that level if resctrited try rotares muscle releases
Manipulation is not helping since the problem is at the tissue you can perform manips as many and as long as you want it wont solve the problem cause the tissue dont let go. Possible damage from constant manips can occur deppends the age may be bad and then handling technique.
Techniques wise you need to tell me what you know till now to suggest you further handling.

[MrPhysio+]

Hi,
Long term joint manipulation is likely to cause ligamentous laxity at the facet joints that in turn results in perpetually tight cervical musculature because the brain interprets cervical laxity as dangerous to the nerve roots leading to a splinting of the muscles via increased resting tension. Ongoing muscle tension increase can give hyperplasic over reactive muscle, thgen the cycle repeats. Good for the over enthusiastic manip therapists that make lots of money from deluded but wrongly grateful patients!
Correct physio treatment requires patient re education and understanding of the problem. They will be keen to understand that money will be saved once the muscle / posture re-education is completed.

Try C6-7 facet joint mobilisation, but you will need to do quite deep (very uncomfortable) mobilisations to be effective. Prior to mthe mobilisation give deep friction massage to the Levatore scapulae origon onto the scapula then the same frictions over the lower scalene points on the facets (5,6,7). Tell the patient to do Levatore scapulae stretching exercise.

The reason for all the above is that the C6-7 level can refer to the inferior angle of the scapula, orbital facial headache and to the ipsilateral upper limb along the triceps and wrist extensors.

If the above does not assist quickly enough, try trigger point dry needling to the Levatore scap and scalenes.
Good luck and let me know how you get on.
Cheers,
MrPhysio+