Manual therapy considerations at the thoracolumbar junction: an anatomical and functional perspective

Anatomically, the human thoracolumbar junction demonstrates considerable resistance to rotary motion in an effort to decrease torsional stress through an area of marked functional transition. Despite this, rotational manipulation and mobilization procedures have been advocated in the treatment of painful mechanical disorders originating from the thoracolumbar junction. The rationale behind vigorous manipulative techniques, particularly those incorporating extension, is challenged in light of cadaveric histological studies of this region, as well as both in vivo and experimental biomechanical investigations. Judicious use of traction and mobilization procedures are recommended.