Coupling Behavior of the Thoracic Spine: A Systematic Review of the Literature

Phillip S. Sizer, Jean-Michel Brismée and Chad Cook

The knowledge of 3-dimensional spine coupling characteristics is important for treating patients with spinal pain. The purpose of this study was to examine the coupling directional pattern of the thoracic spine by systematic review. A systematic review of studies examining in vivo and in vitro thoracic spine coupled motion was conducted using PubMed and Cumulative Index to Nursing and Allied Health Literature searches (1960-2006), as well as a separate hand-search. Of the 56 citations originally identified in the searches, the first two investigators reached consensus on 41 citations and required further assistance by the third investigator on 15 citations. The reliability between investigators was rated fair (K = 0.38). Twenty-one citations were deemed acceptable for further review. Of 21 citations, 8 met the inclusion criteria and were fully reviewed. No consistent coupling pattern was observed across the 8 studies, where they exhibited ipsilateral, contralateral, or mixed coupling behaviors.  The authors concluded that dfferences in study design, measurement method, and tissue preparation may have contributed to differences between studies. More quality, in vivo investigations are needed to evaluate thoracic coupling in symptomatic subjects in both a flexed and extended position.

Journal of Manipulative and Physiological Therapeutics, 20047, 30(5), 390-399

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