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Varna Medical Forum

Clinical efficacy of manual therapy for functional thoracic spine disorders

Tsvetomir Yankov, Iliya Todorov


Functional disorders are the most common cause of pain and restricted movement in the thoracic spine. They are reversible conditions characterized by reduced joint mobility, muscle tension, and pain in the paraspinal muscles. The higher prevalence of functional disorders in the thoracic spine over structural pathologies shows the need for specific therapeutic protocols for their treatment. Manual therapy, encompassing various diagnostic and treatment approaches, aims to alleviate joint "blockages" in the musculoskeletal system. Particularly, acute functional thoracic spine disorders respond favorably to manual manipulation.

Aim of the study: To investigate the immediate and long-term clinical effects of the application of manual therapy in patients with functional disorders in the thoracic spine.

Material and methods: Twenty patients aged 18 to 50, diagnosed with thoracic spine functional disorders through both clinical history and manual assessment, underwent manual therapy. The therapeutic course included manual manipulation targeting the "blockaged" thoracic spinal segments—once on the study's first day and again after 15 days. Outcomes were evaluated using Ott’s sign, lumbar-locked rotation test, and VAS for spontaneous and palpable pain. Patients were evaluated three times: at the beginning of the trial, after the end of the therapeutic course, and 45 days after the beginning of the therapy.

Results: In all patients, there was an improvement in the range of motion, a reduction in pain, and an improvement in the functional state of the thoracic spine. Recent findings suggest that the benefits achieved through manual therapy are sustainable in the long term.

Conclusion: Manual therapy has a successful and long-lasting therapeutic effect on patients with functional disorders in the thoracic spine. Further exploration, including the integration of manual therapy with other physiotherapeutic interventions, holds potential for better pain reduction and muscle tone modulation.


functional disorders, thoracic spine, manual therapy

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Левит К. Мануална Терапия в Рамките На Медицинската Рехабилитация. София, Медицина и Физкултура, 1981.

Тодоров Т. Мануална Медицина – Диагностика и Терапия. Варна, ВСУ „Черноризец Храбър“, Университетско Издателство, 2005.

Benjamin RL. A Retrospective Cross Sectional Survey of Thoracic Cases on Record at Durban University of Technology Chiropractic Day Clinic.

Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5(6):455-464. doi:10.2217/pmt.15.39.

Briggs AM, Bragge P, Smith AJ, Govil D, Straker LM. Prevalence and associated factors for thoracic spine pain in the adult working population: A literature review. J Occup Health. 2009;51(3):177-192. doi:10.1539/joh.K8007.

Campbell BD. Snodgrass SJ. The Effects of Thoracic Manipulation on Posteroanterior Spinal Stiffness. Journal of Orthopaedic and Sports Physical Therapy, 2010 40(11): 689.

DeVotch JW. Pickar J. Wilder DG. Spinal manipulation alters electromyographic activity of the paraspinal muscles: A descriptive study. Journal of Manipulative and Physiological Therapeutics, 2005, 28(7): 465 – 471.

Edmondston SJ, Singer KP. Thoracic spine: Anatomical and biomechanical considerations for manual therapy. Man Ther. 1997;2(3):132-143. doi:10.1054/math.1997.0293.

Gongalsky V. The role of biomechanics disorders in formation of pain syndrome in the thoracic spine region (dorsalgia). Український неврологічний журнал.— 2014.— № 1.— С. 5—10. 2014.

Heneghan NR, Gormley S, Hallam C, Rushton A. Management of thoracic spine pain and dysfunction: A survey of clinical practice in the UK. Musculoskelet Sci Pract. 2019;39:58-66. doi:10.1016/j.msksp.2018.11.006.

Lee JH. Effects of forward head posture on static and dynamic balance control. J Phys Ther Sci. 2016;28(1):274-277. doi:10.1589/jpts.28.274.

Linton SJ, Hellsing AL, Halldén K. A population-based study of spinal pain among 35-45-year-old individuals. Prevalence, sick leave, and health care use. Spine (Phila Pa 1976). 1998;23(13):1457-1463. doi:10.1097/00007632-199807010-00006.

McPartland, JM., Giuffrida, A. et all. Cannabimimetic effects of osteopathic manipulatiwe treatment. J Am Osteopath Assoc. 2005;105(6):283-291.

Neumann H-D, Gilliar WG. Introduction to Manual Medicine.; 1989.

Reynaldo R. Manipulation, Traction, and Massage. In: David X, Henry L, editors. Braddom's Rehabilitation Care: A Clinical Handbook. Elsevier; 2018 p 111-118.

Schekelle P. Spine update: Spinal manipulation. Spine, April 1994 - Volume 19 - Issue 7 - p 858–861.

Vernon, HT., Dhami, MS., Howley, TP., Annett R. Spinal manipulation and beta-endorphin: a controlled study of the efect of a spinal manipulation on plasma beta-endorphin levels in normal males. J Manipulative Physiol Ther. 1986;9(2):115-123.

Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic resonance imaging of the thoracic spine: Evaluation of asymptomatic individuals. J Bone Jt Surg - Ser A. 1995;77(11):1631-1638. doi:10.2106/00004623-199511000-00001.



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