Cervical Pain Thoracic Manipulation: Jerry Hesch, MHS, PT Letter to the Editor
Not published, submitted, though I did not pursue revision recommendations Cervical Pain Thoracic Manipulation
Dear Editor,
RE: Krauss J, Creighton D, Ely J. D., Podlewska-Ely J. The Immediate Effects of Upper thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial. J Man & Manip Ther 16(2):93-99.
The recent article provoked some thoughts I would like to share. The authors are to be commended for adding to the knowledge base by showing cervical pain reduction and cervical motion gains, in clients treated with thoracic manipulation. This is an important relationship and this study, along with other similar ones, should guide contemporary practice. In the discussion section the authors mentioned several ideas for future studies on the same topic. I would like to add to that list. The relationship of the costal joints to thoracic and cervical spinal motion might be appropriate for inclusion in future studies. It seems plausible that the authors may be altering rib mobility with thoracic manipulation. Alternately, there may be cases in which rib mobilization is a necessary antecedent to successful thoracic mobilization. The ribs form a joint with the thoracic segments which has been detailed by several authors. (Neumann Levangie) and treatment directed to the rib joints has been described (Flynn, dvorac) . The costo-transverse and costo-corporal joints are very close to the thoracic facet joints, particularly at the 3rd thoracic segment, per direct observation Future studies could evaluate rib mobility before and after thoracic mobilization to determine whether or not direct rib mobilization is necessary, and then evaluate the influence on cervical pain and mobility.
Thank you very much.
Sincerely Yours,
Jerry Hesch, MHS, PT
Dear Editor,
RE: Krauss J, Creighton D, Ely J. D., Podlewska-Ely J. The Immediate Effects of Upper thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial. J Man & Manip Ther 16(2):93-99.
The recent article provoked some thoughts I would like to share. The authors are to be commended for adding to the knowledge base by showing cervical pain reduction and cervical motion gains, in clients treated with thoracic manipulation. This is an important relationship and this study, along with other similar ones, should guide contemporary practice. In the discussion section the authors mentioned several ideas for future studies on the same topic. I would like to add to that list. The relationship of the costal joints to thoracic and cervical spinal motion might be appropriate for inclusion in future studies. It seems plausible that the authors may be altering rib mobility with thoracic manipulation. Alternately, there may be cases in which rib mobilization is a necessary antecedent to successful thoracic mobilization. The ribs form a joint with the thoracic segments which has been detailed by several authors. (Neumann Levangie) and treatment directed to the rib joints has been described (Flynn, dvorac) . The costo-transverse and costo-corporal joints are very close to the thoracic facet joints, particularly at the 3rd thoracic segment, per direct observation Future studies could evaluate rib mobility before and after thoracic mobilization to determine whether or not direct rib mobilization is necessary, and then evaluate the influence on cervical pain and mobility.
Thank you very much.
Sincerely Yours,
Jerry Hesch, MHS, PT