IMPACT Manipulative Physiotherapy teaches a comprehensive thoracic assessment and manipulation/mobilization program. Participants learn how to evaluate and treat rib, facet subluxations. Additionally segmental anterior and lateral subluxations evaluation and treatments were taught and performed.

Included below are some mobilization and neuromuscular retraining progressions we use following manual therapy.

Thoracic Mobility

Quadruped Thoracic Rotation

• Start with the elbow pointing up and forward rotating to the left

• Finish with the left elbow directed toward the right hip. Note the rotation coming from the thoracic spin and not lumbar spine and hips.

• Perform this exercise for 3 sets of 10 repetitions

Cat-Camel

• Start with the back arched , head up and the pelvis tilted down.

• Arch back up with head flexed and posterior pelvic tilt.

• Perform this exercise for 3 sets of 10 repetitions.

Passive Thoracic Extension with Exercise Ball

• Lying over the ball allow the spine to fully extend. Add a cross body stretch of the shoulder to add a rotational stretch
• Perform this movement for 2 sets of 30 second repetitions.

Foam Roller Mobilization

• Roll placed perpendicular to the spine, lift hips off the ground and flex and extend upper spine on the foam roller. Move one inch up or down to mobilize the next vertebral segment.
• The extended position extending the spinal vertebra just above the foam roller on the segment stabilized by the foam roller. This technique is not as effective in the upper thoracic/neck region and lumbar region to the joint positions and lack of rib stabilization.

• Perform this exercise for 3 sets of 10 repetitions.

Warrior Lunge

• Start with front knee in line with the toes, back leg and foot in line with the front. Laterally rotating the foot alters the left hip and pelvic position.

• Left rotation: place hand inside the foot. Front foot knee and hip should remain in line with the knee staying lined up over the shoe laces. Rotation come from the hip and thoracic spine. Loss of either is noted by hyperextension of the shoulder as compensation.

• The next move is to place the left hand on the ground rotating to the right. Hip and knee positions should remain stable not letting the right knee go laterally. Note thoracic spine rotation.
• Perform this exercise for 3 sets of 10 repetitions on either side.

Book Openers

• Begin lying on your side, with legs together and slightly bent at knees and hips (as seen in photo).

• Rotate the outside arm in the opposite direction while keeping the legs in place. Be sure to keep the inside arm as flat on the ground as possible throughout the exercise.

Perform this exercise for 3 sets of 10 repetitions on both sides.

Lower Thoracic Wipers

• Begin with your back flat on the ground keeping shoulders flat. Extend both arms out to the side, creating a “T” with your upper body. One leg will remain extended, while the other rotates.

• Rotate the moving leg, in a controlled manner, laterally keeping the back, arms, and opposite leg as still and flat as possible. (as seen in the photo).

Perform this exercise for 3 sets of 10 repetitions on both legs.

Quadruped Thoracic Rotation

• Begin on all fours, with one hand on the back of your head and the elbow pointed towards the sky with that same arm.

• Rotate the elbow towards the chest and return to the starting position. Do your best not to round the back as you rotate inward.

Perform this exercise for 3 sets of 10 repetitions.

Quadruped Single Arm Thoracic Rotation

• Begin on all fours (up on hands and toes), maintaining a stable, core, back and neutral spine.

• Rotate the leg and torso in the direction of the opposite side.

NOTE: The free arm remains relaxed throughout the movement

• You should now be in a rotated three point position. After firmly planting the the rotated leg, push the hips forward towards the ceiling.

Perform the exercise for 3 sets of 10 repetitions on either side.

Thoracic Stability

Single Leg Stance Back Hands

Single leg stance requires good lumbar-thoracic stabilization to achieve proper shoulder motion. As with most athletic moves the spine serves to transfer energy from the lower body to the upper body and a stable spine is essential.

• Maintaining a stable back and core, begin with your arm extended out in front of you. Keep the knee and foot in alignment.

• Keeping the core engaged and back stable, pull the cable back so that you have a 90 degree bend in the elbow and the armpit. As you pull the cable back, retract the scapula.
• Perform this exercise for 3 sets of 10 repetitions on either side.

Single Leg Shoulder Extension

• Start with the arm extended out in front of you, using a hammer grip (vertical grip). Keep the foot and knee in alignment with the stance leg.

• Keeping the core and back engaged, extend the cable back, slightly past the hips. Be sure to maintain a straight (not locked) elbow.
• Perform this exercise for 3 sets of 10 repetitions on either side.

Single Leg Rows with Resistance Bands

• Begin with the arm extended out in front you. Maintain a stable back and core. Keep the knee of the stance leg in line with the foot.

• Pull the cable back towards the side of the rib cage, while maintaining a stable back and core

• Perform this exercise for 3 sets of 10 repetitions on either side.

Crossing Patterns with Resistance Bands

• Maintain a stable back and core
• The lifted leg should not be in contact with the stance leg
• Pull cable directly across the body from hip to eye level

BENEFITS:

• improved core stability, ankle stability, thoracic mobility and stability, glute medius strength
• Perform this exercise for 3 sets of 10 repetitions on either side

Upper Cut with Resistance Bands

• Maintain a stable back and core
• The lifted leg should not be in contact with the stanc

  -ce leg

• Pull the band directly across the body from hip to shoulder level

BENEFITS:

• improved core stability, ankle stability, thoracic mobility and stability, glute medius strength
• Perform this exercise for 3 sets of 10 repetitions on either side

I, T, Ys

• Begin with only your chest in contact with the exercise ball. The legs should be extended straight back to provide balance.

• Lift the arms above the head to make a “Y” with your arms. Be sure to bring your arms to head level and no further.

• Extend your arms up to make a “T” with your upper body.

• Extend the arms straight back, keeping the arms close to the body. Palms should be facing upward as you perform the movement.
• Perform this exercise for 3 sets of 10 repetitions (one ITY cycle counts as one repetition).

Dave Bender PT, FAAOMPT