HoIf you are a newer clinician or haven’t had time in the clinic to practice your manual techniques, you may not feel very comfortable treating the cervicothoracic region. Due to the sensitive structures around the cervical region, many clinicians and patients alike don’t feel comfortable with manual treatment or receiving hands on care in this region. In order to effectively treat this region, improving your clinical reasoning and manual skills can make you and your patients feel more confident in their care.
Neck pain is one of the most common problems seen in physical therapy. As most people spend many hours sitting at their work stations and spend a lot of time on their electronic devices, it is only going to behoove you as a clinician to get comfortable with treating the cervicothoracic region. When discussing the cervicothoracic region, there are more areas to think about besides cervical and thoracic spine. They include the nerves and neurodynamics, CT junction,rib cage, and shoulders. Due to the proximity, we know through regional interdependence that these areas affect each other. But how do you go about blending clinical reasoning, assessments, and different interventions together to get the most effective outcomes?
I remember a time when it was difficult to get quick outcomes with some of my cervical patients. Recently, I was able to effectively utilize manual therapy to help a patient who has been dealing with shoulder pain for 12 years. She had previous carpal tunnel surgery in bilateral wrists, but still had numbness and tingling in her right arm and hand. The numbness and tingling was worse with the arm above 90 degrees of elevation, but also noted below the shoulder height.By assessing her cervical spine, neurodynamics and integrating different manual therapy techniques, I was able to reduce her pain levels drastically in two visits. There is still a lot to work on, but utilizing manual therapy by improving her cervical range of motion (ROM) and decreasing her pain significantly allowed her to believe in her care.
Without learning how to properly assess for neural tension and learning different mobilization/manipulative techniques to the cervicothoracic region, it may have been a very frustrating case. Although I haven’t perfected my assessment and manual skills, this case taught me a few things.
First off, manual therapy isn’t dead. We see so many negative talks about manual therapy though social media, and insurances are reimbursing less for manual therapy. While I agree that you don’t want someone to RELY on your hands alone,manual therapy allows a great opportunity to create positive change for our patients if done properly. It also allowed me to feel and assess the area instead of just looking at movement.
Second,the nervous system is powerful. All the connections in our bodies and the hundreds of road maps in our bodies play a large role in protection. However,when stimulated appropriately, we can make positive changes even in chronic pain conditions. Manual therapy allowed me to assess as well as treat in order to start the patient on the right path.
Effectively, treating the cervicothoracic region will require management of many areas including cervical spine, thoracic spine, ribs, nerves, and upper extremities.If we can’t properly stimulate the region that houses our powerful nervous system, the outcomes may be limited. If you are a newer clinician looking for a good foundation of manual therapy skills or seasoned clinician who has gone stale in manual skills and would like to become confident in treating the cervicothoracic region, luckily for you there is a course coming up by Dr. Brandon Cruz of Pursue PT, which will help you achieve better outcomes.