Mobilization with movement (MWM) is applicable for the treatment of painful thoracic vertebral and rib dysfunction.  A challenge faced by the physical therapist in the application of MWM for thoracic cage dysfunction is the necessity to first rule out such problems as thoracic tumors, inflammatory disease, muscle strains and visceral pathology which can mimic musculoskeletal dysfunction.

Making matters even more difficult is that afferent nociceptive signals arising from the vertebral column are capable of facilitating activity in the central nervous system resulting in signs and symptoms that mimic visceral disease.  This has misled some clinicians to think that spinal manipulation can cure visceral disease.  At this point, no scientific research exists supporting the notion that spinal manipulation cures visceral disease. (1)  The clinician must keep in mind that somatic disease can mimic visceral disease and vice versa.   Visceral problems of the esophagus, stomach, duodenum, liver, gallbladder, pancreas, spleen, intestines, kidneys, and ureters can refer pain to the posterior aspect of the thoracic cage. (2) (3) (4)

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