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MANAGEMENT OF A PATIENT WITH SUB-ACUTE RIB CAGE PAIN USING MANUAL PHYSICAL

THERAPY TECHNIQUES, FEAR-AVOIDANCE BELIEF EDUCATION, AND EXERCISE


Thomas S
Manual Therapy Fellowship Fellow - Regis University Manual Therapy Fellowship Program
Physical Therapist, Hamilton Physical Therapy, Baltimore, MD

Purpose: Procedures: Discussion:


The purpose of this case report The patient was seen 11 times over 4 weeks. Treatment The results of this case
is to illustrate the potential included thrust and non-thrust manipulations directed to demonstrates the efficacy of
interdependence between the the cervical spine, thoracic spine, and rib cage; stretching a multimodal physical
spine and rib cage by presenting of cervical and chest wall musculature; fear-avoidance therapy treatment approach
the results of a multimodal education; deep cervical flexor endurance training; and integrating education,
physical therapy treatment specific exercises aimed at improving joint mobility and exercise, and manual
approach directed at the range. physical therapy directed to
cervical spine, thoracic spine, the cervical spine, thoracic
and ribcage in the management spine, and ribcage in
of rib cage pain. improving traumatic sub-
acute rib cage pain in E.M.
Subject: Results:
E.M. was a 63 year-old woman By discharge all outcome measures including pain, Clinical Relevance:
with post-MVA intense burning function, and fear had improved. And the patient reported
pain in the left anterior chest The results of this case
her condition to be a “great deal better” (i.e. Global study suggests that regional
wall region, aggravated with Rating of Change score = +6).
coughing and inhalation. interdependence between
Active Range of Motion Measurements the cervical spine, thoracic
Physical examination revealed Cervical Cervical Cervical Cervical Cervical Cervical Thoracic Thoracic Thoracic Thoracic spine, and rib cage may
Flexion Extension Sidebend Sidebend Rotation Rotation Flexion Flexion Sidebend Sidebend
limited cervical and thoracic Right Left Right Left (Level of (Level of Right Left exist. Further research is
AROM and therapist perceived scapular Inferior necessary to validate this
spine) scapula)
cervical and thoracic segmental hypothesis.
Initial 54 43 40 38 62 57 10 8 15 20
hypomobility. (degrees)
D/C 60 60 60 55 70 80 20 8 20 25
(degrees)

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