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Area Shortened muscles Lengthened muscles

Clockwise

rotation Deep thoracic spine rotators on the right

Right internal oblique Left external oblique Left psoas

Left lumbar erector spinae Muscles that rotate neck to the left

Deep thoracic spine rotator on the left

Left internal oblique Right external oblique Right psoas

Right lumbar erector spinae Muscles that rotate neck to the right

Anti-clockwise rotation

Deep thoracic spine rotator on the left Left internal oblique

Right external oblique Right psoas

Right lumbar erector spinae Muscles that rotate neck to the right

Deep thoracic spine rotators on the right

Right internal oblique Left external oblique Left psoas

Left lumbar erector spinae Muscles that rotate neck to the left

What You Can Do as a Therapist

■ Appreciate that segments within the thorax can rotate to differing degrees, and patterns of activity between deep and superficial muscles vary within the thorax. For example, the action of multifidus may be to control motion at T5 and T8, and T11 may control coupling between rotation and lateral flexion movement (Lee et al. 2005).

Global exercises to help strengthen weakened muscles and lengthen shortened ones may be useful, but for effective correction of posture in this region, it is likely that a physiotherapist or osteopath needs to conduct an assessment. Focused on mecha-nisms required for restoring normal function (rather than postural correction), Lee (2008) highlights the importance of specific assessment in this region of the spine.

■ Help your client to identify and address causal factors. Are there any postures that involve rotation of the spine that the client maintains for prolonged periods?

■ Passively stretch shortened tissues of the thorax by facilitating a gentle stretch to the direction opposite to that which your client is rotated. For example, if your client is rotated clockwise, stretch the torso in an anticlockwise direction. Instead of trying to rotate the thorax while stabilizing the pelvis, it is safer to stabilize the thorax and rotate the pelvis (figure 4.8a). Exercise care when performing passive stretches of the spine in this manner to avoid overstretching and potentially harming your client. Recognize that this is a global stretch and will not necessarily address localized points of soft tissue restriction.

■ It may be useful to experiment with treatment positions. The stretch in figure 4.8b is commonly used to facilitate a stretch to the lateral side of the trunk and quadratus lumborum and could be useful in treating rotation.

■ Massage shortened tissues of the trunk. Massage is a technique that specifically addresses shortened tissues of the trunk. For rotation to the right (clockwise), you will need to address the deep thoracic spine rotators on the right, the right internal oblique and the left external oblique. Rotators are located deep to back extensors.

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Sometimes it is helpful to start by gliding down either side of the spinous processes using either your fist or forearm (figure 4.8c), assessing the tone of these muscles.

You can then work in a more focused way using your fingers to palpate and massage specific areas of localized tension.

roTATeD ThorAx

Figure 4.8 Therapist techniques for rotation of the thorax include (a) gentle passive rotation of the spine, (b) stretch to quadratus lumborum, experimenting with (c) side-lying positions or (d) the supine position to access the oblique muscles. (continued)

a

b

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roTATeD ThorAx

Figure 4.8 (continued)

c d

■ One way to access the obliques is to position your client on her side (figure 6.3a).

This helps to open the area and, with the use of pillows, may be combined with slight rotation of the torso.

■ When massaging obliques with your client in the supine position, take care not to press too hard beneath the ribs. Instead, experiment with asking your client first whether she can identify any tension in one side compared to the other side. Second, notice that when massaging this area, your client can facilitate a stretch. To do this, begin by gently pressing into the soft tissue as in figure 4.8d with the client’s arm resting to one side. Then ask your client to raise her arm (on the side you are work-ing) above the head, flexing at the shoulder until the arm is by the ear. This tenses the whole of the soft tissues on that side of the trunk, thus facilitating a stretch.

■ Address shortness in other areas of the body. If you are treating rotation of the thorax to the right (clockwise rotation), you will need to assess and address psoas and lumbar erector spinae on the left and treat muscles that rotate the neck to the left.

What Your Client Can Do

■ Identify and limit factors that may contribute to this posture. For example, ensure that a work station is set up correctly to avoid rotation to one side for prolonged periods. It is not always possible for athletes to address a preference for rotation to one side. For example, a golfer may not be able to swing the club equally well from one side as from the other; a javelin thrower will favour one arm; a canoeist may have a preference for using the paddle on one side over another. In such cases it may be necessary to address the imbalance through weight training, taking care to develop strength bilaterally (e.g., always performing the same number of oblique curls on each side of the body, always stretching both sides of the body for the same duration and to the same degree, taking note of where restrictions are felt in the body when stretching).

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■ Stretch the torso in the opposite direction to that which it is rotated. A simple stretch is to rest supine and twist the lumbar spine whilst keeping the shoulders on the floor (figure 4.9a). Clients will soon learn to which side they should rotate because that is the side to which they find most restriction.

■ Seated stretches may be enhanced by holding a chair (figure 4.9b) to facilitate the stretch.

Closing remarks

In this chapter you learnt about three common thoracic postures: kyphosis, thoracic flatback and rotated thorax. The anatomical features of each are stated along with pho-tographic examples and illustrations. The consequences of each posture are described, and for each posture a table is provided with lists of shortened and lengthened muscles to help you plan your treatments. Treatment ideas are detailed with suggestions about what you might do as a therapist and what your client might do to help correct each of the postures described.

roTATeD ThorAx

Figure 4.9 Client techniques for rotation of the thorax include stretches of the torso in (a) supine and (b) seated positions, using a chair to facilitate the stretch.

a b

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