Injury & Rehab:
Thoracic spine mobility

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, says Merrin Martin.

The thoracic spine is an interesting, complex and critical component of the body. Numbered T1 to T12, the 12 thoracic vertebrae are designed to protect our vital organs. In addition to allowing us to breathe and providing an immense platform for muscle attachment sites, it also protects the nerves which supply our trunk/core muscles and deep organs of the body. It is not unusual for personal trainers to encounter limited thoracic spine mobility in clients.

What limits thoracic mobility?

Thoracic mobility is limited by two major factors: anatomy and behaviour.

Anatomy

There are a few noticeable differences between the thoracic spine and the lumbar and cervical spines. Firstly, it is stiffer, less mobile and attached to the rib cage. It also has smaller intervertebral discs and thicker yellow ligaments (ligamentum flavum). Furthermore, the spinous processes of the vertebrae are angled almost directly downwards – which limits spinal extension in particular.

Unlike the rectangular vertebral body shape of a cervical or lumbar vertebra when viewed laterally, the typical thoracic vertebra has more of a wedge shape, with its posterior aspect 1 to 2mm higher than its anterior aspect. This naturally gives a slightly curled (flexed) C-shape to the thoracic spine (kyphosis). The ligamentous connections between the ribs, spine and sternum are quite stable, allowing for only limited movement. Because of this, movement in the thoracic spine, while possible in all directions, occurs only in small amounts.

Behaviour

Poor dead lift posture

Most of our days are spent in thoracic flexion (i.e. in positions enabled by decreasing the angle of joints). A client may present with a very stiff thoracic 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 (sit ups, prone plank positions, dead lifts (photo 1)).

Additionally, conditions such as Scheuermann’s disease, osteoporosis or ankylosing spondylitis will affect thoracic spine mobility.

All these poor postural habits will increase the amount of thoracic flexion or kyphosis and reduce the overall amount of mobility in the thoracic spine.

Increased risk of injury to other areas

A kyphotic thoracic spine rarely develops in isolation. As the thoracic curvature increases there are accompanying anatomical consequences.

  • Neck. In sitting, the cervical spine and head move forward (‘poke neck’ posture). This causes 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. In athletes, it may lead to reduced tidal volume and VO2max, impacting on sporting performance.
  • Shoulder. Movements of the thoracic spine are required for optimal shoulder functioning. Single arm full range abduction requires thoracic lateral flexion, and if both arms are raised into abduction or flexion it requires some thoracic extension mobility. If the thoracic spine is held in kyphosis, the scapulae must also move in a relatively anterior-tilted, downward-rotated and protracted position – a position linked with glenohumeral joint impingement – which leads to micro-trauma to the supraspinatus (rotator cuff) and other sub-acromial structures causing shoulder pain.
  • Lumbar spine. Prolonged slumped sitting and thoracic kyphosis can also cause posterior pelvic tilting, which contributes to lumbar flexion or loss of lordosis, which can tighten hamstrings, increase risk of posterior disc injuries and inhibit gluteal firing, leading to pelvic weakness and instability.

"A client may present with a very stiff thoracic spine for a number of reasons, the most common being poor postural habits"

Improving thoracic mobility and posture

Learning to move the thoracic spine in isolation – without lumbar or cervical movement – is essential. The following techniques can help achieve better thoracic mobility and posture.

  1. Incorporate mobility exercises into all ranges of movement, including rotation, lateral flexion, flexion and extension. Examples include:
    • Small noodle/towel thoracic extension (photo 2)
    • Foam roller prone slides (extension) (photo 3)
    • Roller cat (flexion) (photo 4)
    • Fitball side bends (lateral flexion) (photo 5)
    • Side-to-side on the ball (photo 6)
    • Sit twists on ball/bench (rotation)
    • Thread the needle in four-point kneeling
    • Book openings/chest release in side-lying.
  2. Practice lateral basal breathing without activating accessory breathing muscles (e.g. scalenes and sternocleidomastoid muscles).
  3. Stretch pectoralis 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 (photo 7).

Many movement exercises address the limited range of motion in the thoracic spine, and it is essential to include some of these in your client’s program. Not only will they improve posture and shoulder function, but breathing, lumbar spine function and cervical spine posture may also benefit.

Furthermore, because the nerves from T7 to T11 vertebrae (lower thoracic) supply transversus abdominus (which is in turn partly responsible for core control), thoracic mobility exercises can also improve core stability.

 

Merrin Martin, BAppSc (Physio)
Based in Sydney’s Neutral Bay, Merrin is the director of Active Anatomy which provides quality accredited education to qualified health and fitness professionals. Combining her experience as a physiotherapist, Pilates instructor and exercise scientist has enabled her to become a specialist in corrective exercise programs. To contact Merrin or the Active Anatomy team call 0414 423 744 or visit www.activeanatomy.com