Thoracic Spine Issues

Written on January 17, 2008 at 1:18 pm, by Eric Cressey

Fantasy Day at Fenway Park

I’ll be making my Fenway Park debut on Saturday. I know it’s hard to believe, but it won’t be for my catching abilities, base-stealing prowess, or 95-mph two-seam fastball. Rather, I’ll be speaking on a panel at the annual Fenway Park Fantasy Day to benefit The Jimmy Fund. And, if people don’t give a hoot about listening to me, they’ve got a skills zone with batting cages, a fast-pitch challenge, and accuracy challenge on top of loads of contests and tours. I’ll be sure to snap some photos for you.

This is an absolutely great cause, and while I know most of you won’t be in attendance, I’d highly encourage you to support the cause with a donation to the Jimmy Fund. What they are doing is something very special, and I’m honored to be a part of it.

Subscriber Only Q&A

Q: One quick question. As a trainer, I’m sure you’ve come across certain clients who have a problem with their thoracic spine (mild hump) and need to work on mobilizing this region. Other than foam rollers, are there any other techniques or methods that can be used? Maybe there’s a book or video out there I could purchase that gives me a better understanding of how to implement some new methods?

A: Thanks for the email.  It really depends on whether you’re dealing with someone who just has an accentuated kyphotic curve or someone who actually has some sort of clinical pathology (e.g. osteoporosis, ankylosing spondylitis, Cushing’s Syndrome) that’s causing the “hump.”  In the latter case, you obviously need to be very careful with exercise modalities and leave the “correction” to those qualified to deal with the pathologies in question.

In the former case, however, there’s quite a bit that you can do. You mentioned using a foam roller as a “prop” around which you can do thoracic extensions:

Thoracic Extensions on Foam Roller

While some people think that tractioning the thoracic spine in this position is a bad idea, I don’t really agree. We’ve used the movement with great success and absolutely zero negative feedback or outcomes.

That said, I’m a firm believer that the overwhelming majority of thoracic spine mobilizations you do should integrate extension with rotation. We don’t move straight-ahead very much in the real-world, so the rotational t-spine mobility is equally important. Mike Robertson and Bill Hartman do an awesome job of outlining several exercises along these lines in their Inside-Out DVD; I absolutely love it.

With most of these exercises, you’re using motion of the humerus to drive scapular movement and, in turn, thoracic spine movement.

The importance of t-spine rotation again rang true earlier this week when I had lunch with Neil Rampe, director of corrective exercise and manual therapy for the Arizona Diamondbacks. Neil is a very skilled and intuitive manual therapist, and he had studied extensively (and observed) the effect of respiration. He made some great points about how we can’t get too caught up in symmetry. Neil noted that we’ve got a heart in the upper left quadrant, and a liver in the lower right. The left lung has two lobes, and the right lung has three – and there’s some evidence to suggest that folks can usually fill their left lung easier than their right. The right diaphragm is bigger than the left –and it can use the liver for “leverage.” The end result is that the right rib winds up with a subtle internally rotated position, which in turns affects t-spine and scapular positioning. Needless to say, Neil is a smart dude – and once I got over how stupid I felt – I started scribbling notes. I’m going to be looking a lot more at breathing patterns as a result of this lunch.

Additionally, it’s very important to look at the effects of hypomobility and hypermobility elsewhere on thoracic spine posture. If you’re stuck in anterior pelvic tilt with a lordotic spine, your t-spine will have to compensate by rounding in order to keep you erect. And, if you’ve shortened your pecs and pulled the scapulae into anterior tilt and protraction, you’ll have a t-spine that’s been pulled into flexion. Or, if you’ve done thousands and thousands of crunches, chances are that you’ve shortened your rectus abdominus so much that your rib cage is depressed to the point of pulling you into a kyphotic position.

On the hypermobility front, poor rotary stability at the lumbar spine can lead to excessive movement at a region of the spine that really isn’t designed to move. It’s one reason why I like Jim Smith’s Combat Core product so much; he really emphasize rotary stability with a lot of his exercises. Lock up the lumbar spine a bit, and you’ll get more bang for your buck on the t-spine mobilizations.

As valuable as all the t-spine extension and rotation drills can be, they are – when it really comes down to it – just mobility drills. And, to me, mobility drills yield transient effects that must be sustained and complemented by appropriate strength and endurance of surrounding musculature. Above all else, strength of the appropriate scapular retractors (lower and middle trapezius) is important. You can be very strong in horizontal pulling – but have terrible posture and shoulder pain – if you don’t row correctly.

Not being cognizant of head and neck position can lead to a faulty neck pattern:

Cervical hyperextension (Chin Protrusion) Pattern

Here, little to no scapular retraction takes place. And, whatever work is done by the scapular retractors comes from the upper traps and rhomboids – not what we want to hit.

Then, every gym has this guy. He just uses his hip and lumbar extensors to exaggerate his lordotic posture and avoid using his scapular retractors at all costs.

Another more common, but subtle technical flaw is the humeral extension with scapular elevation. Basically, by leaning back a bit more, an individual can substitute humeral extension for much of the scapular retraction that takes place – so basically, the lats and upper traps are doing all the work. This can be particularly stressful on the anterior shoulder capsule in someone with a scapula that sits in anterior tilt because of restrictions on pec minor, coracobrachialis, or short head of the biceps. Here is what that issue looks like when someone is upright like they should be. A good seated row would like like this last one – but with the shoulder blades pulled back AND down. We go over a lot of common flaws like these in our Building the Efficient Athlete DVD series.

Finally, don’t overlook the role that soft tissue quality plays with all of this. Any muscle – pec minor, coracobrachialis, short head of the biceps – that anteriorly tilts the scapulae can lead to these posture issues. Likewise, levator scapulae, scalenes, subclavius, and some of the big muscles like pec major, lats, and teres major can play into the problem as well. I’ve always looked at soft tissue work as the gateway to corrective exercise; it opens things up so that you can get more out of your mobility/activation/resistance exercise.

Hopefully, this gives you some direction.

All the Best,

EC

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One Response to “Thoracic Spine Issues”

1. Roc Byrd, D.C. Says:
   September 30th, 2010 at 7:13 am

   Eric,

   Thoracic mobility can be significantly enhanced with Chiropractic Manipulation. The foam rollers are wonderful for helping to maintain mobility, but if there is significant restriction in the joint play of the intervertebral (especially facet joints) or costovertebral joints, the foam rollers will be limited in their effectiveness and may be painful. Once those joints are “freed up” with the manipulation, the rollers will actually feel good, the thoracic mobility, as well as much reflexive muscular inhibition, will improve dramatically. That is one of many reasons that when I was in chiropractic school in 1990 there was only 1 OFFICIAL chiropractor on the Olympic Medical team (Dr. Jan Corwin — because the athlete demanded it). Since that time the medical director has been a chiropractor. We are all about improved function and improved biomechanics. Chiropractic joint manipulation is one very effective tool to help achieve that.

   ~ Roc Byrd, D.C.