tlj - mapta€¦ · 9/22/19 3 10th ring l latexion: example o left z-joint extends (inferior glide)...

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Assessment&TreatmentoftheThoraco-Lumbar

JunctionBobby Bemis PT, DPT, COMT, Dip. MT,

FAAOMPT

ASpecialThanksO  The Institute of Manipulative Physiotherapy & Clinical

Training (IMPACT).

O  Gail Molloy and Bev Parrott! I will always appreciate the time and commitment they put into me.

O  Jenn Berry and Jordan Couchon. Who helped me through the grind.

O  The rest of the IMPACT team who taught me the art

and the science of manual therapy.

MAPTA SUMMIT: 2019 Bemis TLJ 2

WhatdoestheTLJconsistof?

O  T10 - T11 (10th Ring) O  T11 - T12 (Rotational Segment) O  T12 - L1 (Transitional Segment) O  11th Rib O  12th Rib


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Definitions

O  Rotexion: Rotation and ipsilateral side bending.

O  Latexion: Side bending and contralateral side

bending


The10thRing O  The z-joints flex and extend O  The ring rotates in latexion or rotexion O  The ring translates laterally


10thRingRRotexion:Example

O  Right z-joint extends (inferior glide) O  Left z-joint flexes (superior glide) O  Entire ring translates left O  Right rib slides antero-medial O  Left rib slides postero-lateral


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10thRingLLatexion:Example

O  Left z-joint extends (inferior glide) O  Right z-joint flexes (superior glide) O  Side bending compresses L rib and creates a

superior posterior moment that creates a pull by the L rib and thus creating a R rotation of the segment.

O  R rib slides antero-medial


TheRotationalSegment O  False rib does not limit rotational motion of z-

joints. O  Flexes and extends the same as rest of the

thoracic spine. O  False rib embedded in Q/L and is

hypothesized to increase the power output of this muscle. Example: Patella for Quad.


TheTransitionalSegmentO  One vertebrae shaped like thoracic and one

shaped like lumbar O  The nature of the shape of this segment

allows for more form closure for stability, especially from forces above.

O  Rotexion, Latexion, Flexion and Extension are reinforced by the shape of this segment.

O  When forces are coming from below L1 moves under T12 creating a latexion moment that is required for gait.


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AssessmentoftheTLJ


Set-upforTLJAssessmentinStanding

O  Patient: Standing with arms crossed O  Therapist: Standing to one side

O  Fixation: Therapist’s lateral hip stabilizes against the patient’s lateral hip. The therapist places their arm between the patient’s arm with hand on patient’s shoulder opposite of the hip fixation.

O  Localization: Start with 10th rib and find T10 – T11


Assessmentofthe10thRinginStanding

O  Latexion: Side bend toward therapist and and rotate away.

O  Rotexion: Rotate away and side bend away.

O  Unilateral Extension: Side bend away and either inferior glide from above or superior glide from below.

O  Unilateral Flexion: Side bend toward and either superior glide from above or inferior glide from below


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AssessmentoftheRotationalSegmentinStanding

O  Unilateral Extension: Same as T10-T11 O  Unilateral Flexion: Same as T10-T11

O  Rotation: Perform pure axial rotation bilaterally


AssessmentoftheTransitionalSegmentinStanding

O  Latexion: Side bend away and rotate toward

then glide L1 superior underneath T12

O  Unilateral flexion and extension is the same.


The11thand12thribsO  Subluxation of these ribs typically occur due

to:

O  Large contraction of the Q/L pulls the rib laterally

O  A prolonged segmental hypomobility of any

other TLJ joints and a large rotation and/or contraction of the Q/L is required


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Assessmentof11th&12thribsO  Patient c/o of chronic cramping or spasm of

Q/L local to the ribs. O  Exquisite tenderness over the costo-vertebral

joint. O  Restricted rotation toward the subluxed rib

side. O  No motion when you glide the rib.


TreatmentTechniques


11th&12thRib“Gap”Techniques

O  “Gap”: 11th & 12th rib in side-lying

O  “Gap”: 11th & 12th rib in prone


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Extension&RotationTechniques

O  Side-lying Extension: All segments

O  Supine Extension: All segments

O  Rotation: T11 – T12


Latexion&RotexionTechniques

O  Latexion: T10 – T11 & T12 – L1 O  Rotexion: T10 – T11 & T12 – L1


TheEndTheBeginning


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References1.  Lee, D. Biomechanics of the thorax – research

evidence and clinical expertise. J Man Manip Ther. 2015: 23(3), 128-138.

2.  Meadows, James T.S. Orthopedic Differential Diagnosis in Physical Therapy: A Case Study Approach. New York: McGraw-Hill, Health Professions Division, 1999. Print.

3.  Molloy, G. Thoracic Spine Assessment and Manipulation. Denver, CO: Course Notes; 2015.

4.  Pettman, E. Manipulative Thrust Technique: An Evidence Based Approach.


tlj - mapta€¦ · 9/22/19 3 10th ring l latexion: example o left z-joint extends (inferior glide)...

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