Category: Musculoskeletal

THE THORACIC SPINE ENIGMA

7/2/2020

THE THORACIC SPINE ENIGMA

A well-functioning thoracic spine can accelerate your running and promote pain-free living.

The thoracic spine is the mid-back between the neck and the waist (lumbar-region). The ribcage attaches to it. This special part of our spine gets less attention in science journals than other spine areas. It an important source of local or referred pain for spine, hip and shoulder problems. This is due to its unique nerve supply and mechanics as a junction between the upper and lower body.

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

As an important mechanical lever of the body, taking 47% of body weight ⁽¹⁾, the curve of the thoracic spine impacts on shoulder girdle movements ^(2-3) and the lower limbs. For example, walking and running rely on thoracic rotation to store and generate momentum. In turn, the thoracic spine is very stable alongside its partner, the ribcage, affording protection to vital organs. Consequently, it is less mobile than the neck or low back.

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

Motion of the shoulders relies on rotation and side bending in the thoracic spine ^(2-3). If this part of the spine loses the little flexibility it has, more load is placed on the shoulder joint, girdle and rotator cuff. The compressive forces from a lack of spine flexibility can set up problems elsewhere in these other tissues.

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”

Walking and running uses to-and-fro arm swing and shoulder motion, whilst simultaneously the thoracic spine winds up and down via twisting motions. This enables balance and, like a spring, enables energy transmission to the arm swing to propel the body forwards. In fact, to increase speed when running, you need to increase your thoracic twisting motion ⁽⁴⁾. You can compensate for this via the hips or overarching the lumbar back, but for how long?

The nerve supply of one thoracic vertebral segment is also known to include several levels, meaning a mixed nerve supply. A problem in one area can refer to many seemingly unrelated regions of the arms, buttocks and legs. Occasionally, when counterfeit symptoms resembling organ pain are from thoracic joints, physiotherapists will judiciously examine for key features of musculoskeletal involvement, being pain on movement, tenderness and tightness of musculoskeletal structures ⁽⁵⁾. If these musculoskeletal features are absent, then the case requires further consultation from a medical practitioner.

References
1. White, A. A. 1969. Acta Orthopaedica Scandinavica Suppl: 127, 8-92.
2. Tsang, S. M. H., Szeto, G. P. Y. & Lee, R. Y. W. 2013. Manual Ther: 18, 431-437.
3. Crosbie, J., Kilbreath, S. L., Hollman, L. & York, S. 2008. Clin Biomech: 23, 184-192.
4. Tojima, M., Osada, A. & Torii, S. 2019. J. Phys. Ther. Sci.: 31, 661-665.
5. Harding, G. & Yelland, M. 2007. Aust Fam Physician: 36(6), 422-3, 425, 427-429.

Comments

Musicians and Musculoskeletal Health

10/12/2018

Comments

Whether someone is an elite musician or a student embarking on a new instrument, muscle, joint and tendon injuries are highly prevalent within their career. With thousands of hours spent in repertoire practice, technique exercises and perfecting what is required to produce "beautiful music", it is no wonder that musicians do injure themselves, and often. Performance stress and anxiety can also be a major factor.

Anecdotally, here in Australia, we find it surprising that so little time is spent in music education teaching students about the need to stay healthy and to recognise where performance can hurt musicians. Music performance and musculoskeletal health are not mutually exclusive. The key is learning preventative strategies and installing good healthy habits in our performing artists.

Music, more than bows and strings, percussion and brass!

The shoulder blade (or scapula) is key in upper limb and neck biomechanics. This includes the elbow, as in the video. This scapula is a moving platform for the ball and socket shoulder joint. It sits on the back of the upper torso enabling us to shrug and reach. Poor scapula position awareness (a wobbly or uncoordinated shoulder girdle- if you like!) can affect the neck, the shoulder and arm muscles, joints and nerves ⁽¹⁾.

