Injury and Rehab: Thoracic Spine Mobility
Do you have a stiff mid back? Neck, shoulder or lower back pain? If so, below is a summary of an article on how to improve your thoracic mobility in order to help alleviate any pain/stiffness in the above areas.
Both anatomical and behavioural factors contribute to limited mobility of the thoracic spine. By teaching clients how to move the thoracic spine in isolation, you can help them improve thoracic mobility and posture.
The thoracic spine is a very important section of our spine, the vertebrae are designed to protect our vital organs, in addition to allowing us to breath and provides an immense platform for muscle attachment sites. It also protects the nerves which supply our trunk/core muscles and deep organs of the body.
What limits thoracic mobility?
Anatomy There are a few noticeable differences between the thoracic spine and the lumbar and cervical spines. Firstly, it is stiffer, less mobile an attached to the rib cage. Furthermore, the spinous processes of the vertebrae are angled downwards – limiting spinal extension in particular.
The T-spine naturally has a slightly curled C-shape to it, and the ligaments between the ribs, spine and sternum are quite stable, allowing for only limited movement.
Behaviour For most people, their days are spent in thoracic flexion. A person may present with a very stiff T-spine for a number of reasons, the most common being poor postural habits, which include: • Sleeping in the foetal position at night • Spending long hours hunched over desks studying/reading • Prolonged periods spent at desk jobs/computing • Breastfeeding babies in awkward positions • Driving for prolonged periods • Poor training techniques and exercise postures (1)
All these poor habits will increase the amount of thoracic flexion and reduce the overall amount of mobility in the T-spine.
Increased risk of injury to other areas
As thoracic curvature increases, there are usually accompanying anatomical consequences.
• Neck: In sitting, the cervical spine and head move forward causing excessive upper cervical extension and lower cervical anterior shearing, often creating neck pain and headaches.
• Breathing: Any reduced rib and thoracic spinal mobility will affect the normal movement of respiration. In older patients, the result might be worsening respiratory conditions.
• Shoulder: Movements of the T-spine are required for optimal shoulder function. Single arm abduction (lifting arm out to the side) requires thoracic lateral flexion, and if both arms are raises into abduction or flexion (out in front) it requires some thoracic extension mobility. If the spine is held in kyphosis (hunched over) this will also place a lot of strain on the sub-acromial structures, possibly causing shoulder impingement or pain.
• Lumbar spine: prolonged slumped sitting and thoracic kyphosis can also cause posterior pelvic tilting. This can contribute to lumbar flexion which can tighten hamstrings, increase risk of disc injuries and inhibit gluteal firing, leading to pelvic weakness and instability.
Improving thoracic mobility and posture Learning to move the T-spine in isolation – without lumbar or cervical movement – is essential.
1. Incorporate mobility exercises into all ranges of movement, including rotation, lateral flexion, flexion and extension. Examples include: • Foam roller/towel thoracic extension (2) • Foam roller prone slides (3) • Roller cat (4) • Fitball side bends (5) • Side-to-side on the ball (6) • Seated rotations on ball/bench • Thread the needle in four-point kneeling • Rib pulls/book openings in side-lying
2. Practice breathing without activating accessory breathing (elevating your shoulders and through your neck)
3. Stretch pec major and minor, latissimus dorsi, quadratus lumborum, abdominal obliques, upper trapezius and rhomboids.
4. Include some scapula stability strengthening exercises in your training e.g. weight bearing through the arms in four-point kneeling or plank position.
Not only will these exercises improve posture and shoulder function, but breathing, lumbar spine function and cervical spine posture may also benefit.
Furthermore, because the nerves from T7-T11 vertebrae supply transversus abdominus (partly responsible for core control), thoracic mobility exercises can also improve core stability.
