Is the patient suffering from a thoracic internal derangement?
There are different interesting manipulation techniques which can be used, mostly those techniques are rather aspecific, but sometimes we can "focus" the manipulation more or less on a certain level.
Adding a traction component also attributes to safety.
As usual, a prior relevant functional examination and diagnosis is imperative. Take into account Hat all times the specific indications and contra-indications.
Grip : for a left rotation the therapist stands at the patient’s left side. He puts his left pisiform bone on the left transverse process of the lower vertebra. Initially, his fingers face outwards, then he turns his hand to make his fingers face downwards : in this way he can move the muscles away from the spine, so that he now has a bony contact on the transverse process. The trapezio-first metacarpal joint of the right hand is put on the right transverse process of the upper vertebra in exactly the same way : first with the fingers pointing outwards, then upwards.
Then traction is applied, we wait about 2 seconds and the manipulative thrust follows.
We always start with the central extension pressure. After the first technique, as always, we check the positive tests from the examination. As long as we get improvement we continue with the same technique. The moment there is no extra improvement anymore, we choose for the extension-rotation technique, first in the direction of the less limited and/or painful direction. Mostly we just need a few manipulations to obtain symptomatic reduction of the internal derangement.