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.