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Thoracic Segmental Joint Restriction

Your spine is made up of 24 bones stacked on top of each other with a soft “disc” between each segment to allow for flexibility. Normally, each joint in your spine should move freely and independently. Our examination of your spine has shown that one or more of your spinal vertebra is slightly misaligned and restricted. We call this condition “spinal segmental joint restriction” or more simply a “subluxation.” The term “subluxation” literally means “less than a dislocation.”

To help visualize this, imagine a normal spine functioning like a big spring moving freely in every direction. A spine with a joint restriction is like having a section of that spring welded together. The spring may still move as a whole, but a portion of it is no longer functioning.

Joint restrictions can develop in many ways. Sometimes they are brought on by an accident or an injury. Other times, they develop from repetitive strains or poor posture. Being overweight, smoking, strenuous work, and emotional stress can make you more susceptible to these problems.

Restricted joints give rise to a self-perpetuating cycle of discomfort. Joint restriction causes swelling and inflammation, which triggers muscular guarding leading to more restriction. Since your spine functions as a unit, rather than as isolated pieces, a joint restriction in one area of your spine often causes “compensatory” problems in another. Think of this as a rowboat with multiple oarsmen on each side. When one rower quits, the others are placed under additional stress and can become overworked.

Joint restrictions most commonly cause local tenderness and discomfort. You may notice that your range of motion is limited. Movement may increase your discomfort. Pain from a restricted joint often trickles around your rib cage or up and down your spine. Be sure to tell your chiropractor if your symptoms include any chest pain, shortness of breath, unusual cough, indigestion or flu-like complaints.

Long-standing restrictions are thought to result in arthritis – much like the way a slightly misaligned wheel on your car causes premature wearing of your tire.

You should recognize that your problem is common and generally treatable. Chiropractic care has been shown to be the safest and most effective treatment for joint restrictions. Our office offers several tools to help ease your pain. To speed your recovery, you should avoid activities that increase your pain. Be sure to take frequent breaks from sedentary activity. Yoga has been shown to help back pain sufferers so consider joining a class or picking up a DVD.

No universally agreed upon description exists for the ubiquitous chiropractic diagnosis of “Subluxation”. Chiropractors believe that subluxations are complex functional and structural problems that create neuromusculoskeletal irritation capable of influencing organ system function and general health (1).

For the purpose of this discussion, thoracic subluxation will be defined as “spinal segmental joint dysfunction characterized by altered joint alignment, motion, or physiologic function in an intact spinal motion segment.” (2) This mechanical intersegmental joint dysfunction (ISJD) most commonly results in local non-radicular discomfort.

Research suggests two basic origins of ISJD, mechanical and reflexive. Mechanical dysfunction arises from an outside force acting on a segment for either; a brief trauma or an extended period of overuse. Janda has suggested that the latter cause of altered joint mechanics may begin from an imbalance between the associated muscle groups (3). Lower crossed syndrome is a common example of muscular imbalance, or postural strain, that may lead to ISJD. ISJD might also arise from sustained visceral nociceptive irritation triggering reflexive segmental muscular guarding, resulting in altered joint mechanics. Psychological and emotional factors may contribute.

ISJD primarily affects the synovial facet joints. Hypomobility of these joints is thought to produce concurrent increased local nociceptive activity and diminished mechanoreceptive input (4,5,6,7). ISJD may give rise to a self-perpetuating cycle of discomfort in which the negative effects of hypomobility are perpetuated by inflammation, muscular hypertonicity (via Hilton’s Law) and imbalance. ISJD is rarely an isolated event as dysfunction in one segment often leads to involvement of other segments and the spine as a whole (3). Longstanding joint dysfunction is thought to result in premature degenerative change (8).

While the specific incidence of thoracic intersegmental joint dysfunction is difficult to estimate, complaints involving the thoracic region compromise of approximately 15% of all spinal problems. (9) The one-year prevalence of thoracic spine pain is estimated at 17%, much lower than the frequency of cervical and lumbar complaints. (10) Thoracic spine pain has received considerably less attention than its cervical and lumbar counterparts, yet can be equally disabling. (11-13)

Thoracic spine complaints affect all age groups. (14) Up to 10% of adolescents have experienced thoracic spine pain that has interfered with school or leisure activities. (15) The use of backpacks seems to correlate with adolescent thoracic spine pain. (15-16) Adolescent females are affected slightly more frequently than males. (16)

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