Chapter 1 - ANATOMY OF THE THORAX
Regions and Osteology of the Thorax
Vertebromanubrial region
Vertebrosternal region
Vertebrochondral region
Thoracolumbar region
Arthrology of the Thorax
Zygapophyseal joints
Costal joints
Intervertebral discs
Manubriosternal symphysis
Sternoclavicular joint
Myology of the Thorax
Deeper muscles of the thorax
Transversus thoracis
Transversus abdominis
Diaphragm
Rotatores thoracis
Multifidus
Levator costarum
Internal and external Intercostals
Superficial muscles of the anterior thorax
- Serratus anterior
- Pectoralis major
Pectoralis minor
- Subclavius
- External oblique
- Internal oblique
- Rectus abdominis
The anterior fascial connections
Width of the linea alba - the inter-recti distance
The posterior fascial connections
Superficial muscles of the posterior thorax
- Semispinalis thoracis
- Spinalis thoracis
- Longissimus thoracis
- Iliocostalis thoracis
- Iliocostalis lumborum
- Serratus posterior superior
- Serratus posterior inferior
Neurology of the Thorax
Thoracic spinal nerves
Sympathetic trunks
Surface Anatomy - Land Marking the Thorax
Thoracolumbar junction
Vertebrochondral region
Vertebrosternal region
Vertebromanubrial region
Conclusion
Chapter 2 - BIOMECHANICS OF THE THORAX
Introduction
Terminology
Research Evidence
Clinical Expertise
Forward bending of the trunk
- Thoracic spine osteokinematics
- Thoracic spine arthrokinematics
Palpation of thoracic spinal osteokinematics and arthrokinematics
Costal osteokinematics
- Costal arthrokinematics
- Palpation of the thoracic costal osteokinematics and arthrokinematics
Backward bending of the trunk
- Thoracic spine osteokinematics
- Thoracic spine arthrokinematics
Palpation of thoracic spinal osteokinematics and arthrokinematics
Costal osteokinematics
- Costal arthrokinematics
- Palpation of the thoracic costal osteokinematics and arthrokinematics
Side-bending of the trunk
- Thoracic spine osteokinematics
- Thoracic spine arthrokinematics
- Palpation of thoracic spinal osteokinematics and arthrokinematics
- Costal osteokinematics
- Costal arthrokinematics
- Palpation of the thoracic costal osteokinematics and arthrokinematics
Axial rotation of the trunk
- Thoracic spine osteokinematics
- Thoracic spine arthrokinematics
- Palpation of thoracic spinal osteokinematics and arthrokinematics
- Costal osteokinematics
- Costal arthrokinematics
- Palpation of the thoracic costal osteokinematics and arthrokinematics
- Manubrium and clavicle osteokinematics
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Elevation of the arm
Breathing
- Osteokinematics of inhalation
- Arthrokinematics of inhalation
- Palpation of the thoracic costal osteokinematics and arthrokinematics
- Osteokinematics of exhalation
- Arthrokinematics of exhalation
- Palpation of the thoracic costal osteokinematic and arthrokinematics
Conclusion
Chapter 3 - ASSESSMENT OF THE THORAX AND ITS RELATIONSHIP TO THE WHOLE BODY
Introduction
The Neuromatrix or Cortical Body Matrix Approach
Principles of the Integrated Systems Model Approach
Hearing the story and identifying the meaningful complaint
Determining the meaningful task
The screening tasks and finding driver(s)
Determining the system impairments related to the driver(s)
The Clinical Puzzle
Where to put findings in the Clinical Puzzle?
