During the assessment of someone who presents with a painful body region, it is widely considered that it is important to assess the areas above and below the site of pain. Gray Cook and Mike Boyle, a physical therapist and strength and conditioning coach respectively, created an approach that can be used to clear the contribution of adjacent areas known as the “joint-by-joint” approach. They believe that areas of limited mobility can effect areas requiring stability, and vice-versa; for example, someone presenting with lower back pain can be contributed to immobility through the hips or thoracic spine.
This article is going to focus on how to improve thoracic spine mobility. Thoracic mobility and posture has been proposed to contribute to shoulder pathology (Khan et al, 2016). Also, it can act to limit scapular rotation during movements of the upper arm (Crawford & Jull, 1993). Furthermore, it has been suggested that thoracic spine thrust manipulations can be utilised to improve mechanical neck pain (Cross et al. 2011). Therefore, if you’re struggling to reach full shoulder movement or have neck pain it can be wise to look at the contribution of the thoracic spine.
These are some ways (a very small amount of examples) in which you can act to improve thoracic mobility in ways that I think progress from least 'aggressive' to more 'aggressive'; however, please see your Myotherapist before beginning any of these exercises or if you experience pain while performing these exercises as not everybody needs, or is suited to thoracic mobility drills.
Improving the mobility of the thoracic spine:Mobilising using active movements: These following videos can be used with minimal equipment however are equally, if not more effective than the examples demonstrated later in the article.
- Thoracic Rotations progressions: https://youtu.be/dZdbF9ZhUm0
- Here, Dr. John Rusin demonstrates variations on techniques to improve your thoracic rotation through controlled active movement – He utilises a foam roller, however, the foam roller can be substituted for another object if required.
- Quadruped rotations: https://www.youtube.com/watch?v=yS1xoj2XWb8&index=15&list=PLh74Wdd506iJ4ElEQ94p0x154SuwcxiaU
- The Prehab Guys quickly demonstrate a variation of the thoracic mobilisation to above, continuing the trend of using active movement to improve mobility. This variation allowing us to progress from lying on the ground, onto our hands and knees.
- Bench mobilisation https://www.youtube.com/watch?v=KmTLtdf-Z4w
- This mobilisation is focused more so on the extension of the thoracic spine – this is one of my go-to exericises for those who spend a lot of time in sitting or slouched over and requires a foam roller.
The following 3 videos each require specific pieces of equipment (foam roller, BackBalls, or therabands).
- These techniques by Tim Keeley, an Australian based Physiotherapist, explains different thoracic foam rolling techniques with his progressions – this approach is different to the previous four, as it specifically requires a foam roller or a similar piece of equipment: https://youtu.be/qCrYe698zJU
BakBalls (two tennis balls taped together):
- These exercises with the BakBalls is considered more intense and specific when compared to the foam roller. This would not be a place that I would begin most of my patients at – but can be very beneficial for those that require a more specific approach.
Warm-up Routine: https://www.youtube.com/watch?v=dBZubZcgPRk
- Dr. Ryan Debell demonstrates a fantastic warm-up routine for those that require more attention for their thoracic spine before exercise. Similar to Dr. John Rusin’s video, he demonstrates a more active approach to mobilisations and how to incorporate it into our training.