There are four main movements of the thoracic spine to assess, the most important of which is rotation, as this is the movement that so frequently reproduces the patient's pain where it is facetal joint or costovertebral in origin.

The movements of the thoracic spine and their normal ranges are:

1. Extension 30°

2. Lateral flexion L and R 30°

Ask the patient to sit on the table with hands placed behind the neck and then perform the movements. Check these four active movements noting any hypomobility, the range of movement, reproduction of symptoms and function and muscle spasm.

Passive movement, superimposed on active movements, is needed to stress the joints and reproduce pain if it has not been elicited by normal active movement. A passive 'overpressure' can be applied at the end range of each movement, especially with rotation. This is a sensitive method to stress the joint and reproduce the patient's pain. Record the patient's direction of movement, degree of restriction and presence of pain on the direction of movement diagram (Fig 11.1).

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