Thoracic Spine and Rib Complex

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Course Instructor: Dr. Rob Sillevis, PT, DPT, PhD, OCS, FAAOMPT-click for bio

Course Instructor: Dr. Karen Wyss, PT, DPT, CFC-click for bio

CEU’s: Pending

Course objectives


Based on the material presented in the course seminar, the on-line material, and independent study; the student will be able to:

• Demonstrate proper clinical decision making skills, including clinical reasoning, clinical judgment, and reflective practice as it relates to the thoracic spine and rib complex.

• Participate in scholarly activities to understand or contribute to the body of physical therapy knowledge.

• Perform a complete evaluation of the thoracic spine and rib cage. This should be influenced by history, systems reviews, and by utilizing valid and reliable tests and measures (evidence based).

• Determine based on evaluation findings and current evidence within what classification category the patient falls and what the optimal clinical management approach will be based on this.

• Identify the PT diagnosis/prognosis/differential diagnosis based on the evaluation/assessment of the clinical presentation.

• Determine the proper/best (evidence influenced) treatment approach based on PT diagnosis.

• Understand the value of pre-test/post-test assessment to determine the success of clinical intervention.

• Successfully apply manipulation techniques to the thoracic spine and rib cage to treat joint dysfunction.

• Utilize the proper augmented exercises for the thoracic and rib cage to maximize the outcomes following manipulation.

Thoracic Spine and Rib Complex

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Course Description

This course will present a systematic approach to the management of patients with thoracic and ribcage related problems. The medical community has long ignored thoracic back pain, in part due to the thought that the ribcage has such a stabilizing effect on this part of the spine that mechanical dysfunction was not likely. Increased understanding of biomechanics and advanced imaging techniques have ignited the thought that the thoracic spine and ribcage can house several primary dysfunction that can lead to pain and limited function of our patients. Considering the fact that biomechanically the upper thoracic spine functions together with the lower cervical spine and the lower thoracic spine functions with the lumbar spine the manual therapist must consider this part of the spine as a source of dysfunctions.

Dysfunction that one should consider when dealing with pain in the thoracic spine and ribcage include but are not limited to; muscle imbalance due to poor posture, degenerative changes due to aging and posture adaptations causing issues with facet and vertebra-costal joints, discogenic relates issues, spinal stenosis, ribcage related dysfunctions such as costochondritis, vertebral fractures due to trauma and osteoporosis, idiopathic conditions such as ankylosing spondylitis (AS), neurological conditions (such as T 4syndrome and Herpes Zoster) and chondritis. One should always consider the inter-regional dependence model when considering a spine patient and evaluate the thoracic spine and ribcage area.

The course participant will be introduced to a structured evaluation process that includes the identification of yellow and red flags, neurological assessment, the use of clinical prediction rules when appropriate, and the identification of muscle and joint dysfunction. The treatment component of this course will introduce the participant to a variety of manipulation techniques and augmented exercises to maximize clinical outcomes. After completion of this thoracic/costal course the participant will be able to effectively classify and treat patients with thoracic and or costal dysfunctions based on the latest research evidence.