Treatment planning
Summary
Common Screening Tasks for Assessment of Function of the Thorax
Standing posture
Third thoracic ring to the hips
Pelvic ring correction
Hip correction
Thoracic ring correction
Second thoracic ring to cranium
Upper thoracic ring correction
Cervical segmental correction
Cranial correction
Clavicle and scapula correction
Lower extremity
Hind foot correction
Squat
Pelvic control test in a squat
Impact of the thorax on pelvic control in a squat
Impact of pelvic control on alignment of the thorax
Seated head, neck and thoracic rotation
Summary
Tests to Determine the Underlying System Impairment of the Driver(s)
Further tests - vector analysis
Articular system - assessment principles
Active physiological mobility tests
Passive accessory mobility tests
Passive control tests
Articular system - specific tests
Active physiological mobility tests - costal joints
Active physiological mobility tests - thoracic zygapophyseal joints
Passive accessory mobility tests - costal joints
Vertebromanubrial region
Vertebrosternal region (including 2nd thoracic ring)
Vertebrochondral region
Passive accessory mobility tests - thoracic zygapophyseal joints
Mediolateral translation - Inter-thoracic ring mobility
Passive control tests
Anterior translation thoracic spinal segment (intra-thoracic ring)
Posterior translation thoracic spinal segment (intra-thoracic ring)
Anterior distraction costotransverse joint (intra-thoracic ring)
Posterior translation costochondral and sternocostal joints (intra-thoracic ring)
Lateral translation (intra-thoracic ring)
Neural system - assessment principles
Neural system - specific tests
Tests to determine which muscles to release
Tests to determine when to release the nervous system
Active control tests
Thorax - inter-thoracic ring control
Lumbar spine - intersegmental control and thoracic ring drivers
Pelvis - sacroiliac joint control and thoracic ring drivers
Hip - control and thoracic ring drivers
Cervical - intersegmental control and thoracic ring drivers
Visceral system
Pericardial vectors and posture
Myofascial system
Thorax Driver(s) and Motor Control Strategies
Thoracic deep and superficial back muscle recruitment strategies
Abdominal muscle recruitment strategies
Response to verbal cue - transversus abdominis and the pelvic floor
Short head and neck curl-up task
Pelvic floor muscle recruitment strategies
Dural/Perineural Mobility
Conclusion
Chapter 4 PRINCIPLES OF THE INTEGRATED SYSTEMS MODEL FOR TREATMENT OF THE INDIVIDUAL PATIENT
Introduction
Release - Cognitive and Emotional barriers
Release - Physical Barriers
Teach - Optimal Strategies for Function
Reinforce, Strengthen and Condition - Better Strategies for Function
Conclusion - Getting to Wow!
Chapter 5 CASE REPORTS THAT HIGHLIGHT THE RELATIONSHIP OF THE THORAX TO THE WHOLE BODY
Thorax Driven Pelvis and Hip - Diane Lee
Jennifer's story
Jennifer's current meaningful complaints... Jennifer's cognitive beliefs... Jennifer's emotional status... Meaningful task and screening tests chosen for strategy analysis
Screening task analysis - standing postural screen
Impact of corrections on standing posture - finding drivers
Screening task analysis - squat
Impact of corrections on squat task - finding drivers
Vector analysis of the drivers
Primary driver - thorax (2nd, 3rd, and 4th thoracic rings)
Secondary driver - left hip
Impact of the thoracic driver on abdominal wall recruitment strategy
ISM treatment for Jennifer's thorax driven pelvis and hip
Release and align... Connect and control... Move
Conclusion
Pelvis then Thorax Driven Recurrent Hamstring Injury - Diane Lee
Steve's story
Steve's current meaningful complaints... Steve's cognitive beliefs... Steve's emotional status... Meaningful task and screening tasks chosen for strategy analysis
Screening task analysis - prone hip extension with resistance
Vector analysis of the driver - pelvis
Hypothesis to explain Steve's pain and impairments
Initial ISM treatment for Steve's pelvis driven hamstring
Follow up - second session one month later
Screening task analysis - prone hip extension
