A commonly mis-assessed ‘ between-the-blade’ pain generator is termed a dorsal dish. Inaccurate understanding of the biomechanics of this dysfunction frequently causes therapists to escalate the client’s pain and sometimes cause injury. Visual observation and thoracic spine palpation reveal a flat spot (approximately T2 to T7) where there should be a convex curve (Figure 1).
If you have access to a plastic spine, contour it until you’ve established normal lumbar, thoracic, and cervical curves. Then place the spine prone on a table and notice how the T-spine’s gentle convex curve continues through the shoulder blades.
Now, with a couple fingers, press down on the T4 transverse processes and observe what happens. If your pressure is equal with both fingers, the facet joints will approximate each other causing the intervertebral joints to close bilaterally.
Therapists unfamiliar with the Laws of Spinal Motion commonly dig on the bony knots lying deep to the thick layer of paravertebral tissue thinking they’re releasing trigger points or muscle adhesions. Unfortunately, placing downward pressure on already chronically locked joints really hyperexcites joint mechanoreceptors. Prolonged over-approximation of joint surfaces compacts and, in time, degrades the articular cartilage. Tissue damage may stimulate an inflammatory response which hyperexcites the sensitive chemoreceptors. When mechanoreceptors and chemoreceptors ‘gang-up’ and bombard the neuronal pool with continual noxious stimuli, pain delivering nociceptors fast track the information to the thalamus, gray matter and other cortical centers. The brain usually responds by locking down the area with protective myospasm. Session after session, the therapist digs on the fibrotic knots until the client finally terminates therapy and moves on in search of someone who can help break their pain-spasm-pain cycle.
Fixing the Flat Spot
Since we’re dealing with joints that won’t open (Figure 2), begin spinal groove palpation one segment below the flat spot and proceed headward with client in flexed position performing chin-tucks (Figure 3).
So, if your client has a T2 to T7 dorsal dish, begin at T8 and move up segment by segment assessing and correcting all vertebra and rib problems on the client’s right side. Then roll them over and perform the identical routine on the opposite side.
Once normal vertebral/rib motion is restored, deep tissue techniques must be performed with the client prone. Standing on the client’s right side, reach across and place extended fingers in the lamina groove so you can hook and scoop the spinalis, longissimus and paravertebral fascia medial to lateral. Ida Rolf used to say, “Dig a hole to allow the spine a place to come back to.
After you dig the ‘guy-wires’ out of the groove and restore left-sided paravertebral muscle extensibility, walk to the other side and repeat the procedure.
Once spinal compression and buckling are removed and extension is restored to the dorsal dish, a home-retaining exercise like the ‘wall-press’ is recommended.
For a complete description of this ‘dorsal-dish’ routine, read the article Rib Pain “Can’t Get No Respect”