Thoracic Ring Approach

Thoracic ring approach was developed by Canadian physio Lj Lee. The thoracic spine and ribs when not functioning optimally often lead to failure elsewhere – cervical spine, pelvis or hip.

The thoracic spine is not as inherently stable as once thought. There are muscles that attach from the thorax to the cervical spine, the lumbar spine and pelvis. Hence the integral role the thorax plays in load transfer and efficient movement.

The technique assesses the three-dimensional functions of the thoracic spine and ribs and helps to train the segmental controls of the thoracic spine. Through this approach we treat pain and disfunction in the thorax as well as elsewhere it impacts.

Dysfunction of the thorax often leads to failure elsewhere in the body – cervical spine, pelvis, hip or anywhere else where load transfer becomes non-optimal. The thorax is essential in optimal function of the body as a whole.

The thoracic spine is the largest region of the spine and although it has been commonly taught that it is inherently stable, this is not in fact true. There are muscles that attach from the thorax to the cervical spine, lumbar spine and the pelvis. Therefore the thorax is essential in the transfer of loads between the different regions and this is another reason why it is so integral to controlled efficient movement.

Lj has developed a technique for assessing the function of the thoracic spine together with the ribs and instead of only assessing from the back , this technique assesses the function of each rib, the sternum and the adjacent two vertebrae to which it attaches- the functional unit called the “thoracic ring”. She used the research into lumbar, pelvic and cervical stability training and developed a system for training the segmental control of the thoracic spine.

Using this approach we not only treat pain and dysfunction of the thorax, but also assess whether dysfunction in this region is the underlying cause of pain or dysfunction elsewhere.

The approach helps determine whether the problem is one of joint stiffness (there are 13 joints in a thoracic ring!) or of neuromuscular control. If neuromuscular control is impaired then joints may appear stiff and correcting the motor control will change this. Thanks to Lj’s work we know how to train segmental control in the thoracic region to ensure patients can achieve optimal whole body function. Training segmental control in the thoracic spine is an important part of achieving core stability.

It is also important to note that the abdominal muscles receive their nerve supply from the lower six thoracic levels too. In this way problems in the lower thorax can affect recruitment of the muscles in the abdominal canister and therefore impair lumbo-pelvic stability. The thorax is often pain free although not functioning correctly and therefore the driver of problems and pain elsewhere.

At JBS Physio Lane Cove we have been trained in the Thoracic Ring Approach and can assess whether your thorax is a driver for pain elsewhere and help to teach you to move in a way that ensures optimal efficiency. We use techniques for manual correction of your dysfunction and then train optimal control.

If you are you interested in Thoracic Ring Approach, we recommend you read this article.

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