When I was in physical therapy school, I was taught about the issue of an increased thoracic kyphosis (i.e. hunchback) and its possible relationship to postural dysfunction. Fast forward 18+ years and what I see more than increased thoracic kyphosis is actually the opposite: Flattened/decreased thoracic kyphosis (flat back) What it will typically present with is significant scapular winging, forward shoulders, forward head posture, and elevated scapulae (shrugged shoulders). And since kyphosis means flexion in the spine, rather than getting flexion from the thoracic spine theres a tendency to get it from the junction, or meeting, points such as the cervico-thoracic (dowagers hump) spine or the thoracolumbar (upper lower back) spine. So if youre flat like a 2 x 4 board, it will effect the mechanics and function of several areas such as your ribcage expansion, respiration, and scapular stability/shoulder joint function just to name a few. For example, I presently seeing a patient with complaints of right upper back pain around the area of the inferior angle of the right scapula. The scapula needs the roundedness of a thoracic kyphosis with a ribcage in which it can move about considering it is only connected to them through the muscles and other soft tissues. Take out the roundedness and the muscles will have to compensate to provide the necessary stability for the scapula and thus shoulder joint (humero-glenoid) function. With this particular case, her right lower serratus anterior was facilitated and contributing to her area of pain complaints. The right upper serratus anterior was disengaged because the upper ribcage was rotated to the right, which placed the ribs in a more externally rotated position (which placed the upper serratus anterior in a more lengthened state). Also, because the scapula stabilizers were having difficulty providing stability for the shoulders, the deltoids were compensating for the serratus anterior. On the right shoulder, the anterior deltoid was working more to pull the already posteriorly oriented right shoulder (due to the right oriented ribcage) more forward. On the left shoulder, the posterior and middle deltoid were overworking to pull the left shoulder more back. So I guess the moral of the story is to not believe everything you were taught in school until you actually examine a patient (or several thousand)........ Never too late for your evaluation at Michael Jocson Physiotherapy ;)
Posted on: Mon, 20 Oct 2014 17:50:10 +0000
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