Issue link: https://www.massageandbodyworkdigital.com/i/72121
TABLE LESSONS We were clearly missing something important that might take us in a different direction. midback pain, the scalene muscles are implicated. We thoroughly examined them, fi nding nothing remarkable. Since nothing we had done so far seemed helpful, we decided to regroup and start over. We were clearly missing something important that might take us in a different direction. Thinking about the mechanics of moving luggage gave me an idea. "Would you please lie face down on the table? I'd like to check something." After Ms. L. was situated on the table, I began to slowly press against the spinous processes in her thoracic spine. As I approached the lateral aspect of the spinous process of T4, she reacted strongly. "That's it. When you press there, I feel it right down my arm and into my hand. That makes all the symptoms come back at once." As soon as she said this, the source of her problem became clear. A few years previous, I had also seen a few people who presented with neural symptoms that I found perplexing. One person with these symptoms was really helped when I treated her thoracic spine, which I addressed through a treatment protocol best described as "fl oundering." Her improvement was dramatic and I resolved to research why this worked. I soon discovered that other clinicians had also discovered the source of atypical upper extremity neural symptoms to be in the thoracic spine. This condition is called T4 syndrome, which is slightly misleading since the source could be any one of the upper thoracic vertebra from T2–T5. The sympathetic nerves emanating from T2–T5 affect the upper extremity, and there is a close relationship between the segmental nerves and the sympathetic nerve afferents. The sympathetic chain also is strongly affected by problems at the costovertebral joints. The palpatory confi rmation of T4 syndrome is a highly sensitive spinous process at the site of entrapment, which must recreate presenting symptoms. I treated muscles affecting the costotransverse junction such as the levator costorum, rotatores longus and brevis, and iliocostalis. With Ms. L., the immediate results were a lessening but not a cessation of her symptoms. We called to check on her two days later; symptoms had continued to decrease. Having not heard from her since then, it was extremely gratifying to know that her symptoms disappeared completely about a week after the session and had not returned in three years. As evidenced by the way she effortlessly tossed my luggage onto the conveyor belt, work hasn't been a problem either. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 35