Deciphering Thoracic Derangement with Cervical Symptoms
Week in Review: Nerve Pain in Gymnastics, Thoracic Dysfunction in Runners, and Complex Spinal Derangements
In this week’s FARM: Week in Review podcast, the team tackles three challenging yet insightful clinical cases that underscore the importance of thinking regionally, assessing function over structure, and letting patterns—not assumptions—guide clinical decision-making. These cases span from elite-level athletics to the complexities of spinal pain presentations, offering valuable takeaways for anyone working in rehab, sports performance, or integrative care.
Case One: Anterior Cutaneous Nerve Entrapment in an Elite Gymnast
The episode opens with a deep dive into a case involving an elite gymnast presenting with anterior abdominal and lower rib pain. Initially misattributed to muscle strain or costochondritis, the true culprit turned out to be an entrapment of the anterior cutaneous nerve—a subtle, often overlooked condition. The FARM clinicians discuss how a detailed history and high-level palpation skills revealed symptom reproduction that aligned with this diagnosis. What made this case particularly interesting was the high-performance demands placed on the athlete's core and thoracic spine—movements that created compressive and rotational forces ideal for nerve irritation. Dr. Sloan Beard brings unique expertise to this case, detailing how to modify gymnastics programming while integrating neural glides, fascial release, and core control strategies to resolve symptoms. The case serves as a powerful reminder: when it comes to nerve pain, don’t just look for “big nerves”—look for the functional context in which entrapments emerge.
Case Two: Lateral Hip Pain Tied to Thoracic SMCD in a Cross Country Runner
Next up is a high school cross-country runner presenting with lateral hip pain. While most would assume this points toward gluteal tendinopathy or IT band irritation, The FARM team took a broader view. Through movement screening and functional audit, they identified a subtle—but critical—thoracic spine segmental motor control dysfunction (SMCD). The impaired ability to rotate and extend through the mid-back had created compensations down the kinetic chain, overloading the lateral hip stabilizers during running. Treatment focused not just on the symptomatic hip, but on restoring dynamic control and rotation through the thoracic spine. The outcome? Reduced symptoms, improved running gait, and a more resilient athlete. This case reinforces the importance of zooming out to consider regional interdependence when local treatment fails to resolve pain.
Case Three: Discerning a Thoracic Derangement with Cervical Radicular Symptoms
The final and most complex case involves a patient with cervical radicular symptoms—numbness, tingling, and pain radiating down the arm. While imaging and clinical patterns initially pointed to cervical disc involvement, directional preference testing complicated the picture. The team began exploring the thoracic spine and discovered a possible thoracic derangement mimicking cervical radiculopathy. The process of ruling in—or ruling out—competing drivers of pain became a layered clinical puzzle. By testing repeated movements, evaluating centralization, and integrating MDT principles, the team gradually zeroed in on the thoracic contribution to the patient’s symptoms. It was a reminder that pain doesn't always follow the rules, and the spine is a highly integrated system that demands critical thinking beyond a single region.
This week’s cases are a masterclass in treating the person, not just the part. From elite gymnasts to endurance athletes and complex spine presentations, the clinicians at The FARM continue to demonstrate why fundamentals, function, and curiosity matter most.
