Here’s What You Need To Know…
While some people do present with a thoracic spine (upper/mid back) that is extended (flat/over-arched), most people present to the clinic with too much thoracic flexion (pronounced upper back)
Poor thoracic posture and position can potentially cause / lead to various upper body musculoskeletal issues.
Poor thoracic posture typically decreases performance in overhead positions and movements (i.e chin-ups, overhead press) and many sports (golf/tennis, just to name a few) due to a lack of range of motion in the area and compensations in other areas.
You can do a basic assessment to get an idea if you need more mobility in your thoracic spine
While there are many exercises, the 4 in this blog post have worked well for me in the clinic.
While both static and dynamic postures are topics that are largely debated in the world of healthcare, it is hard to argue that they play an important role in improving performance, musculoskeletal health and can often aid in the reduction of pain in the upper body (and often lower body).
A common postural presentation we often see at the clinic is a pronounced thoracic spine (also known as kyphosis), where the upper curvature of the spine is curved too much (flexed). In addition, we see movement dysfunctions as well, particularly in rotation. This is a critical motion of the thoracic region. Since most people we deal with sit in flexion all day hunched over a computer screen or slouched looking at handheld devices, the body tends to bias towards these positions and movements over a period of time.
So Why Does This Matter?
The thoracic spine / ribcage relationship is really important as it is the foundation for which the scapula (shoulder blade) sits. Effectively this is what dictates the function of the shoulder blade in all of our upper body movements.
A poor position in the upper back yields poor movement of the shoulder girdle as a whole, which can potentially lead to a whole host of problems - shoulder pain/impingement, elbow pain, wrist pain, among many others.
Point being: thoracic spine/ribcage/shoulder blade position IS CRITICAL for upper body health.
So much so, that as healthcare professionals, we often say that “A shoulder OR elbow problem is a scapulo-thoracic (shoulder blade / upper to mid-back relationship) dysfunction unless proven otherwise”.
In other words, you must make sure there is optimal function of the thoracic region as a whole.
To give you some perspective on the importance of thoracic extension ('opening up'), try this quickly:
Stand up, and ‘hunch’ your upper back as much as you can
Maintaining this position, see if you can lift your arms overhead. Take note of how it felt and how high you got your arms up overhead.
Next, lets do the opposite. Without overarching your lower back, open up your chest/upper back as much as you can and lift your arms overhead. How did that feel? I guarantee the latter position felt a lot more efficient.
A Quick Screen To Identify Poor Thoracic Mobility & Movement..
An unfortunate trend in the industry is to just randomly start giving mobility exercises. But first, it’s important to do a quick screen to make sure you have a mobility restriction.
In the video below, I have given you two simple (but effective) screens to check to see what is going on.
1) Lumbar Locked Thoracic Extension and Rotation Test
2) Spinal Curvature Observation
2 major observations to watch out for:
1) Unloaded Spinal Curvature: When the spine is unloaded in this 'rockback' position, what does the natural curvature look like? Is it a uniform spinal curvature OR is there prominence of a 'pronounced' upper back in a certain spinal segment? Ideally, there would be a uniform curvature. It's not good or bad if you don't, but it may be something we can consider working with.
2) Movement: How well does your upper back rotate? This region is designed for rotation. If you don't have it, other parts of your body will do the work which can lead to poor performance and dysfunctional movement. Here, we expect approximately 50+ degrees of rotation both sides relative to a straight line from the ears to the hips.
Please Note: There is one other major variable that has not been shown in this video that I'd like to simply point out. First, we have to ask ourselves if it is a true mobility deficit (i.e. there is true musculature/vertebral restriction of the area?) OR is there actually a stability deficit (i.e. you can't control the movement well when you perform it yourself (actively), but when assisted by another person (passively), you can move through the range of motion with ease). Often times it can be a stability issue, which may require a different intervention, but I'll explain this concept in another blog post in the near future. For now, just have some awareness that if you can't rotate, there could be a few things going on here. However, a mobility restriction is more common, so we'll keep moving along in that direction.
Four Exercises to fix/Improve Thoracic Position & Movement
While there are many exercises to improve the position & movement of the thoracic spine, here are a few I have found useful in the clinic.
Step 1: Learn how to breath effectively to extend ('open up') the thoracic spine.
It is literally like stretching from the inside out when you learn how to fully inflate and deflate your lungs with air. Nothing will improve rib and upper back mobility more effectively than expanding your rib cage 360 degrees. This is what will create the foundational relationship between your upper back and scapula. Conscious breathing is powerful.
There are many positions and movement patterns to further challenge and improve your breathing strategy, but this one is a simple starting point.
Key Points:
Ideally, get air into the lower rib cage first, followed by the chest (expanding 360 degrees)
Use minimal, not excessive, amount of abdominal contraction, particularly the obliques (outside abs) to keep lower ribs down during inhale (3-5 seconds)
Exhale fully (5+ seconds) through the mouth without heavily tensing or cramping down on your your rectus abdominal (6 pack muscle).
Pause 2-3 seconds before inhaling again.
Limit straining your neck.
The inhales and exhales should be relatively effortless.
Step 2: Learn to 'extend' (or open up) the upper back with a few drills:
The bench thoracic spine mobilisation drill (video below) is great in that it works tricep (back of arm), lat (upper back) and spinal mobility all in one, which are all common areas to get tied down in the society we live in.
Key Points:
Place your elbows on a bench (or coffee table)
Sit back into your hips
Maintain a natural arch in your lower back, but don't over-extend (don't arch too much). To reduce this motion, slightly contract your abdominals as you sit back.
Next, open your chest up towards the ground (flatten your upper back)
Next, if you have a foam roller, this is a useful exercise to add to the sequence as well. (See the video below)
Key Points:
Find the areas of the upper back region which feel stiff/need some additional mobility based on our basic screen above shown earlier
Without excessively arching the lower back, open up your thoracic spine as much as you can
Add some breath work and try to increase mobility each time
Work on different segments of the spine as needed, but don't work your way down towards the lower back too much
Step 3: Learn how to rotate the upper back (a critical function for movement)
As I have already touched on, along with extension of the upper back, rotation is another critical movement. Whether it be a golf swing, or putting some clothes up on the line to dry, most of your rotation should occur at the thoracic spine segments (particularly the mid to lower parts of thoracic spine).
Remember, if you don't get movement where you should, your body will overcompensate in other ways. It could be your lower back, your shoulder joint, or other areas. Check out the side-lying rib pull in the video below.
Key Points:
Place your body in a side-lying position on the ground
Bring the top knee to at least 90 degrees to lock out the lower back (lumbar spine) and support it with your bottom arm.
With your top arm, place it on your ribcage
On the exhale of your breath, rotate your top shoulder behind you, towards the ground. With each exhale, try to get more rotation. Do not use your hips to rotate!
Wrapping Up
Repeating one exercise, a few exercises or the whole sequence everyday or in warm-ups as a part of your workout can be a great way to make sure that you improve the movement quality of your thoracic spine.
While the thoracic spine is critical in many functions, extension and rotation typically get neglected because of how most of us live (lack of daily movement). So get to work and give them a try, and see how you feel!
Final Note: If you have pain, please make sure you get assessed by one of our Osteopath's, as issues arising in the thoracic region can be caused by many factors. This post is only a guideline on how to improve positioning and mobility of the mid-back (thoracic spine).
Any questions? Give us a call, shoot us an email, or reach out on social media.
Travis English
Exercise Physiologist