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MCPA I'CAMT

THE THORAX An Integrated Approach

DIANE LEE BSR (Honours), FCAMT

Wh i te Rock, British Columbia, Canada

Copyright 2003 Diane C. Lee Physiotherapist Corporation

ISBN 0-9732363-0-2

For my momI

will always remember for both of us For my dad and my brother unconditional love

PREFACE, 1ST EDITION In the literature pertaining to back pain, the musculoskeletal components of the thorax have received little attention. The reference list at the end of this text reRects the paucity of research available for review. And yet, clinicians are presented daily with the challenge of treating both acute and chronic thoracic pain. It was this challenge which initiated the clinical work presented in this text. A biomechanical approach to treatment of the thorax requires an understanding of its normal behaviour. Without a working model, the clinician is limited to using unreliable symptoms for direction and treatment planning. If the optimal behavior of the thorax is understood, then this knowledge can be applied to the examination of the painful thorax. A systematic examination of mobility/stability of the associated bones and joints can then be done. Since function is related to structure, an understanding of the anatomy is required. The clinical investigation began in J990 when Jan Lowcock presented a paper on stability testing of the thorax to the Canadian Orthopaedic Manipulative Physiotherapists. I am indebted to her, and many others, for the subsequent academic and clinical discussions which lead to the evolution of the bio­ mechanical model presented here. Much of this material remains empirical and requires validation through research. The First chapter reviews the anatomy of the thorax as it pertains to the biomechanical model. The emphasis has been placed on osseous and articular anatomy although the muscular and neural con­ tribution to function is acknowledged. Chapter two describes the biomechanical model and chapters three to five the clinical application of this model to examination and treatment of the thorax. The purpose of this text is to provide the clinician with the ability to assess and treat articular dysfunction of the thor!tion of

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