Screening task analysis - squat task
Screening task analysis - seated thoracic rotation
Vector analysis of the driver - thorax
ISM treatment - second session
Follow up - third session two weeks later
On field visit two weeks later
Conclusion
Thorax Driven Abdominal Wall and Pelvis - Diane Lee
Amanda's story and current meaningful complaints
Amanda's cognitive beliefs and emotional status... Meaningful task and screening tasks chosen for strategy analysis
Screening task analysis - standing postural screen
Screening task analysis - standing weight shift
Vector analysis of the driver - thorax
Abdominal wall assessment
Abdominal profile and behavior in standing
Abdominal wall and thoracolumbar control
Supine single leg load - active bent leg raise test
Behaviour of the abdominal wall and linea alba in a curl-up task
ISM treatment for Amanda's thorax driven abdominal wall and intra-pelvic ring control
Release and align
Connect and control
Conclusion
Thorax Driven Persistent Diastasis Rectus Abdominis and Poor Lumbosacral Control - Diane Lee
Christine's story and current meaningful complaints
Screening task analysis - standing postural screen
Screening task analysis - standing weight shift
Screening task analysis - lumbar segmental control under load
Screening task analysis - short head and neck curl-up
Vector analysis of the driver and relationship of the driver to motor control strategies - thorax
ISM treatment for Christine's thorax driven DRA and poor lumbosacral control
Follow up - 4 months later
Thoracic and Cranial Driven Pelvis
Brad's story
Brad's meaningful complaints... Brad's cognitive beliefs and emotional status
Screening task analysis
Screening task analysis - standing postural screen
Impact of corrections on standing posture - finding drivers
Screening task analysis - squat
Impact of corrections on squat task- finding drivers
Screening task analysis - right and left one leg standing (OLS)
Impact of corrections on OLS tasks - finding drivers
Vector analysis of the drivers
Driver - thorax (2nd and 7th thoracic rings)
Driver - cranial region
Driver - pelvis
Impact of drivers on pelvic floor recruitment strategies, strength and endurance
A biologically plausible mechanism for thoracic and cranial contributions to incontinence
ISM treatment for Brad's thoracic and cranial driven pelvis
Release and align
Connect and move
Conclusion
Thorax and Cranial Driven Pelvic Floor - Tamarah Nerreter
Lisa's story and current meaningful complaint
Lisa's cognitive beliefs... Lisa's emotional status... Meaningful task and screening tests chosen for strategy analysis
Screening task analysis - standing
Impact of corrections on standing posture - finding drivers
Screening task analysis - squat to sit
Impact of corrections on the squat task- finding drivers
Vector analysis of the drivers
Primary driver - thorax (2nd, 3rd, 4th and 5th thoracic rings)
Secondary driver - cranial region
Impact of thorax driver on abdominal wall and pelvic floor recruitment strategy
ISM treatment for Lisa's thorax and cranial driven pelvic floor
Release and align
Connect and control
Move
Conclusion
Short Case Reports
Thorax Driven Head/Neck for Rotation - Diane Lee
Miyuki's story and current meaningful complaint and task
Meaningful task analysis - left head and neck rotation in sitting
Vector analysis of the driver - thorax (3rd thoracic ring)
Active listening during correction of the 3rd thoracic ring
Passive listening on release of the correction of the 3rd thoracic ring
ISM treatment
Thorax Driven Thorax for Rotation - Articular System Impairment - Diane Lee
Ayami's story and current meaningful complaint and task
Meaningful task analysis - right rotation of the thorax in sitting
Vector analysis of the driver - thorax (3rd thoracic ring)
ISM treatment
Pelvis Driven Thorax for Sitting - Diane Lee
Leah's story and current meaningful complaint and task
Meaningful task analysis - sitting using a weight bearing arm strategy
Thorax Driven Neck Control for Arm Elevation - Diane Lee
Elayne's story and current meaningful complaint and task
Meaningful task analysis - left arm elevation
