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The Thoracic Ring Approach

By Robin Angus PT, MS, Cert. MDT

Have you ever wondered why your physical therapist puts her hands high up into your armpits, feeling your ribs while you are still and when you are moving? She may be using assessment and treatment techniques from “The Thoracic Ring Approach,” which was developed by international lecturer and Canadian physiotherapist, LJ Lee PhD, BSc, BSc(PT), FCAMT, MCPA.

The thorax is the area of your body between your neck and low back. There are 136 joints that move in this region, which should all be aligned properly and move normally to allow optimal, efficient movement and allow transfer of forces through our system with movement of our trunk, arms, and legs.

A thoracic ring is comprised of a vertebra, intervertebral disc, another vertebra, the corresponding left and right ribs, and attachment to the sternum (breastbone). Thus, the 5th thoracic ring includes the 4th and 5th thoracic vertebra, the right and left 5th ribs, and their attachment into the sternum. Each ring has 13 moveable joints.

When still, your physical therapist feels your thoracic rings to see if they are in normal alignment. With activities such as trunk rotation, arm raising, and squatting, she assesses the stability and control of the individual rings. We often find one or more thoracic rings that lack inherent stability and control with movement. This impairs the ability for normal movement to occur. She then must assess the underlying reason for this non-optimal force transfer, or loss of stability control, for a given movement.

Multiple neuromuscular vectors, or hypertonic muscles, are one of many causes of loss of normal movement. These vectors may pull a ring into a non-optimal position during a particular movement and are assessed by your physical therapist.

Once your physical therapist assesses your alignment, identifies movement faults and associated hypertonic muscles (vectors), and determines that these are underlying drivers for problems you have performing your meaningful task(s), a treatment plan is then designed and implemented. You will first be educated in our findings to better understand the treatment rationale used to meet your meaningful task activity goals. You will then learn to stack and align your thoracic rings into optimal alignment followed by training of the deep muscular system to improve stability control of the involved thoracic ring(s). Once you are able to activate the 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 your meaningful task(s). Once mastered, progression to the meaningful task(s) that you are having difficulty with are incorporated, including self care, activities performed at home and work, and/or recreational or sports-related activities. Taping and physical therapist hands-on techniques may be utilized during treatment sessions to help improve your movement and reach your goals.

For more information regarding The Thoracic Ring Approach, please refer to LJ’s website.