8 The thorax

from container to contents

8.1 The container

Before approaching the cardiovascular component of the thorax, it is imperative to release, as much as possible, any osteochondral or ligamentofascial tensions of the thorax.

Intervertebral and costovertebral articulations can also affect the intrathoracic organs.

A free thoracic cage allows us to refine our intrathoracic visceral vascular techniques and to better distribute the pressures they exert.

8.2 The rigid components

The sternum is a flat bone that has an excellent intraosseous memory for trauma, or for prenatal or postnatal malposition. It is similar to the sacrum, whose bone and periosteum have the same ability.

The sternum serves us both as a means of testing and as a handle for freeing restrictions.

The ribs, with their osseous and cartilaginous components, are subject to numerous physical traumas through the course of life. When one suffers a fall or a car accident, the ribs are more affected than is the spinal column – although this is not the case in severe trauma.

8.2.1 Sagittal evaluation

In decubitus position

The patient lies down, with their hands resting on the abdomen and their elbows on the table to release myofascial tension in the shoulders.

First test

The palms are placed one on top of the other, over the angle of the sternum. Begin by compressing the sternum in a posterior and slightly caudal direction (Fig. 8.1). Move your palms towards the left and towards the right to appreciate the chondrosternal and chondrocostal elasticity.

Fig. 8.1 Sagittal evaluation of the thorax.

Perform the same maneuver below the angle of the sternum. This is a test to find anterior chondrosternal fixations. These restrictions offer a distinctive resistance in the thoracic cage on compression.

Second test

Slide the flat of your palm under the dorsal spine. Using your fingers, push the costovertebral and costotransverse junctions, and the posterior rib angles (the most prominent part of the posterior ribs) anteriorly while externally rotating the upper extremity with your free hand.

This excellent test allows you to distinguish clearly between posterior osteoarticular fixations and those of neighboring soft tissue.

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