By: Wayne Henry Zemelka, DC
Keeping the record straight: The anterior thoracic is the loss of curvature in the dorsal region which gives the appearance that the vertebrae have moved anterior-ward, which in turn gives the appearance of flattening of the kyphotic curvature of the Dorsal vertebrae (Fig. 1). Therefore the name, ‘Anterior Thoracic.’
There are several primary indicators for the anterior thoracic. The main thing you will find upon palpation is that there is a loss of curvature and that there is pain associated with palpation at the spinous processes. This condition gives the appearance that the spine has moved forward or anterior, as noted in Figure 1. Another condition to be found is a dishing of three or four vertebrae and is referred to as ‘Pottingers Saucer.’ Having the ‘dishing of the vertebrae’ coupled with the tender spinouses along four of five vertebral motor units confirms that you have an Anterior Thoracic problem.
We will use the Dorsal and Lumbar drops with the patient supine and the arms crossed over the chest and the hands on the shoulders. A blocker is placed at the level of the last tender spinous at the inferior of the Pottingers Saucer (Fig. 2).
Lay the patient back on the table and place the patient’s hands over the top of the shoulders (Fig. 3). The objective is to have the patient as comfortable as possible with the headpiece raised. In some instances it may be necessary to have the patient bring his/her chin down to the chest to ‘pre-Stress’ the dorsal region prior to the adjustment. Otherwise have the patient placed as shown in Figure 3.
Place the arms in the axillary area next to the doctor’s chest and keep your arms close into the body (Fig. 4). In most cases as you proceed to thrust in a scooping action, have the patient breathe out through the mouth. Prior to making the adjustment turn the patient’s face to one side or the other. Three or four thrusts are all that is needed, and in most cases the patient will not feel the segment move. Upon palpation after the adjustment, the pain will be decreased and the Pottingers Saucer will be reduced or gone.
Another method in the adjusting of the patient is to have the patient breathe in and out prior to the thrust onto the table. This is why you have the patient turn the head to the opposite side to which the doctor is standing.
The Anterior Dorsal is thought to be a compensation due to some other problem in the spine, either above or below. In any event be sure to check the cervicals and low back as you provide care for your patient with this type of problem.
Another peculiarity you may find with this type of situation is that the spinous processes will be tender from about the 2nd dorsal down to near the 10th dorsal. If you find this condition to exist in your patient you have a situation referred to by Dr. Thompson as an ‘Atlas Subluxation.’ You will find the Atlas to be subluxated laterally and in need of a ‘Toggle Recoil’ style of adjustment. After the adjustment you should find the tenderness to be substantially diminished or eliminated.
There is indeed a necessity to examine the lumbar and cervical region and correct any subluxations found there as well. Another thing that has become evident over the past years is the need to examine the patient for the need of functional orthotics to correct the problems that are caused by problems of the feet. Measure and compare the arches with the use of a Postural Stability Indicator™ (PSI) card, available free from Foot Levelers. Perform a thorough examination of the feet and ankles of the patient and recommend the proper orthotics to stabilize the lower foundation of the patient.
A View on Pain
Patients react to pain; it’s called ‘crisis therapy’ by some healthcare specialists. We as Chiropractors must be prepared to know what pain syndromes to take into account as we gather data on a particular patient.
There are a few ‘pain syndromes’ to take into consideration in our patient care:
- Anterior Dorsal. Pain is prominent on the spinouses of one to four vertebrae, with a noticeable dishing or Pottingers Saucer that is palpable.
- Rib head. Pain is palpable at the transverse area where the rib connects with no rotation or laterality present in the vertebra, and the pain is traceable along the course of the rib to the sternum.
- Lateral Facet Syndrome. The pain is persistent on one side of the dorsal area with no rotation or posteriority of the vertebra, and rotation of the rib has been ruled out.
Pain should not be the only factor in your consideration when examining a patient. The texture and temperature of the skin can also provide important information in your decision process. Don’t forget that all important technique of palpation, and Insight thermal scanning of the spine also supplies additional information to aid in the decision-making process.
Orthopedic and neurologic information should also be a part of this overall picture of the patient, as well as X-ray and laboratory results that can contribute to your decision when and where to provide conservative Chiropractic adjustments.
We must avoid the tendency to focus too quickly on a solution for a problem based solely on pain. By developing a methodology of assessing and listing information on each patient, and utilizing the Decision Tree Concept, you will make the right decisions in rendering conservative Chiropractic care to your patients.