What is Thoracic Manipulation?

The thoracic spine is the part of the spine where your ribs attach.  This area is below the neck and above the low back.  A physical therapist performs thoracic manipulation by applying a quick push to this area.  This quick impulse may or may not cause a harmless pop to occur.

What Are The Benefits of Thoracic Manipulation for Neck Pain?

More and more studies are showing the benefits of manipulating this area for neck pain.  A recent study in the Journal of Orthopedics and Sports Physical Therapy found that patients with acute neck pain who received this thoracic spine manipulation had superior clinical benefits that persisted beyond the 1-month follow-up period.  You can view a synopsis of the article here.

Here is a video demonstration of thoracic manipulation:

The Following Links Provide Further Support For The Use of Thoracic Manipulation by Physical Therapist For Neck Pain:

1. Thoracic Manipulation For Radiculopathy
2. Short term effects of thoracic manipulation for neck pain
3. Immediate effects of thoracic manipulation for neck pain
4. Improvements in neck range of motion after thoracic manipulation
5. A way to determine which patients will benefit from thoracic manipulation

We have found the use of thoracic spine manipulaiton combined with patient education, specific exercises and other manual therapy techniques to be very effective in alleviating neck pain.  If you live in the Lakewood, CO area and would like relief from this very debilitating condition contact Belmar Physical Therapy at (303) 274-2404.

What is Adhesive capsulitis?

Adhesive capsulitis, also known as frozen Shoulder, is a disorder of the shoulder in which the capsule surrounding the joint becomes inflamed and stiff.  As the condition worsens range of motion of the shoulder is severely reduced.  The exact cause of frozen shoulder is unknown.  However, there are a number of risk factors for this problem including diabetes, stroke, trauma, lung disease, connective tissue disorders and heart disease.  Frozen shoulder usually occurs in 3 phases:

People with Frozen Shouler typically lift the entire shoulder girdle when attempting to lift the shoulder.

1. The Freezing Phase: This is the most painful stage.  Pain occurs with any movement and there is a gradual reduction in range of motion.
2. The Frozen Stage: During this stage the pain in the shoulder gradually decreases.  However, the shoulder is extremely stiff during this stage.
3. The Thawing Stage: During this stage range of motion of the shoulder gradually returns to normal.

Each stage can last months and full resolution can take over a year.

What is The Best Treatment For Adhesive Capsulitis?

Physical therapy can be very effective in decreasing the duration of frozen shoulder as well as improving function during this period.  However, it is important that the physical therapist use effective treatment techniques.  A recent study in the Physical Therapy Journal examined the records of 2,370 patients (That’s alot of patients!) with adhesive capsulitis to see which treatments were effective in decreasing pain and improving function and which treatments were not effective.

The treatments that increased the likelihood of pain reduction and improved function were:

1. Joint mobilization performed by a licensed physical therapist.
2. Exercise

The treatments that decreased the likelihood of pain reduction and improved function were:

1. Ultrasound
2. Massage
3. Iontophoresis (Delivery of steroid with electrical stimulation)
4. Phonophoresis (Delivery of steroid with ultrasound)

You can view a synopsis of the article here.

If you think you may have adhesive capsulitis (frozen shoulder) we would be glad to help you. Please contact Belmar Physical Therapy at (303) 274-2404.

For years, the first line of treatment for painful tendons has been anti-inflamatory treatments such as medication and ice.  However, recent studies have concluded that inflamation is not a factor in persistent tendon pain explaining the lack of results with this treatment approach.  These studies have concluded that excessive loading causes weakening of the tendons structure leading to pain. These recent advances in the understanding of tendon problems have lead to the development of the EdUReP (Education, Unloading, Reloading, Prevention) model for treatment.

Treating Tendonitis with EdUReP

Following is a summary of the EdUReP approach.

• Education: The patient is educated in the basic physiology of tendinopathy as well as how their posture and activities may be contributing to overuse of the tendon. The patient and the physical therapist work together to find ways for the patient to perform activities while minimizing stress to the tendon.
• 

  Kinesio tape can help "unload" the painful tendon.

  Unloading: During this phase of treatment the therapist uses patient specific strategies to minimize load to the tendon.  These strategies may include external supports (braces, orthotics or taping), strengthening of other structures that may be underused or stretching of tight structures that are placing more strain on the tendon.

• Reloading:  Once adequate pain control has been achieved through unloading the tendon needs to be strengthened in order for the patient to return to regular activity.  One such strategy is the use of eccentric strengthening exercises discussed in our Get Eccentric” post.  During this stage exercises of progressive difficulty are administered until the patient is able to tolerate the loads required for their particular activity.

• Prevention:  This phase occurs once the patient is able to return to their activities pain free.  Prevention may include re-emphasis of prior education as well as adaptation to technique and form.  The ultimate goal is the patients independence in self-management.
  

  Once adequate pain control has been achieved the patient is given progressive exercises to "reload" and strengthen the tendon.