profile

Atlas Health

Part 3, Thoracic Pain That Doesn't Respond to Extension...At First

Published 3 months ago • 2 min read

Hi everyone, here's part 3.

I'm leaving the FAQs at the bottom for a little while. Glad they're helpful.

RECAP: Patient is a 42-year-old female with the onset of intermittent symmetrical mid-low thoracic pain about one year ago after roughhousing with her young boys. I sent her out with sustained extension to confirm or rule out a derangement, and her R TH pain progressively worsened. She messaged me to let me know, and I updated her HEP with Repeated TH rotation R.

UPDATE: She stopped TH rotation R because of "rib subluxation", then she went to the osteopath for adjustments and feels better. Sitting at rest, she had no symptoms.

TH motion testing:

  • Flex: no loss, NE.
  • Ext: min loss, L>R subscap region awareness.
  • Rot R w COP: no loss, ERP central TH.
  • Rot L w COP: no loss w L subscap pain

Slump test: R posterior thigh is tighter than L only with TH flexion moment. She is able to front fold and hinge through the hip, which produces no tightness on the R. Test-Retest confirmed. This indicates a changeable mechanical structure producing tension only with a TH flexion moment.

All neuro checks are normal.

During a recheck of her HEP (TH rot R), she demonstrates avoidance of end-range due to apprehension of risk of "rib subluxation". Recheck of sustained TH ext over a small ball produces discomfort centrally, but generally feels good. We retested TH rotation R with gradual force progression to achieve end-range and then with clinician overpressure. She felt better about TH rot R afterward.

I sent her out with continued TH rot R to end-range and resumption of TH extension sustained over a ball. This required a lot of education on why end-range is important to produce lasting reduction instead of near end-range "biting" without reduction. Also, I approached the rib subluxation issue with one simple statement: "The probability of you subluxing a costovertebral joint through rotating your thoracic spine is very, very low, even though it felt like that."

TAKEAWAY: R neural tension is only present during a TH flexion moment. She was avoiding end-range TH rotation R due to apprehension. A lot of education was needed to set the stage for what to pay attention to (when to keep going/stop).

The videos below are what I sent her for HEP.

​
​

Until next time,

Ryan Tauzell, PT, Cert. MDT

ryan@atlashealth.io

​atlashealth.io​

​Click HERE to use the full functionality with Atlas Health's platform for a FREE trial with 5 patients.

FAQs

  • We've had several people ask if certain features are "subscription-only" during the free trial. You can use the full functionality for 5 patients. You won't be able to add the 6th patient until payment is made. So, add up to 5 patients, poke around, test it out, send messages, exercises, patient education, set alerts and outcome measures, everything, all you want...for 5 patients 🙂).
  • We are serious, no credit card is needed for the free trial. The card is required only when you add the 6th patient. You create your account and start using it.
  • You do need a subscription for white-labeling. It's just not cost-effective to white-label free trials. But white-labeling looks really nice and promotes brand recognition when you send programs to patients.
  • The Cost: $49 per clinician per month or $490 per clinician per year.
  • Yes, we offer enterprise subscriptions. Just send me an email.
  • You can cancel anytime, and your account will be prorated.
  • We can not make the avatar look like you yet. But if enough people want it, we can prioritize developing this option.
  • We do have a female avatar, but not ready for production yet.
  • Thank you, everyone, for your questions!!

​Click HERE to book a demo with Jason Ward or me and see how we use it.

P.O. Box 11195, Blacksburg, VA 24062
​Unsubscribe · Preferences​

Atlas Health

Read more from Atlas Health

Hi, here's the Part 3 follow-up to the patient with Parkinsonian tremor who has returned with vertigo-like symptoms. RECAP: 72-year-old male with a 9-month history of "Parkinsonian tremor" right-sided that responded to cervical spine mechanical repeated movements and remained better. He then returned a few months later with vertigo-like symptoms. Sustained retraction and sustained upper TH extension supine over #1 soccer ball improved multiple baselines. MRI Results Disc space heights:...

10 days ago • 1 min read

Hi, Reader We’ve heard all your feedback on pricing, and we don’t want cost to get in the way of you being able to treat your patients well. So, we've made a pretty big change. We’re lowering the price of our patient management platform from $49/month to $22/month, a 55.1% reduction, or $220/year (2 free months compared to a monthly subscription). For $22/month, you get everything Atlas Health offers to enhance your patient's experience: Precise video instruction, 700+ exercises, patient...

14 days ago • 1 min read

Hi everyone, here's a follow-up to the 65 y/o male with L lower leg numbness that sounds like a no-brainer for extension. RECAP: Current Symptoms: 6 week history of numbness L>R lower leg and foot lateral and bottom aspect-constantly due to hours of kneeling to lay flooring. Chronic weakness on R LE plantarflexion from previous lumbar surgery-constantly. Not much pain, just increased numbness. Worse: Prolonged sitting (e.g., long car rides), reclining with feet elevated, and possibly...

26 days ago • 2 min read