MANAGING MOVEMENT: THORACIC SPINE AND RIBS – KINETIC CONTROL (KC)

COURSE INTRODUCTION: 

Presentations of the thoracic spine and ribs are frequently associated with altered movement, whole body alignment and impaired respiratory function. It is generally acknowledged they can be difficult to evaluate and manage. This course demonstrates innovative techniques to evaluate uncontrolled movement related to presentations of the thorax and ribs. The evaluation and mobilisation of thoracic and rib presentations is detailed and cognitive movement control strategies explored. 

COURSE OUTLINE: 

Pain in the thoracic and rib region often appears related to unwanted changes in the function of the costo-vertebral, cervico-thoracic, scapulo-thoracic and thoraco-lumbar regions. Any desire to successfully manage patients’ presentations must therefore be considerate of this complexity and employ a systemized route of assessment to steer intervention. This assessment must be inclusive of not only considering articular and myofascial restrictions of these regions but also the associated compensations evident within the movement system. There is then the need to test for the presence of uncontrolled movement (UCM). 

This two-day course reviews the functional anatomy of the thorax. Functional classification of thoracic musculature is outlined with local and global ROLE synergy systems identified. Based upon a systematic assessment and interpretation of an individual’s specific presentation, an integrated treatment approach is presented. It details the retraining of local and global role systems for the thoracic spine and ribcage, emphasizing rehab strategies based on a rigorous clinical reasoning framework. This course is orientated to a ‘hands on’ practical application of movement control assessment and retraining using patient examples where possible. 

KEY FEATURES: 

Positional diagnosis of thoracic and rib compensations for restrictions in the thorax. The anatomy and functional classification of thoracic musculature is outlined with local and global stabilizer role synergies identified. 

The application of manual mobilisation (muscle energy based) techniques to mobilise restrictions 

Based upon a systematic and logical assessment of alterations in spinal function, an integrated, individualized treatment approach is presented. 

The retraining of movement impairments is detailed at 3 levels 

Direction control of the site and direction of uncontrolled movement 

Local stabilizer role synergist retraining to control thoracic or rib translation Influence of recruitment inefficiency between muscle synergists 

The course details the rehabilitation of the movement control system at local and global system levels for the thoracic spine with an emphasis on rehabilitation strategies for appropriate clinical decision making. 

LEARNING OUTCOMES: 

At the end of this course the participant should 

be able to: 

Demonstrate understanding of the proposed development of uncontrolled movement Display an ability to analyse the association between restriction and potential compensations in articular and myofascial tissues 

Demonstrate the ability to palpate the thoracic spine and rib cage to make a positional diagnosis of thoracic and rib compensation for restriction 

Display an ability to demonstrate manual techniques to mobilise thoracic and rib restrictions Clinically assess movement strategies strategies to identify and diagnose the site and direction of uncontrolled movement and retrain uncontrolled movement associated to the thorax 

Assess and rehab local stabiliser role synergists recruitment efficiency in the thoracic spine Discuss the influence of altered global role muscle synergies 

PROGRAMME: 

DAY ONE: 

9.00 – 10.30 Uncontrolled Movement Theory 

Functional anatomy review 

10.30 – 10.50 Coffee 

10.50 – 12.30 Palpation & mobilisation of thoracic & rib restrictions 

Upper quadrant loading dysfunction 

Cervico-thoracic palpation & mobilization 

Thoracic rotation 

Manual mobilisation of the segmental rotation restrictions 

12.30 – 13.30 Lunch 

13.30 – 15.00 Palpation of ribs dysfunctions 

Positional diagnosis: 

Identification of compensation for primary restrictions 

Structural rib dysfunction 

Treatment principles 

15.00 – 15.20 Tea 

15.20 – 17.00 Structural rib treatment 

Anterior rib 

Internal rotation 

External rotation 

Posterior rib 

1st rib 

2nd rib 

DAY TWO: 

9.00 – 10.30 Thoracic control of direction 

Thoracic flexion control tests and flexion control rehabilitation 

Thoracic extension control tests & extension control rehabilitation 

Thoracic rotation control tests & rotation control rehabilitation 

Thoracic & rib respiratory control tests and respiratory control rehabilitation 10.30 – 10.50 Coffee 

10.50 – 12.30 Thoracic control of translation 

Local stabiliser role synergies recruitment to control thoracic and rib translation 12.30 – 13.30 Lunch 

13.30 – 15.00 Thoracic control and global role synergies 

Global stabiliser role synergists 

Global mobiliser role synergists 

15.00 – 15.20 Tea 

15.20 – 17.00 Review/ case studies, Q&A