MOBILIZATIONWEDGETHORACICDISCLESIONSPESTERPHYSIOTHERAPYBACK

MOBILIZATION WEDGE FOR THORACIC DISC LESIONS - Olive K. Pester, M.C.S.P. M.C.P.A
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MOBILIZATION WEDGE FOR THORACIC DISC LESIONS

Olive K. Pester, M.C.S.P. M.C.P.A.
Although many physiotherapists are able to diagnose and
effectively treat patients with cervical and lumbar disc lesions,
patients having thoracic disc lesions may suffer unnecessary pain
or receive misguided treatment when their condition is labelled
as fibrositis of the chest wall, pleurodynia, inter-costal
neuritis, and so forth.
Diagnosis is not difficult, however, if thoracic disc lesions
are kept in mind. The influence of both posture and exertion, on
the pain, should be elicited in the patient's history, and the
movements of the thoracic spine should then be tested.
Evaluation of clinical data
The only basis for deciding whether or not to manipulate is a
careful and informed evaluation of the clinical data. The
articular, dural, root and cord signs should be carefully
evaluated, and if there is any evidence of pyramidal pressure,
manipulation is absolutely contraindicated.
The difficult cases are those with a primary posterolateral
onset. Root pain is felt in the anterior thorax or abdomen,
emerging without previous backache. A physician must examine
these patients and rule out any involvement of the viscera
(heart, lungs, stomach, and so on). Vertebral manipulation will
relieve pains of spinal origin, but not those correctly ascribed
to the viscera.
In the orthopaedic department, most patients with spinal joint
pain are suffering from a minor displacement of a fragment of
disc. It is immaterial whether the disc is thin or thick, or
whether osteophytes are present or not. X-rays are used to help
rule out the pathologies not treatable by manipulation:
osteoporosis, ankylosing spondylitis, rheumatoid arthritis,
fractures, tumors, neoplasms, and so on.
The diagnosis of thoracic disc problems is arrived at by a
"Cyriax-type assessment" which involves examining for articular
signs and for dural signs and symptoms.
Mobilization/manipulation technique
The simplest and most effective method of treating thoracic
disc problems is by a mobilization/manipulation of the thoracic
spine. The results of the treatment, for disc problems, are
unusually excellent. Three hundred patients having thoracic disc
problems were treated in this manner during a recent 12-month
period at the author's clinic. Treatment ranged from two to eight
sessions, depending on the number of levels involved in the spine
and the degree of stiffness, pain and symptoms present. The
success rate has been better than 90 per cent.
The main problem is to inculcate in the patient a desire to
maintain the
erect posture for much of his working day.
Although slouching may be harmful for any areas of the spine, it
is disastrous for the thoracic region. A follow-up program
including swimming, walking, dancing, fencing - all activities

that encourage an awareness of posture and relaxation - should be

recommended to the patient.
The wedge: aid to mobilization
A common problem of the treatment, mobilization/manipulation
of the thoracic spine, occurs when a 5'4" female physiotherapist
attempts to mobilize the thoracic spine of a 6'2", 200 pound
patient. By the time the physiotherapist has placed her hand
around the chest wall of the patient, to fixate the thoracic
spine being treated, she frequently has no power and little
leverage left with which to mobilize the offending joint.
A small wedge has therefore been developed by Norwegian
physiotherapist Freddy Kaltenborn as an aid to the painless
mobilization of the thoracic spine. It enables a physiotherapist
to mobilize successfully, and with little physical effort, the
thoracic spine of large, heavy patients.
Construction: the wedge is made of molded polypropylene with a
base measuring nine inches and a height of three and one-quarter
inches. The central groove, in which the spinous process fits, is
one inch across.
Directions for use: the patient lies supine and clasps his
neck in such a way that his elbows are brought together over his
sternum. The therapist stands on the right side and grasps the
patient's elbows with her left hand. She rolls him toward herself
and firmly fixes the thoracic vertebrae to be mobilized within
the groove of the wedge. The wedge now acts as a fulcrum and the
physiotherapist, by leaning over the patient, can thrust through
the patient's elbow in a downward direction. By altering the
position of the wedge or by altering the degree of flexion of the
thoracic spine, the physiotherapist can mobilize or manipulate
all thoracic joints in this manner.
Conclusion
The wedge has been used for over a year in the author's clinic
and is recommended in the treatment of patients with thoracic
disc problems. In cases involving the toracic spine, it is the
maintenance of a reduction which is difficult. After the
mobilization manipulation procedure, a program of extension
exercises must be initiated.

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