00:01
Articulatory technique for the
thoracic cage and the spine
So with pregnancy, there's a lot
of hypertonicity of the muscles
that could potentially restrict
motion of the spine and the ribcage.
00:13
So to try to optimize motion of the thoracic
spine and the ribcage, what we could do
is articulatory technique to gently try
to mobilize the spine and the ribs.
00:21
So first to mobilize the spine, what we
wanna do is to find the spinous processes,
then we get our thenar eminence on the
ipsilateral side from where we're standing.
00:31
My arms are gonna drape across the shoulders,
and what I wanna do is to gently sidebend
and at the same time, translate
the spine laterally away from me.
00:40
and so as I move down, I'm gently articulating the
thoracic spine finding regions of restriction,
areas that might be a little bit tighter,
we might work a little bit longer
and so here in the thoracolumbar spine, I feel like
it's a little bit tighter, so I'm just kind of
gently encouraging more motion here as I move lower,
I could go ahead and move in to the lumbar spine
Here you might just have to do a little bit more
sidebending to get the translation to that level.
01:05
and so we're gonna go up and
down the thoracolumbar spine
and if there's areas of restriction, we're
just gonna mobilize it a little bit more.
01:13
Now if we wanna mobilize the ribcage, what we're
gonna do is we're gonna induce rotation so
I'm gonna have the patient bring her
head up and place it on her shoulder,
this gives me a leverage to
kind of hold on the arm,
and now I could apply a little
bit of rotation.
01:26
As I rotate, my thenar eminence is now on
the opposite side along the rib angles,
just a little bit medial to the
rib angles on the opposite side.
01:35
Now I'll put my
thenar eminence there
and just add a little bit of extra
rotation when I reach that endpoint.
01:41
So here we're just mobilizing the ribs on
the opposite side from where I'm standing
and we could go down all the way down the
ribcage and almost into the lumbar spine
and make that a little bit more of a
fascial stretch with some articulation
so we go up and down the
ribcage in this fashion.
02:01
And then once we've completed that,
we could reassesed the area,
I would definitely do both sides,
to try to mobilize the spine
and treat the spine
the ribs bilaterally.
02:14
Thoracic spine articulatory technique
So what we wanna do here with the
patient seated, is to try to address
any musculoskeletal complaints and issues
in the posterior aspect of the spine,
the thoracic spine and
also the ribcage.
02:28
What we're going to do is to contact the ribcage
just medial to the rib angles with our fingers
and we are going to leverage and extend a little
bit over our fingers so in order to do that,
we're gonna have the patient's
arms placed over our shoulder
and I'm gonna place my fingers
along the rib angles here
and so I'm going to slowly lean back
and extend the patient over my fingers
pulling a little bit
superior and towards me
and feeling for the ribs to move a
little bit more on the thoracic spine
so this is a rib raising technique
also to try to mobilize the ribcage.
03:07
So this is a good technique to perform especially
with pregnancy to try to articulate the ribcage,
get more expansion in the thoracic
cage, increase thoracic compliance.
03:18
We could also try to articulate
the ribs with the arms crossed,
if you're more comfortable, you could place the
elbows on your shoulder and do the same things.
03:27
There's a way to also articulate
the thoracic spine directly
We could keep the arms
crossed like this,
I'm gonna slide my arm underneath and
hold on to the opposite shoulder,
I'm gonna have the patient lean forward
and that creates a fulcrum over my hand.
03:40
I'm gonna articulate the thoracic spine now
with my thenar eminence on the same side
of the thoracic spine so I'm gonna contact
just medial to the thoracic spine on my side
and create a transitory force.
03:55
And as I create a transitory force,
I could also use my other arm
to create a little bit of extension over my head and
so we kind of walk our way down the thoracic spine
If there's an area that's more restricted, we
could articulate that area a little bit more
and then once we finish articulating up and down
the thoracic spine, we could bring her back
and then slowly recheck the musculature and
the ribcage to see if there is decreased
somatic dysfunction in the area.
04:23
Cervical myofascial release
So to promote cervical myofascial
release, what we want to do is to first
assess the cervical muscles to see
if there is any hypertonicity
We're gonna stand on the opposite
side from where we wanna treat,
so here we're treating
the left side here
What we wanna do is to take our fingers and contact those cervical paraspinal muscles
and then we're gonna
apply anterior traction
and as I pull the muscles superiorly, it's
gonna start to loosen up the muscles
If I don't stabilize the head when I
pull, the whole head's gonna turn
so what I do with my other hand is I
stabilize the head by the forehead
and my other hand grasp the posterior
musculature and just kinda leans back
You don't want to lean back and pull too
quickly, myofascial should be done slowly
and you can move up and
down the cervical spine
and even down into the trapezius
muscles to try to get a good stretch.
05:16
You hold this stretch until you feel
a release and then you come back
and then afterwards, you could reassess to see
if the muscles are a little bit more relaxed.
05:26
Thoracic inlet release
So it's important to address any somatic
dysfunctions around the thoracic inlet to make sure
that we treat any muscle
hypertonicities, restrictions here
and remember the thoracic inlet is also the
region for terminal lymphatic drainage,
so we're gonna contact the posterior
aspects of the first ribs with our thumbs,
want to place our fingers around the clavicles and
my pinky kinda reaches around to the shoulders
We're going to find the freedom
of motions in the thoracic inlet
so we're gonna check side bending by pushing
down towards the feet and see which way
the thoracic inlet likes to sidebent towards
so here it likes to sidebend to the left.
06:04
I'm gonna hold back and stack the
freedoms so now I'm gonna check rotation
and here the thoracic inlet
likes to rotate to the right
and then when I check a little
bit of flexion, and extension
and here the thoracic inlet
likes to go into extension
so I'm holding all three freedoms and I'm gonna
apply a little bit of a lateral traction
by the first rib opening up the inlet and try
to decrease some of the muscle tension here.
06:30
So you're gonna match the tension
underneath your fingers,
you're gonna hold it until you start to feel
the tissues start to soften a little bit more
and once you feel that tissue release,
you could bring the hends back
and then reassess to see if there's improved
mobility and motion in the thoracic inlet.