A new study of musicians by Silva⁽²⁾ examined the coordination of shoulder blade position and neck control. Musicians carrying an injury performed poorly in muscle memory tests with uncoordinated neck control. This makes sense, as with any injury, our body directs a change in muscle memory patterns to essentially maintain the same movement.⁽³⁾ For music production, however there is no margin for error. The prevention and fix for these problems lies with the development of habits which include:

Warm up, stretching and cool down.
Paced practice. Frequently we see high loads in short periods
Technique exercises and help with a music teacher.
Advice on instrument set up and fit.

Physiotherapy will not just assist in screening for problems, but unpick the control and movement issues that make musicians needlessly suffer.

Bravo to all you maestros out there, making music and enriching all our lives!

1. Cools, A., Struyf, F., De Mey, K., Maenhout, A., Castelein, B., & Cagnie, B. (2014). Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete.
2. Silva, F., Brismée, J., Sizer, P., Hooper, T., Robinson, G., & Diamond, A. (2018). Musicians injuries: Upper quarter motor control deficits in musicians with prolonged symptoms - A case-control study. Musculoskeletal Science And Practice, 36, 54-60. doi: 10.1016/j.msksp.2018.04.006
3. Hodges, P., & Tucker, K. (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain, 152(Supplement), S90-S98. doi: 10.1016/j.pain.2010.10.020

Comments

Heavy head or a Weak Neck?

22/11/2018

Comments

Neck pain from the musculoskeletal system (that’s our joints and muscles) is common affecting 70% of us in our lifetime and 50% of us in any one year. It is likely to reoccur. In summary neck pain is one of the leading causes of disability.⁽¹⁾ When this is examined more closely, we find pain changes the way the neck will coordinate head-support and movement in different ways.

First there is reduced endurance of the supportive neck muscles. They don’t activate and contract smoothly, they fatigue quickly leaving the neck joints (both facet and intervertebral disc joints) assuming more of the work load. As well as control loss, there is strength loss. Second, the joints stiffen become less flexible and are easily irritated. Thirdly head movement accuracy is affected, meaning when tested, a neck pain sufferer cannot look away and return to the same position.

Exercise is recognised in research trials and clinical guidelines as beneficial,⁽²⁾ but it is not a one size fits all approach. That’s because there are many kinds of musculoskeletal neck pain. For example neck pain from whiplash is different to that of a headache or migraine sufferer, and again different from the pain of age related changes. Combination pains do occur and on occasion the involvement of the nerve system can make neck pain more complex.

This highlights that neck pains can have different mechanisms of ignition and different mechanisms of being sustained.

Complexity doesn’t mean complicated

Physiotherapists deploy sophisticated examination tools to detect the mechanisms underlying the pain (or pains). Relying on a search for a crooked part in the neck alone can lead to the wrong decisions on diagnosis and treatment. With examination of the mechanisms of neck pain and an account for bodily structure is complete, we can then make a treatment plan to address these factors and the different kinds of neck pain present.

Treatment can include specific exercise, joint movements (manipulation) and lifestyle/ergonomic advice. There is growing evidence to support such an approach.⁽³⁾

References:
1. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. (2017). The Lancet, 390(10100). doi: 10.1016/s0140-6736(02)65865-9
2. Fredin, K., & Lorås, H. (2017). Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – A systematic review and meta-analysis. Musculoskeletal Science And Practice, 31, 62-71. doi: 10.1016/j.msksp.2017.07.005
3. Falla, D., & Hodges, P. (2017). Individualized Exercise Interventions for Spinal Pain. Exercise And Sport Sciences Reviews, 45(2), 105-115. doi: 10.1249/jes.0000000000000103

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THE THORACIC SPINE ENIGMA

THE THORACIC SPINE ENIGMA

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”

Musicians and Musculoskeletal Health

Heavy head or a Weak Neck?

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

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Contact Us

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Connect With Us

THE THORACIC SPINE ENIGMA

THE THORACIC SPINE ENIGMA

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.” ​

Musicians and Musculoskeletal Health

Heavy head or a Weak Neck?

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

Archives

Categories

Contact Us

Support

Connect With Us

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”