Thoracic Spine Manual Therapy for Aging and Older Individuals

Abstract

With the advancement of medicine and technology, along with improvements in preventative medicine, the average age of the US population continues to rise. Research estimates that by the year 2050, there will be more than 65 million older adults living, with 19 million being older than 85 years. As the population ages, more individuals will seek out physical therapy services for spine-related pathologies. Little evidence is currently available on the safety and effectiveness of manual therapy interventions in older adults. The purpose of this review was to discuss the safety and effectiveness of manual therapy interventions targeted at the thoracic spine in older individuals.sents the highest prevalence rates among the 4 conditions identifi ed. 4 These conditions, in addition to other less common conditions such as ankylosing spondylosis, frequently contribute to thoracic pain or immobility in the older adult. In addition, the presence of osteoporosis paired with the potential increased rate of falls results in higher risks of compression fractures in the thoracic spine in older adults. 3 Although primary thoracic pain has been cited as occurring less frequently than neck or low back pain, 5 it can be equally and/or more severe and disabling. 6 , 7 The point prevalence for thoracic spine pain ranges from 3% to 70%, with a 1-month prevalence that ranges from 10% to 38%, a 3-month prevalence between 13% and 39%, and a 1-year prevalence ranging from 25% to 55%. 8 In addition, there is research to suggest that thoracic spine pain increases during the middle adult years (40-50 years), with a decrease in later adult years ( > 70 years). 9 Furthermore, because of the proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine and/or rib cage can potentially have an infl uence on pain, mobility, and stability in these regions. While mechanisms are unclear, substantial evidence suggests that manual therapy interventions directed at the thoracic spine can decrease pain and improve motion in the thoracic spine and adjacent regions. 10-20 According to the Guide to Physical Therapy Practice, 21 manual therapy can be defi ned as techniques that involve skilled passive movements to the joints and/or related soft tissues that can be applied at varying speeds and amplitudes, including a small-amplitude, high-velocity movement (thrust manipulation). 10 Considering the central role the thoracic spine has in spinal health, the aging population, and the relative cost-effectiveness of manual therapy for managing spinal pain, 22 the main aims of this article are to review thoracic spine anatomy, biomechanics, pathoanatomy, and differential diagnosis to establish the current knowledge of the role of manual therapy and exercise as interventions in the management of thoracic spinal pain in older individuals. THORACIC SPINE ANATOMY AND MECHANICSThe thoracic spine is conceptually divided into 3 regions: an upper (T1-T3), a middle (T4-T7), and a lower (T8-T12) thoracic spine. 23 In addition...