Technique Highlight: Supine Thoracic Thrust Manipulation | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Technique Highlight: Supine Thoracic Thrust Manipulation

This is my preferred technique for thoracic thrust manipulation. Most true thoracic patients should be resolved within 2-4 visits. I prefer the control of this technique over the simplicity of the prone P/A.

This is a variation on the "pistol-grip" which I had used prior to learning this. That technique is often as uncomfortable for the practitioner as it is for the patient. This technique uses a flat hand, fingers facing superiorly with the SP in between the thenar and hypothenar eminences.

Pt: Supine

PT: leverage hand fingers facing superiorly, the spinal level SP you want to perform the technique to between the thenar and hypothenar eminences.


  • first roll the patient toward you, to place you hand on the level you want to perform the thrust to
  • you may do some P/A springing in sidelying to confirm for restrictions and/or tenderness
  • over roll the patient over your leverage hand, as in more than 90 degrees as the first component
  • next, horizontally adduct your leverage hand UE to SB the patient away from you
  • the patient grasps their shoulders if possible placing their elbows as close to together as possible
  • your thrust hand is cupping the top elbow and your sternum is over your hand for leverage
  • take up all the slack of the shoulders and forearms by pushing them into GH extension
  • you can start to mobilize to get a feel for barrier
    • mobilization and thrust performed in the direction of the forearms, NOT A/P 
    • it is A/P and superior 
  • last component is the leverage wrist is extended, radially deviated, and forearm is pronated, which works really well as final components
  • the pt inhales, at start of exhale, bear down to take up all P/A, pull SB away UE closer to you
  • in between the middle of the exhale and end (don't wait until the end as pts tense) perform a quick abdominal thrust with a slight UE push in the A/P and superior direction
  • you may repeat this at several levels if needed
  • works well only from about T1-T6/7
  • For T1-3 you have to pull the patient's spine inferiorly and thus into flexion to flatten out the upper thoracic facets to get the same leverage on T3-6/7

Don't forget the HEP, which should clear up any true thoracic (only) complaints in 2-4 visits!
IASTM to the paraspinals and possibly around the bony contours of the ribs may help for persistent complaints.

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