The thoracic rings reside in the thorax, the area of your body between the neck and low back. 136 joints are found in this region. They should be aligned properly and move normally for optimal, efficient movement and to allow transfer of forces through our system with movement of our trunk, arms, and legs.
One thoracic ring is comprised of a vertebra, intervertebral disc, another vertebra, the corresponding left and right ribs, and the attachment to the sternum (breastbone). For example, the 6th thoracic ring includes the 5th and 6th thoracic vertebrae, the right and left 6th ribs, and their attachments into the sternum. 13 moveable joints are in each ring.
When using LJ's thoracic ring approach during an assessment, the physical therapist feels the thoracic rings to see if they are in normal alignment. With activities such as trunk rotation, arm raising, and squatting, the client’s ability to control the individual rings is then evaluated. Often, one or more thoracic rings are found to move too much and have poor control with movement. This impairs the ability for normal movement to occur, not just in the chest, but often in other areas of the body, as well. As a result, the therapist must then evaluate the effects of manually correcting the rings' alignment and the way they move (biomechanics) not only on the particular rings being evaluated, but also on the area of pain as well as on the surrounding rings and other body regions.
One or more thoracic rings may be found to be the driver(s) or co-driver(s) (underlying cause) of pain and non-optimal movement in the chest or upper back, as well as in the painful region, whether it be in the pelvis, neck, or some other location. Therefore, don't be surprised if your therapist has their hands on your ribs when you come into the clinic complaining of pelvic girdle pain!
Once the driver or co-drivers are determined, the physical therapist evaluates and determines the underlying causes (“impairments”) for each driver. There are usually several for each driver, including muscles with too much tone placing abnormal forces on bones and joints and muscles with poor ability to turn on (activate) at the appropriate time (motor control). A treatment plan is then designed and implemented. Clients are educated in our assessment findings to better understand the rationale for the recommended treatment plan to meet their meaningful tasks (activity goals). If the thoracic rings are found to be a driver, clients are then taught how to align their thoracic rings. Training of the deep muscular system to improve stability control of the involved thoracic ring(s) then follows. Once clients are able to effectively activate their deep supporting muscles, movement training is initiated, emphasizing alignment and neuromuscular control of these rings. This begins with isolated movements and progresses to more complex movements pertaining to the meaningful task(s). Once mastered, progression to the meaningful tasks that the client is having difficulty with are incorporated, including self-care, activities performed at home and work, and/or recreational or sports-related activities. Taping and hands-on techniques may be utilized during treatment sessions to help clients improve movement and master their activity goals.
For more information regarding the thoracic ring approach, please refer to LJ’s website. If you feel that this approach might be beneficial for you, please consult your physical therapist.
References:
https://ljlee.ca/teaching-models/the-thoracic-ring-approach/
Course notes: "The Thorax: Connect the Whole Body & Optimize Performance with ConnectTherapy and The Thoracic Ring Approach." LJ Lee, PT.
Course notes: The Thorax and Whole Body Function: A Day with Dr. Linda-Joy (LJ) Lee Demonstrating The Thoracic Ring Approach. LJ Lee.
