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Do you ache somewhere in your ribcage or back? Perhaps between your shoulder blades? Do you feel restricted when you twist like when reversing the car, swinging your golf club or running? Do you feel limited when taking a big breath or perhaps it feels asymmetrical? These are all things we hear you say all the time and are symptoms of non-optimal things going on in your ribcage or “thorax” as we call it.
Patients will commonly have already noticed asymmetries in their thorax before they come and see us, regardless of where their symptoms are.
If you aren’t sure, go find a mirror and have a look! Some examples of things you may notice are;
Did you see anything? Most of us have one or even all of these things, all of which are signs that your thorax is not optimal.
It has been a common belief that the ribcage is a rigid box that protects the vital organs that lie within it. From a Physio perspective we have been used to treating the ribs and spine in this region separately with focus on the joints. Are they stiff or how much do they move?
What we understand now thanks to the research of Dr LJ Lee (https://ljlee.ca) is that this view of the ribcage is not the case and we as Physio’s need to radically change our thinking, assessment and treatment of this region. Your ribcage is actually made up of 10 rings stacked on top of one another making up a slinky. Because the connections that join the vertebra and ribs and chest bone are so strong they form a circle, a functional unit that we call a “ring”. Each ring has 13 joints in it and is made up of the rib on each side and the adjacent vertebra that they join to. Movement of a rib therefore has an impact on the vertebra in that ring.
If you are trying to assess the whole ring in space and where it is relative to your feet and your centre of mass, only feeling from the back and feeling the vertebra and back of the ribs (as we have traditionally done) isn’t going to give us very accurate information on what is happening throughout the whole ring. Rings should be stacked on top of one another like a lovely stack of plates. But, when this region is non-optimal we feel rings that are more translated and rotated to one side, rings that are compressed and squished into the ones below or above, rings that are more forwards or rings that move more compared to other rings.
So, when assessing this region we need to feel at the sides of each ring to get way more information about what is going on in the whole unit. Your ribcage starts just below your collar bone so we will need to feel all the way up into your armpits!
By feeling the sides of each ring we can assess several things;
THEN and most importantly,
Photo courtesy of ljlee.ca/teaching-models/the-thoracic-ring-approach/
Top picture shows beautifully stacked rings.
Bottom picture shows non-optimal rings that are being compressed in the right and translating the middle ring to the left.
What we also know from research and further work from Dr LJ Lee is that the thorax is actually a relatively flexible region of the body. Remember there are 13 joints in each ring and joints move. Movement needs to be controlled and this control comes from the nervous system and the muscles they innervate. For more on this read our blog ‘Putting a Spring in Your Step’.
So, your “One Thing” to do this week is go and have a look at your body most specifically your trunk and ribcage. Check for the non-optimal signs above that your rings are stacked! See what you find.
Remember, as we have said before, your ribcage can be causing pain and problems anywhere in your body. Treating your thorax has never made more sense than with the Thoracic Ring Approach™. For more information please get in touch and also check out LJ’s website which is geared towards Physio’s but also has heaps of information that will make a whole lot of sense to you!