Thoracic Ring Approach – the missing link when assessing the whole body

Physiotherapists love movement, and we love seeing our patient coming away moving smoother and happier. It’s not just about getting rid of pain. It’s about the whole body working as one. Therefore, having pain, restriction or heaviness in 1 area can be caused by a separate part of the body. One of these areas can be the Thoracic Ring. You don’t need to have pain in this area, but if it’s not functioning the way your body wants it can cause or “drive” issues elsewhere. The thorax makes up 20% of the body’s length and 35% of the body mass (Lee LJ 2015). It therefore makes sense to include it when looking at how a person moves.

What is a Thoracic Ring?

1 side is compressed, the other translates. This causes increased weight bearing on 1 side – LJ Lee

Is your mid back actually stiff?

Do you have a “stiff” mid back/thoracic spine? Have you been told you have a scoliosis? This may not be the case. The thoracic spine is a mobile structure, that can rotate, twist and side bend. But if there is a muscular dysfunction, the thorax loses its “spring” function and gives the illusion of stiffness. If the muscle around and between the ribs can’t maintain their position, they will feel compressed and can’t perform optimally. This may be why you only get a short-term relief when you or someone else manipulates, stretches or foam rolls the mid back. The Thoracic Ring Approach focuses on building muscular control, and therefore can help with any activity you need to do. We work the underactive muscles and release the overactive ones. We then look at the task that is key to your success.

What movements are important to you?

When you have an injury or dysfunction, there will be activities that become restricted. You may be in pain or stiff doing them, they may cause issues after and they may just start to feel unnatural and heavy. You may even have to stop activities that are too painful or no longer enjoyable. When you come and see us at the Physio Company, we will figure out your needs and design the assessment, treatment and rehab program after that. Are you struggling to bend down and pick up your children? We’ll assess you squatting. Are you struggle to sit and type at the computer? We’ll do forward arm movements. We determine what the driver is via preforming your “meaningful task”. This is called Meaningful Task Analysis TM. For the Thoracic Ring, we will assess and palpate each ring and decide if this area moves non optimal during the task. If the task improves when we help this dysfunction, then we have found the driver. (Lee LJ 2008)

Not everyone will need this treatment

Whilst the Thoracic Ring Approach can be a missing link and driver of your complaint, it’s not going to be the cause/driver for everyone. It will be assessed, and after treated if the therapist sees this as the driver. As previously mentioned, the whole body is connected and is full of potential drivers. It is the therapist’s job to find it. If it’s not the Thoracic Ring, it will be something else. This enables the therapist to not have to use a trial and error approach and can much quicker get to the root of your complaint.

References

The Thoracic Ring Approach: A Whole Person Framework to Assess and Treat the Thoracic Spine and Ribcage. Lee LJ 2015 In Magee et al. Pathology and Intervention in Musculoskeletal Rehabilitation, 2e, Elsevier, pgs. 436-470.
Lee LJ. The Essential Role of the Thorax in Restoring Optimal Function. Keynote presentation at the 2008 Orthopaedic Symposium of the Canadian Physiotherapy Association, Montreal, Canada, October 2008.

Further information

LJ Lee website: https://synergyphysiopilates.com/unique-approaches/thoracic-ring-approach/
LJ Lee teaching website: https://ljlee.ca/teaching-models/the-thoracic-ring-approach/