Cervical Spondylosis with left sided breast/chest heaviness?

[sharileedahl]

I agree with the above post that it will be very important and revealing to assess the Tsp. Alot of the symptoms sound very sympathetic-y / thoracic-y (sorry...can't think of REAL words!).
If she is habitually sitting with a flexed Tsp as you noted, she is likely extending through her mid-Csp +++ just to be able to look forward therefore closing down the Csp facets and foramen even more than they are just with the spondylosis.
Therefore, check mobility of Tsp (including ribs) and treat appropriately; educate and train re. posture (as much as is possible given anatomical / arthritic constraints); mobilize the Csp as much as possible.

[jerryhesch]

i agree with las tpost. another thought re the comment aboutt diffficulty reducing "poke chin/forward head". You cannot effectively reduce this in this type of client without increasin extension below. If head and a few cervical segments needs to glide posteriorly, something has to glide anteriorly. Extension and anterior glide is often lost at T1-2-3-4, so using a fulcrum such as a firm rubber ball for 5 minutes per segement and doing same to the ribs, then working on inferior glide to ribs will help this immensely.
Jerry hesch

[jacinta]

Extension and anterior glide is often lost at T1-2-3-4, so using a fulcrum such as a firm rubber ball for 5 minutes per segement and doing same to the ribs, then working on inferior glide to ribs will help this immensely.

hi jerry & sharileedahl,

thanks for ur replies guys!
but jerry, smthg that i don understd.
The highlighted part in above quote, how do i do it? mind u guide me?
I was doing some reading on her condition,
was thinking of can Tx Outlet Syndrome(TOS) be the cause??
will do detail ax on her next visit next wk.
keep u guys posted soon.

jacinta

[jerryhesch]

supine too painful , in standing against wall with rubber ball of 2-3" diameter against spinous process of T1, repeat t2-3-4 while tucking chin. repeat at rib joints just lateral to trnsverse processes. 2-5 minutes each
Jerry hesch

[sharileedahl]

TOS is definitely another thought and worth ruling in/out. Based on your client's posture and tightness in upper traps etc. it is a reasonable thought that the thoracic outlet could be affected.However, based on the symptoms that you have noted I wouldn't expect it to be the main problem. Definitely continue with your assessment though!
Another thing I wanted to add to my last post is that it is unlikely that trigger points are causing the poroblem but releasing them may at least give your client some relief and buy you more time while you try to sort out the real issue. (i.e. some clients will give up on you too soon if they don't get some relief right away) You mentioned upper traps and lev. scap........also check pecs (major and minor), subclavius....

[alpana]

Hi Sharileedah,
I appreciate the suggestions given by Jerry regarding the T1-T4 mobility with the mobility of ribs. I will be more interested to check the status of your patient's latissimus dorsi on her left side. as you must be knowing that latissimus dorsi helps in maintaining the supero-lateral tension of the thoraco-lumbar fascia (TLF). Any slackness in the TLF also slackens the lumbar and cervical core muscles and this leads to slouched posture and expended neck.

Weakness in latissimus dorsi may be accompanied with tightness of pectoralis major and internal intercostals thereby limiting the mobility of ribs. So instead of mobilizing the ribs and vertebrae, first try to stretch the pectoralis major and minor, emphasize on lateral costal breathing, strengthening of latissimus dorsi, and work on core stabilization of lumbar and cervical muscles. This will help your patient with total relief. You may require total of 10 sittings.

But again prognosis depends on presence/absence of radiological evidence of thoracic facet joint arthritis.

Please keep informed.

[linbin]

hi
i did n't understand the relation between lattisimus dorsi slackness and cervical core muscle.i agree with the relation between TDF and lattisimus dorsi and lumbar area

[jerryhesch]

I respectfully disagree re stretching versus mobilization of T spine and ribs. Most adults develop a loss of accessory motions of the spine and ribs due to thise things call chairs, couches/sofas, and automobiles. stretching is important indeed but you must still test accessory motions of the upper 4 ribs. Specifically, test P-A glide just lateral to the spinous processes. Merely applying a P-A force after taking up the slack will lift the rib slightly off of the transverse process and off the relevant vertebral bodies and disc. People tend to develop some kyphosis and restoring this and P-A at upper 4 thoracic segments restores normal accessory motions (or at very least improves them). Another important accessory motion is anteromedial glide (costal).
Before and after you do the stretching you can test the accessory motions. It is unusual for stretching alone to restore normal motion. Spring is an emergent property of connective tissue such as costovertebral and costochondral joints.
A thorough review of capsular and ligamentous (and golgi tendon organ) mechanoreceptors adds to the relevancy.
lastly, re first rib, go beyond what normal mechanics describe and evaluate pathomechanics, recognizing the it can be evaluated anteriorly and posteriorly. It can compress medially, laterally, superiorly and inferiorly.
Yes, this is only a part of the evaluation and treatment, but relevant and effort is very generously rewarded by the body's response.
jerry hesch, mhs, pt
Hesch Seminar
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[jacinta]

hello all,

thanks again for all the replies.
tomorrow the pt will turn up for her treatment
I shall look into her Tx region and re-ax
keep u guys posted again.
hope to produce some good outcome

Sincerely,
Jacinta