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Thoracic ring theory is “the epitome of fragilistic thinking”

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

“There is really nothing new in therapy. If you think you’ve come up with something you just haven’t read enough.”

Greg Lehman, BKin, MSc, DC, MScPT

Greg Lehman has politely but thoroughly criticized some key concepts in the “Integrated Systems Model” and “The Thoracic Ring Approach” to therapy. (Ring is just a fun way to say “rib.”)

The big idea under the microscope here is just another variation on the belief that subtle biomechanical problems can cause disproportionate havoc far away in the body — a biological butterfly effect. For instance, “a plantar fasciopathy could be influenced by the ‘faulty’ biomechanics of a thoracic rib.” Or, um, ring.

da Vinci’s Vitruvian man with superimposed graphics of rings around the rib cage.

Greg excels at this kind of focused analysis. Personally, my own investigation would have consisted of just an exasperated “citation needed.” This is all classic dot-connecting structuralism, or “the epitome of fragilistic thinking,” as Greg put it. But I’m grateful to him for getting into the nitty gritty of this specific instance, and I think several of his conclusions are pitch perfect:

This is all so pessimistic, reductionist and really simple even though it’s couched in such complexity. It implies that tiny little rib movements, and tiny increases in muscle activity (who has said that more activity in the external oblique stops the ribs from moving?) are something that a robust, incredibly adaptable system can’t tolerate. It’s the epitome of fragilistic thinking.

All of these notions suggest the patient is in need of fixing. That they body is inherently weak and can only work well when optimally aligned, with precise muscle activity and perfect motor control and that some magical therapist needs to come in and correct. The body is more self cleaning oven than mechanically tuned carburetor.

… this model is regional interdependence taken to an extreme and is very similar to old school chiropractic theories about properly aligning all joints for the body to function at its most optimal. The approach is pessimistic in its view of the body and could create a sense of therapist dependence.

Read the whole thing: “Thoracic Rings and Integrated Systems: Paleolithic or Pathfinding?