Christie Silvers, who has an extensive background and training in manual tehcniques spoke on the thoracic spine at our recent PT meeting and how it can effect lumbosacral (low back), pelvic and cervical (neck) dysfunction. She quoted Diane Lee’s “rings of dysfunction” and looking for the primary driver as well as Mulligan’s snags techniques and mobilization for the thoracic spine accompanied by deep diaphragmatic breathing. Christie mentioned how a dysfunction in the thoracic and rib area can affect and possibly be the primary driver of the dysfunction in the pelvic floor region, whether it is weakness resulting in urinary or bowel leakage or pelvic girdle muscle overactivity, resulting in urinary or bowel retention, frequency, urgency and/or pelvic and sexual pain. She demonstrated techniques that can be used gently or with moderate pressure to help with mobility in the the thoracic area. Christie reiterated that you should treat soft tissue restrictions and in some cases that alone corrects the dysfunction, but in some cases the joints require more mobilization. It was a great presentation and the main point was to always look up and down the spine, and to look at the whole body, because you may be missing initiator on the dysfunction.