Hi, here's part 4.

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 started with sustained extension to confirm or rule out a derangement, and her R TH pain progressively worsened. She messaged to let me know, and I updated her HEP with Repeated TH rotation R, she stopped because it felt like rib "subluxation" then she saw her osteopath for adjust. I followed up with her, re-assessed, and reassured her that end-range TH rot R was correct and demonstrated the change in real-time. Also, had her perform some sustained mid-TH extension with a ball lying supine.

UPDATE: There has been definite improvement (see pain tracking above). She has done TH rot R to end-range and started sleeping supine to prevent her fetal sleep position. She had one flare-up from bending and leaning to pick up about 10lbs, and reduced it with her instructed HEP. Overall, she is feeling better, but is having difficulty understanding why. She has been indoctrinated into an "all pain is muscle weakness/tightness" mindset. I speak a different narrative of mechanical assessment, and part of my job is to educate her. She is willing to learn, and I gave her a crash course as it relates to her presentation.

TH motion testing:

• Flex: no loss, NE.
• Ext: min loss, mid-TH tightness
• Rot R w COP: no loss, NE
• Rot L w COP: no loss, mid-TH pull

Slump test: R posterior thigh is slightly tighter than L only with TH flexion moment (improved).

All neuro checks are normal.

I added a top-down thoracic extension exercise

TAKEAWAY: I think I am breaking through a belief narrative that she has lived in for a long time. She is starting to understand that the source of her problem is not "muscle weakness that's letting her ribs pop out". She is experiencing the differences.

Is this the right way to treat this person? Do I step into her narrative, or does she step into mine? I operate from the same process no matter what. I think her narrative is flawed because I demonstrated to her that muscle tension in any form is not the culprit for her pain, and her results are convincing.

Any thoughts are welcome.

The videos below are what I sent her for HEP.

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Until next time,

Ryan Tauzell, PT, Cert. MDT

ryan@atlashealth.io

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