Thoracic Aftercare

Chapter VI


Thoracic Aftercare




Chapter 6 Thoracic Aftercare


The aftercare tips in this chapter include chest stretches and breathing exercises, the self-treatment of trigger points, postural correction, and techniques to overcome spasm in the muscle of the thorax. There are of course some important stretches for the upper back too, with guidelines for how these should be carried out. As with the aftercare advice in other chapters, you could use this information to either create a generic handout for your clients or tailor it to their specific needs. Get feedback from them on which aspects of aftercare are useful. Not everything will work for all clients. In this manner, you can start to build up your own unique database of tips and tricks for the thoracic region and may even start to come up with your own ideas. Many of the tips included in this book were gleaned from years of working with clients during which I kept notes about what they said they did to treat their own back problems. At that time, some of these were not well known, yet have since become popularized, for example, the self-management of trigger points and some of the back stretches.


Tip 1: Ten Chest Stretches


When providing aftercare for clients with thoracic problems, chest stretches are valuable for four reasons:


First, one of the problems commonly encountered in clients with thoracic pain is “poor” posture. This usually describes the kind of posture where a person has “rounded” shoulders, their head craned too far forward, not balanced over their thorax. Clients with such postures have lengthened rhomboid muscles due to protraction of the scapulae, and shortened pectorals. Holding a chest stretched for around 30 seconds daily is likely to result in improved posture.


Second, stretches such as those described here can help some clients with breathing problems by “opening” the chest region, increasing thoracic expansion.


Third, they can help reduce pain in both chest and upper back muscles.


Finally, changing the shape of the thorax helps clients to reposition their head and this often reduces neck pain. In some cases, it reduces pain in the lower back too.


Ten stretches illustrated on the following pages range from the simple (stretches 1, 2, 3, and 4) to the more advanced (5, 6, 7, and 8) and specific (9 and 10) stretches. Experiment with these examples, selecting those you think are appropriate for your clients.



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Stretch 1 As rhomboid muscles are the antagonists to the pectorals, simply contracting rhomboids helps reduce tone in pectorals.


Stretch 2 A trick is to ask a client simply to touch the back of their head as shown alongside. In performing this action, they contract rhomboids. The pectorals are stretched if, once in this position, your subject takes their elbows backward.



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Stretch 3 This stretch can be modified by holding the hands behind the back. Not everyone can do this, however.


Stretch 4 A towel could be used. Notice how varying the position of the towel varies the location in the chest muscle where the stretch is experienced.



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Question: Are there any contraindications to these stretches?



Extending the arms in this way with a towel is contraindicated for clients with a history of shoulder subluxations or dislocations.


When a client has space and time available, the following two chest stretches could be used.


Stretch 5 The client rests in the supine position with a towel rolled up and placed lengthwise down the thorax. The head also needs support, either with this towel or with a pillow; otherwise, it falls back, extending the neck and this can be uncomfortable. The advantage of using a towel is that it can be folded or rolled to suit the size of the client. The disadvantage is that heavier clients may need something stronger against which to rest.



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A bolster or foam roller can be used instead of a towel, but some clients find it difficult to position themself on the roller and, of course, the length of the roller cannot be adjusted.


Stretch 6 Standing with their back to a wall, a client could try to press the back of their arms into the wall, using different arm positions, from horizontal to elevated. Alternatively, they could squat, thus changing the position of their arms in that way.



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Stretch 7 Where a client has the edge of a wall available, they could stand close to the wall and experiment with stretching different fibers of their pectoralis major muscles by altering the position of their arms.



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Stretch 8 Where a doorway is available, the same stretch can be performed as the client steps “into” the doorway, varying the arm position as illustrated under stretch 7.



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Stretches 9 and 10 There are various ways of stretching the pectoral muscles, and it can be fun to give a client the challenge of experimenting and discovering for themselves the positions they find most effective. They could utilize something they have close to hand such as a chair (stretch 9), wall, or a park bench, or they could simply alter their position. A client who is bedbound could stretch simply by pushing themselves upward (stretch 10).



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Tip 2: Eight Upper Back Stretches


Stretches to the upper part of the back are particularly useful for helping to decrease pain resulting from muscle tension in this region of the spine. They are particularly useful for clients who maintain static postures for long periods of time as part of their work or hobbies and can be used both to relieve the pain of muscle tension once it occurs and, prophylactically, on a regular basis throughout the day for 30 seconds in order to decrease the likelihood of tension developing.


A selection of upper back stretches has been provided here and, as for chest stretches, these range from the simple (stretches 1, 2, 3, and 4) to the more advanced (5, 6, 7, and 8) stretches.


Stretch 1 In the hug position, the scapulae protract and the rhomboids are lengthened. To enhance the stretch, instruct your client to adopt this position and then to take their chin to their chest.



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Stretch 2 Rounding the back while standing or sitting, pushing the back upward, also stretches the rhomboid muscles.



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Stretch 3 An alternative, which also stretches the thoracic erector spinae, is to round the back with head and neck flexion. Be careful not to place too much force on the head and neck in this position.



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A disadvantage of these positions is possible cramp in the abdominals, which are shortened and, especially in stretch 2, actively engaged.


Stretch 4 This is similar to stretch 2 but is performed in the kneeling position. As with stretch 2, the client needs to focus on contracting their abdominals in order to arch their back. It is sometimes referred to as a “cat stretch.”



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Stretch 5 Stretch 1 could be enhanced by grasping the sides of a chair and then leaning gently backward. Caution is needed for clients with a history of shoulder subluxation or dislocation.



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Stretch 6 Simply hanging from a rope with one or both arms in front of the body stretches the rhomboids. Again, caution is needed when used for clients with a history of shoulder subluxation or dislocation.



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Stretch 7 Leaning forward in a chair and hooking the hand beneath a foot provides a good anchor to stretch one set of rhomboids at a time. It does, however, require the flexibility for rotation, which not all clients possess.



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Stretch 8 Alternatives are simply to lean forward and reach beneath the chair or hook the hands around or beneath the feet.



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Caution: Stretches 7 and 8 are contraindicated in clients with a previous history of disk herniations. Overweight clients may find it uncomfortable to squash their chest and abdomen in this way.


Tip 3: Self-treatment of Trigger Points in the Thorax


Trigger points, localized points of palpable tenderness, are found throughout the thorax, including around the medial border of the scapulae between approximately T4 and T6 (a), close to the spine itself in deep rotatores (b), within the longitudinal extensor muscles (c), and in the pectoralis minor (d) and the pectoralis major (e) muscles.


Aug 25, 2019 | Posted by in MANUAL THERAPIST | Comments Off on Thoracic Aftercare

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