(upper back backward bending)
and chest expansion
SARS has surely raised the hygiene and general health awareness of the public. Physiotherapy has little to offer at its acute (initial) stage. Chest/respiratory physiotherapy may help to improve the general lung capacity during rehabilitation by diaphragmatic and basal chest expansion type of deep breathing exercises and general fitness exercise program. Such program is designed by physiotherapists in chest/respiratory specialty. Manipulative physiotherapy may help to improve spinal alignment/posture and mobility of the chest cage so as to facilitate chest expansion.
Being the 'backbone' of the chest cage, thoracic spine (upper back) alignment/posture and mobility directly affect chest expansion, hence the ability to deep breathe. Each level of the twelve thoracic vertebrae consists of the central intervertebral joint (disc), posterior intervertebral joints on either sides (facet joints), costovertebral joints and the costotransverse joints where the ribs attach to the spine. The mobility and flexibility of individual joint and its surrounding ligaments, muscles and other soft tissues may determine the overall chest mobility. Thoracic extension (backward bending) is the most important movement required for chest expansion (try taking a deep breath in a full forward bending position!) Due to the more sedentary life-style and the general lack of postural awareness, thoracic kyphosis (forward bending back) is often exaggerated and joint mobility into backward bending is reduced. Although general fitness exercises could promote backward bending, individual joint stiffness may make such exercises difficult and painful to perform. Our responsibility is to identify the mechanical source and cause of the restriction and treat/advice accordingly. Since the thoracic spine is relatively stable, slightly stronger manipulations and mobilizations could be given with caution. The diagrams illustrate some of the common techniques used.
Other than the thoracic spine, neigbouring structures may also affect chest expansion and should be assessed and treated accordingly: