COMT Techniques for the Thoracic Spine and Rib Cage

COURSE DESCRIPTION

Clinical Orthopedic Manual Therapy (COMT) for the Thoracic Spine and Rib Cage covers the major clinical orthopedic assessment and treatment techniques for the thoracic spine and rib cage. This course is a 2-day hands-on workshop.

Day one begins with postural, orthopedic, and palpation assessment for the common neuromusculoskeletal conditions of the region, including upper crossed syndrome. We then cover body mechanics for deep pressure for working the thoracic spine and rib cage. With proper body mechanics, you will learn how the thoracic region can be worked deeply with little effort.

Day two covers stretching, including arthrofascial stretching (AFS) techniques. We begin with basic stretching for the functional muscle groups of the thoracic spine and shoulder girdle and then learn how to target each specific muscle with multiplane stretching. We then cover advanced neural inhibition stretching techniques, including Contract Relax (PNF/PIR), Agonist Contract (the basis for AIS), and Contract Relax Agonist Contract stretching techniques. Day two concludes with AFS (soft tissue Grade IV joint mobilization for manual therapists), including traction, for the thoracic spine and rib cage. AFS is the only effective means of stretching specific hypomobilities.

Clinical treatment strategy as well as precautions and contraindications are also covered. These manual therapy skills will empower you to do effective clinical orthopedic work. Throughout this hands-on workshop, Dr. Joe Muscolino reinforces the underlying mechanisms for each of the assessment and treatment techniques, encouraging critical reasoning skills.

Clinical Orthopedic Manual Therapy for the Thoracic Spine and Rib Cage is part of the COMT Regional Approach Certification. The other hands-on workshops in this series cover the neck, low back / pelvis, upper extremity, and lower extremity.

COURSE OBJECTIVES

After attending this workshop, the participant will be able to:

Explain and demonstrate the principles of using core body weight and larger muscle groups for efficient body mechanics.
Perform postural, orthopedic, and palpation assessment tests for the thoracic spine and rib cage to determine the ability to safely perform deep pressure massage, stretching, and arthrofascial stretching (Grade IV joint mobilization).
Explain the fundamental concepts of stretching and apply these concepts to the musculature of the thoracic spine and rib cage.
Demonstrate how to stretch each of the functional muscle groups of the thoracic spine and rib cage.
Explain and demonstrate how to stretch each of the muscles of the thoracic region and rib cage in multiple cardinal planes.
Explain the physiologic basis for and demonstrate how to perform contract relax (CR; also known as PIR/PNF) stretching, agonist contract (AC) stretching, and contract relax agonist contract (CRAC) stretching techniques.
Explain the physiologic basis for and demonstrate how to perform AFS of the thoracic spine and rib cage.

DETAILED TIME LINE

Following is the usual time line for this workshop. Note: This time line is often adjusted as needed based on the needs of the particular group.

DAY ONE:

Introductions: 15 min

Introduction to the content of the class
Introduction of instructor and workshop participants to each other

Postural, orthopedic, and palpation assessment of the thoracic spine and rib cage: 120 min

Postural assessment for upper cross syndrome, hypokyphosis, and scoliosis
Orthopedic assessment for thoracic outlet syndrome
Palpation assessment

Neck-COMT-AD-CH4-271-copy-3 Break: 15 min
Body mechanics and prone thoracic work: 60 min

Work laminar groove musculature
Orient core in line with stroke
Keep elbow in
Stack joints
Work perpendicular to contour of client’s/patient’s body
Maintain angle of elbow joint
Lean in with body weight / core
Brace contact

Body mechanics & shoulder girdle work: 45 min

Table must be low
Passively retract scapula and work deep to scapula
Work cross-table

Lunch: 60 min

Body mechanics & side-lying and supine thoracic/pectoral work: 45 min

Table must be low
Access between ribs, serratus anterior, and subscapularis
Work pectoral region
Use body weight

Basic stretching (concept and body mechanics): 75 min

Stretching is a mechanical protocol for making a soft tissue longer
For a muscle, it involves passively bringing the client’s/patient’s muscle into a position that is the opposite of its action(s)
Concept of stabilization: how to figure out how to stabilize
Introduce concept of functional groups of muscles (trunk flexors, extensors, right lateral flexors, left lateral flexors, right rotators, left rotators; scapular protractors and retractors, elevators and depressors, upward and downward rotators)
Incorporate body mechanics with elbow joint in, stacked joints, and using the core
Workshop functional groups

Break: 15 min
Multiplane stretching: 75 min

Begin with functional groups and narrow the scope to be able to target a specific muscle within the functional group
All planes of motion (i.e., all joint actions) must be considered to optimally stretch a muscle: examples: right upper trapezius, pectoralis minor, etc.

Review: 15 min

Question and answer
Discuss treatment strategy

DAY TWO:

Introductions: 15 min

Question and answer over material from Day 1

Contract Relax (CR) stretching: 60 min

Principle of Golgi tendon organ reflex
Demonstrate CR protocol for pectoral musculature
Workshop CR technique for the major functional groups
Workshop CR for specific target muscles

Agonist Contract (AC) stretching: 60 min

Principle of reciprocal inhibition reflex
Demonstrate AC protocol for pectoral musculature
Workshop AC technique for the major functional groups
Workshop AC for specific target muscles

Break: 15 min
CRAC stretching: 60 min

Demonstrate CRAC protocol for the pectoral musculature
Workshop CRAC technique for a few of the major functional groups
Workshop CRAC for specific target muscles

Overview of AFS: 30 min

Explain concept of pinning a bone and moving adjacent bone relative to it
Client/Patient contact
Therapist contact: index finger pads, thumb pad, pisiform or thenar eminence
Steps: 1) Place pin. 2) Bring joint to tension. 3) Mobilize.
Hold for less than a second, 3-5 oscillations
Soft tissue pull to trap underlying bone
Contraindications…
Use hands in concert
Utilize body mechanics

Lunch: 60 min

AFS prone: 60 min

Posterior to anterior (extension)
Transverse process contact
Rib contact

AFS seated: 60 min

Motion palpation assessment technique
Joint mobilization for rib cage and spine
The Saw
Thai move with feet

Break: 15 min
AFS – supine: 90 min

Workshop joint mobilization technique with the client/patient supine
Rib contact
Spinous process contact

Review and paperwork: 15 min

Question and answer
Fill out evaluation forms
Hand out Certificates

WORKSHOP PARTICIPANTS SHOULD BRING

1. Massage table with face cradle
2. Stool
3. Bolster and pillow
4. Sheets and face cradle cover
5. Water-based lotion
6. Soft foam cushion (approx. 6×10 inches) or bath towel
7. Participants should wear a button down shirt that can be worn backwards for access to the back