The thoracic spine is often difficult to assess and treat in physical therapy. It’s occasionally described as no man’s land with treatment focused on improving postural adaptations. With careful evaluation and proper subjective history the thoracic spine and often concurrent rib dysfunctions become more clear. In addition, be sure to clear for systemic and non-musculoskeletal origins of pain as the thoracic spine has many different referral patterns.
The thoracic spine is often a great place to begin manual therapy interventions for the cervical spine. The CT junction and upper thoracic manipulation have demonstrated great effectiveness and with less risk than that of the rotational manipulations of the cervical spine. For those early in their manual therapy career get comfortable with thoracic manipulations first.