USE OF THRUST AND NON-THRUST MANIPULATION FOR COSTOCHONDRITIS:

A CASE SERIES.
Kaarthick Mani, PT, DPT, MS
Manual Therapy Fellowship
Fellow - Regis University Manual Physical Therapy Fellowship Program
Orthopaedic Physical Therapist, Orthopaedic Therapy Specialists LLC, Warrenville, IL

Baseline & Discharge (D/C) Findings NPRSInitial vs. D/C

Purpose:
To describe the examination and manual physical
therapy interventions for patients with sub- 10

Scale 0-
Pain
NPRS(D/C)

10
acute/chronic episodes of recurrent upper thoracic/chest 0
NPRS(Initial)
Case 1 Case 2 Case 3
pain. The purpose is to outline the use of thrust, non- NPRS(Initial) 8 9 8

thrust mobilization/manipulation techniques, rib muscle NPRS(D/C) 2 0 4

energy techniques (MET’s) combined with exercises

for individuals with a diagnosis of costochondritis. Chest ExpansionDifference incm

Approximately 50% of patients attending accident and 10

(U,M, &Lower)
AverageChest
Expansion
emergency departments and out patient cardiac clinics 5

because of chest pain have a non-cardiac basis for their 0

Chest Expansion (Initial)
Case 1 Case 2 Case 3
symptoms. They are often given a non-specific Chest Expansion (Initial) 2.3 2 2.5

diagnosis.
Chest Expansion (D/C) 6.3 4.16 4.1
(1)

It has been suggested that the costovertebral and Conclusion: These patients experienced
costotransverse joints are commonly overlooked a rapid improvement in pain and
sources of atypical chest pain. (2) functions after non-thrust and thrust
mobilization/manipulation and rib MET’s
to thoracic spine region. Clinical
Relevance: A combination of thrust and
non-thrust mobilization/manipulation,
Rib MET’s and scapular strengthening
exercises may be helpful for patients with
a diagnosis of costochondritis.
References: (1) Capwell S, McMurray J. “Chest pain –
please admit”: Is there an alternative? British Medical
Journal 2000;320:951-2
(2) Rabey MI. Costochondritis: Are the symptoms and
sign due to neurogenic inflammation. Two cases
responded to manual therapy directed towards posterior
spinal structures. Manual Therapy 13(2008):82-86