Hypothesis
Summary
Chapter 6 RELEASE TECHNIQUES FOR THE SYSTEM IMPAIRMENTS
Introduction
Release and Align
Cognitive barriers
Emotional barriers
Sensorial/physical barriers
Articular System Impairments
Thoracic zygapophyseal joints
Vertebromanubrial region
Bilateral restriction of flexion - bilateral superior glide T1-2
Bilateral restriction of extension - bilateral inferior glide T1-2
Unilateral restriction of flexion - unilateral superior glide right T1-2
Unilateral restriction of extension - unilateral inferior glide right T1-2
Vertebrosternal/vertebrochondral region
Bilateral restriction of flexion - supine roll down technique
Bilateral restriction of flexion - seated distraction technique
Unilateral restriction of flexion - supine roll down technique (e.g. left T5-6)
Unilateral restriction of flexion - prone arthrokinematic technique (e.g. right T3-4)
Unilateral restriction of extension - supine roll down technique (e.g. left T5-6)
Unilateral restriction of extension - prone arthrokinematic technique (e.g. right T6-7)
Thoracic costotransverse joints
Vertebromanubrial region
Unilateral restriction of anterior rotation right 1st rib
Unilateral restriction of posterior rotation right 1st rib
Vertebrosternal region
Unilateral restriction of anterior or posterior rotation - supine roll down technique
Unilateral restriction of anterior rotation - prone arthrokinematic technique right 4th rib
Unilateral restriction of posterior rotation - prone arthrokinematic technique right 4th rib
Vertebrochondral region
Unilateral restriction of anterior rotation - prone arthrokinematic technique right 9th rib
Unilateral restriction of posterior rotation - prone arthrokinematic technique right 9th rib
Vertebrosternal/vertebrochondral region
Fixation of the left 5th costotransverse joint
Thoracic ring lateral translation/rotation fixation
Left lateral translation/rotation fixation of the 6th thoracic ring
Neural System Impairments
Release with awareness - principles
Dry needling - principles
Muscle recoil or muscle manipulation - principles
Specific techniques for individual muscles
Transversus thoracis
Diaphragm
Multifidus and rotatores
Intercostals
Serratus anterior
Pectoralis major
Pectoralis minor
Subclavius
External oblique
Internal oblique
Rectus abdominis
Back/neck extensors/rotators
General, non-structure specific technique for multiple system impairments
Dural/perineural system release techniques
Cranium to sacrum
Cranium to lower extremity
Cranium to upper extremity
Progression for the dural/perineural system to the lower extremity
Dural and posterior perineural system to the lower extremity
Dural and anterior perineural system to the lower extremity
Myofascial System Impairments
Visceral System Impairments
Summary
CHAPTER 7 MOTOR LEARNING AND MOVEMENT TRAINING
Introduction and Principles for Motor Learning and Movement Training
Intra-thoracic Ring Motor Control Training
Stage 1 - release and connect cues for intra-thoracic ring impairments
Sternocostal or costochondral joint impairment
Thoracic ring lateral translation/rotation impairment
Posterior translation impairment - thoracic spinal segment
Costotransverse joint fixation
Inter-thoracic Ring Motor Control Training
Stage 1 - release and connect cues for inter-thoracic ring impairments
Stage 1 - motor control training for the upper fibres of transversus abdominis and diaphragm
Stage 1 - motor control training prescription dosage
Taping for inter-thoracic ring control
Single thoracic ring translation/rotation - vertebrochondral region
Single thoracic ring translation/rotation - vertebrosternal region
Multiple adjacent thoracic ring translations/rotations
Taping the scapula
Stage 2 - strategy capacity training for inter-thoracic ring control
Stage 2 - training examples using body weight, free weights and light equipment
Stage 2 - training examples using Pilates equipment
Intra-pelvic Ring Motor Control Training
Lumbar and/or Cervical Segmental Control
Inter-regional Movement and Control - Moving into Function
Stage 3 - movement training
Hypopressive Exercise and Low Pressure FitnessTM
Summary
