Thoracic spine

Question 1

Thoracic spine and breathing

Answer 1

• The Tsp is the most mechanically stable part of the spine – least amount of movement available to it.
• This is to allow a secure attachment for the ribs to articulate from during breathing.
• The thorax and rib cage are a closed, sealed system which allows it to act as a bellows.

Question 2

Ribs

Answer 2

A - T1-T6 Pump handle
B - T7- T10 Bucket handle
C - T11-12 Caliper
Ribs 1 and 11,12 only articulate with one verterbra. The ribs articulate with 2 the Tp’s veterbrae and the body of 1 veterbrae.
Common cause of midscapular pain.

Question 3

Normal breaths per min

Answer 3

Adults: 12-18 breaths per min

• 6 years: 18–25 breaths per minute - Smaller rib cage that has to work harder.
• Elderly ≥ 80 years old: 10-30 breaths per minute

Question 4

Pattern of breathing as you age

Answer 4

Osteopathy good for treating respiratory problems
* Children breath predominantly abdominally.
* Adulthood more upper rib thoracic breathers
* Elderly abdominal again

Question 5

Chest shapes

Answer 5

• Pectus Carinatum – pigeon chest, rounded front chest
• Pectus Excavatum – sternum recessed behind the ribs
• Barrel chest – thorax is as deep as it is wide, chronic asthmatics

Question 6

Relationship of diaphragm, rib cage and lumbar spine

Answer 6

Due to Diaphragm attachments –
* Xiphoid process of the sternum
* Anterior bodies of Lumbar vertebrae L1/3 and arcuate ligament
* Coastal cartilages of ribs 7 to 10 and direct attachment to ribs 11 to 12.

Question 7

How can a chronic cough lead to back pain

Answer 7

• The posterior attachments of the Diaphragm being the crus onto anterior vertebral bodies of T12 – L3
• The proximal attachments of quadratus lumborum are the lower ribs 10,11,12 and then onto the posterior Iliac crest.
• Both muscles are key respiratory muscles and can be strained during the expulsive action of coughing.

Question 8

Can Osteopathy cure asthma?

Answer 8

• Asthma is a failure of expiration.
• Develop upper rib breathing and barrel chest, ribs are already extended so they struggle to breath in more as there’s nowhere for the ribs or thorax to go.
• Stretch out the intercostal muscles to get ribs to relax and drop down to a neutral position to help the Pt breath in.
• Can’t cure asthma but can help with the MSK consequences of asthma, mobilise ribs to relax and lower them to aid breathing mechanics. Also encourage the use of assessor muscles of respiration e.g., sit on a chair backwards

Question 9

Limiting factors for breathing

Answer 9

• Age: advanced age leads to increased muscles stiffness which leads to reduced compliance.
• Scoliosis- can lead to excessive side bend and rotation affecting thoracic compliance and rib excursion.
• Schuerman’s kyphosis – leads to excessive thoracic kyphosis, resulting in reduced rib excursion and thoracic expansion.
• Rheumatoid arthritis – leads to increased stiffness and inflammation of the cartilage of sternocostal joints, resulting in reduced rib excursion,
• Obesity

Question 10

How does COPD affect breathing mechanics

Answer 10

COPD causes Airway Obstruction & Loss of lung Elasticity, causing symptoms like including shortness of breath, wheezing, coughing, and reduced exercise tolerance. This is because of:

Increased Work of Breathing: With narrowed airways and reduced lung elasticity, individuals with COPD must exert more effort to breathe. They often rely on additional muscles, such as the accessory muscles of the neck, shoulders, and chest, to help expand the chest cavity and facilitate airflow. The increased work of breathing can lead to a sensation of breathlessness and fatigue.

Question 11

How does hyperinflation disrupt breathing mechanics.

Answer 11

Increased Air Trapping: As air becomes trapped in the lungs due to incomplete exhalation, there is an accumulation of residual volume and an increase in lung hyperinflation. This hyperinflation causes the diaphragm, the primary muscle involved in breathing, to flatten and reduce its effectiveness. The flattened diaphragm reduces the capacity of the lungs to expand during inhalation, further limiting the intake of fresh air.

Question 12

Impact working posture has on breathing mechanics

Answer 12

Slouched or Hunched Posture: Sitting or standing in a slouched or hunched posture can compress the chest and restrict the movement of the diaphragm. This can limit the ability of the lungs to expand fully during inhalation and reduce the efficiency of breathing. It may lead to shallow breathing, where only the upper chest is involved, rather than utilising the full capacity of the lungs.

Forward Head Posture: When the head is positioned forward, such as when working on a computer or looking down at a desk, it can affect the alignment of the spine and thorax. This posture can cause the shoulders to round forward, tightening the chest and potentially restricting the movement of the ribs. It can also put strain on the neck and upper back muscles, affecting the ability of the respiratory muscles to function optimally.

Question 13

Other function of Tsp

Answer 13

• Creates an anchor for the movements of the Upper extremity
• Don’t forget the Tsp has an anterior as well as posterior, e.g., scoliosis asymmetry causes pain in the ribs.
  Facets coronal 60deg.