The Thoracic Spine and Associated Disorders and Treatmentby Joseph Kurnik,DC
My previous articles have referred for the most part to the relationship of the lumbar spine and sacroiliac functioning. The middle (and especially the lower) thoracic spine also may influence SI joint functioning.
There are a few situations involving the mid and lower thoracic regions which can be looked at in relation to SI joint functioning:
This concept especially holds true with congenitally or acquired thoracic round back disorders (hyperkyphotic thoracic spines). You can see this also with hyperkyphotic scoliosis. Kyphosis may extend into the upper lumbar spine, causing increased lumbar lordosis and lumbar facet compression. Within this hyperkyphosis, you can find specific extension restrictions. The existence of extension restrictions increases the rigidity of the thoracic region, as well as the lumbar extension compensation and posterior compartment compression. Correction of this type of situation can be twofold:
b. Some doctors develop low back pain with the frequent bending forward.
3. Wall adjusting. This technique is like supine adjusting, except against the wall. It works well when it can be done. It is difficult if the doctor is small.
4. Incline adjusting. This is the use of a bench table with an incline attachment. It is a standard adjusting bench with a headpiece and an adjustable bench top. The caudal end of the table can be raised to any angle up to about 45-50 degrees. The patient sits and straddles the table and leans back against the raised backboard (as opposed to standing or lying supine). The patient is adjusted as in the supine type of adjusting. There are several benefits here:
a. The doctor does not have to bend very much.
b. The patient does not have to lie supine and may sit.
c. It is easier to adjust upper lumbar extension fixations. On some individuals, I can adjust down to L-3 and L-4 levels. This allows lumbar adjusting without twisting and permits direct extension correction.
I use this incline table much of the time, but I mix up the above adjusting positions based upon the problem and build of the patient. The incline table is like oxygen. You don't always need it, but it can save the day. Other tables are similar and pre-date this table, such as the Pettibon style tables. The incline table I prefer uses a caudal incline, and the Pettibon-style uses a cephalic inclination. This table style also is narrower, allowing for easier straddling in the seated position. This table style also has a narrowed head region for use in performing supine and prone adjusting.
The styles of adjusting and table styles are important considerations
for allowing greater variability of adjusting and for increasing your
success. The Pettibon table style must work well for these doctors who
use them, as other styles work well for other doctors.