Regis Thomas Aaompt Poster 2008

MANAGEMENT OF A PATIENT WITH SUB-ACUTE RIB CAGE PAIN USING MANUAL PHYSICAL THERAPY TECHNIQUES, FEAR-AVOIDANCE BELIEF EDUCATION, AND EXERCISE Thomas S Fellow - Regis University Manual Therapy Fellowship Program Physical Therapist, Hamilton Physical Therapy, Baltimore, MD

Manual Therapy Fellowship

Purpose:

Procedures:

Discussion:

The purpose of this case report is to illustrate the potential interdependence between the spine and rib cage by presenting the results of a multimodal physical therapy treatment approach directed at the cervical spine, thoracic spine, and ribcage in the management of rib cage pain.

The patient was seen 11 times over 4 weeks. Treatment included thrust and non-thrust manipulations directed to the cervical spine, thoracic spine, and rib cage; stretching of cervical and chest wall musculature; fear-avoidance education; deep cervical flexor endurance training; and specific exercises aimed at improving joint mobility and range.

The results of this case demonstrates the efficacy of a multimodal physical therapy treatment approach integrating education, exercise, and manual physical therapy directed to the cervical spine, thoracic spine, and ribcage in improving traumatic subacute rib cage pain in E.M.

Subject:

Results:

E.M. was a 63 year-old woman with post-MVA intense burning pain in the left anterior chest wall region, aggravated with coughing and inhalation. Physical examination revealed limited cervical and thoracic AROM and therapist perceived cervical and thoracic segmental hypomobility.

Clinical Relevance:

By discharge all outcome measures including pain, function, and fear had improved. And the patient reported her condition to be a “great deal better” (i.e. Global Rating of Change score = +6). Active Range of Motion Measurements Cervical Flexion

Initial (degrees) D/C (degrees)

Cervical Cervical Cervical Extension Sidebend Sidebend Right Left

Cervical Rotation Right

Cervical Rotation Left

54

43

40

38

62

57

Thoracic Flexion (Level of scapular spine) 10

60

60

60

55

70

80

20

Thoracic Flexion (Level of Inferior scapula) 8 8

Thoracic Thoracic Sidebend Sidebend Right Left

15

20

20

25

The results of this case study suggests that regional interdependence between the cervical spine, thoracic spine, and rib cage may exist. Further research is necessary to validate this hypothesis.