This topic contains 1 reply, has 2 voices, and was last updated by 
William Brady, DC August 26, 2016 at 6:20 am.
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Adam Holen D.C.
Recently I’ve found myself struggling to adequately treat the T4-T7 area for CT Flexion/Thoracic Flexion. In the instructional video it’s noted to palpate/treat CT erectors from about C7-T6 and in the Cervical Case Study it’s noted more of C7-T3 or around the spine of the scapula. However, trying to generate enough tension from thoracic flexion at T4-T6 or reach that area from above treating the CT erectors (even with decent size hands) are both very difficult for me. It seems like this is a common place for patients to develop (what feels like) adhesion in the rhomboid area.
I’m still just starting to consistently get my hands on cervical spine cases and recently attended the cervical/thoracic seminar, but this has been my biggest draw back (we’ll leave cervical rotation difficulty out as I know CT flexion needs to be cleared first). To me it feels like significant adhesion, but I’m not sure what step I’m missing. Even with patients that have full shoulder ROM and no symptoms, they seem to have this common area of dysfunction and I can’t significantly reduce the T4-T6 ‘adhesion’ that I’m feeling.
My palpation, diagnosis, and ability to treat/develop tension are still fairly new skills so is it mainly that, or is there a better way to go about this? Would better treatment of the accessory nerve help clear this up first? Has anyone else dealt with this before or am I missing something? Any input would be greatly appreciated, even if it’s just clarifying that I’m trying to treat something that isn’t relevant or that I’m skipping steps. Thanks guys!
William Brady, DC
There are a lot of possibilities here. Start with the test: thoracic flexion. Is it limited? Use the pencil test just like we do with lumbar flexion. If there is a flat spot then begin with IAR to the supraspinous. Hopefully, you are not getting tension on the erectors because the supra is blocking motion. If supra is clear and the motion is blocked then treat the erectors at the restricted levels. This region is technique demanding- you need the right position, motion, depth and tension. I’m glad you are watching the videos. Continue to focus on feeling the tissue slide and generating tension. T3-T6 can be worked top down or bottom up, depends on the size of the patient, size of your hands and what you feel.
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