Thoracic Mobility

If you don’t regularly work on your t-spine (mid-back) mobility, you are only hurting yourself. A lack of t-spine mobility affects all other movements throughout the body, particularly the shoulders and hips, two areas that are heavily involved in almost every athletic skill.

To solve your t-spine mobility problems, you first have to understand its role in the body before beginning a training session.
Why is Mobility Important?
Mobility is often confused with flexibility, which is a devastating mistake in athletics. Flexibility refers to the range of motion that a muscle can achieve. It is a component of mobility, which also encompasses joint range of motion and stability. To illustrate the difference, let’s perform a few tests.

Lie on your back with your legs straight. Raise raise one leg as far as you can. You’ve just tested your hamstring flexibility. Now, stand up, reach down and touch your toes. Keeping your fingertips in contact with the ground—if you can get that low—pull yourself into a deep squat position. You’ve just tested your squat pattern mobility.
Mobility is multi-joint, multi-muscle and dependent on how well you can control movement. Mobility is exponentially more important than flexibility because flexibility does not imply control.

Why is the T-Spine Important?

The t-spine is located in what’s commonly known as the upper- and mid-back, spanning the distance between the neck and lower back. It has twelve vertebrae with a joint above and below each. T-spine alignment determines how the shoulder blades rest on the rib cage and, subsequently, how well the shoulders move.

The thoracic spine must be mobile. A rigid t-spine creates problems at both ends of the chain. As mentioned above, the t-spine affects the shoulders, low back and hips. When the t-spine is immobile, the body compensates by making typically stable joints more mobile. The prime example is the lumbar spine. A hypermobile (excessively mobile) lumbar spine causes lower-back pain and starts a cascade of problems throughout the body.
These days everyone sits a lot—including athletes. Hours spent at the computer or watching TV make a supple upper back very stiff, turning the t-spine into a pillar. This is bad news for any athlete.

T-Spine Mobility Exercises

The goal is to get the t-spine to rotate well. Examples are when reaching for a rebound (extension) and throwing a baseball (rotation).
Before improving upper-back movement, it helps to improve upper-back muscle quality.

Athletes should train thoracic mobility every day. On training days, include the mobility drills below in your warm-up. If a training day includes a lot of heavy upper-back work, complete t-spine mobility exercises at the end of the session.
On off days, perform drills intermittently throughout the day. Include t-spine mobility in a recovery circuit, or do them during commercials while watching TV. If you’re be spending a lot of time at the computer, take breaks every hour to roll and move your upper-back.

Primary thoracic spine pain disorders comprise approximately 15% of all back/spine complaints. Compared to cervical and lumbar spine, the research is lacking for the thoracic spine. As a result there is less evidence available for the evaluation and management of thoracic spine disorders. What follows is an outline of a musculoskeletal examination for patients with primary thoracic spine disorders. Where evidence from the peer-reviewed literature is utilized, however more research is required for this region.

Patient Intake

Self report

The following are guiding questions that the clinician should consider to assist with formulating initial hypothesis as to the nature of the patient’s disorder.
• What is the patient’s profile? (Age, gender, occupation, hobbies)
• What is the patient’s chief complaint: (Symptoms could include pain, stiffness, weakness, or neurological symptoms)
• What is the area of the patient’s symptoms? (A pain body diagram is useful to collect this information)
• What is the behavior of the patient’s symptoms?
• What are the aggravating and easing factors?
• Do dynamic or static activities alter symptoms?
• What is the duration of the symptoms?
• What is the 24-hour behavior of the symptoms?
• What is the history of the present condition?
• Is the injury from trauma or over use?
• What is the patient’s past medical history? (A medical screening form is useful to collect this data)

Performance‐based outcome measures
There are no validated region specific outcome tools for the thoracic spine, the following are recommended but require validation for use with patients with primary thoracic disorders:
• Neck Disability Index (NDI) for upper thoracic complaints
• Oswestry Disability Index (ODI) for lower thoracic complaints
• Numeric Pain Rating Scale (NPRS) where patient is able to rate their pain on a scale of 0 (none) to 10 (severe).
• Patient Specific Functional Scale (PSFS) can be used to measure activity limitations and to compare progress from the baseline measurement.

References

• ↑ Linton SJ, Hellsing AL, Hallden K. A population-based study of spinal pain among 35-45-year-old individuals. Prevalence, sick leave, and health care use. Spine (Phila Pa 1976) 1998 Jul 1;23(13):1457-1463.
• ↑ Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976) 2003 Jan 1;28(1):52-62.
• ↑ Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976) 2003 Jan 1;28(1):52-62.
• ↑ Benhamou CL, Roux C, Tourliere D, Gervais T, Viala JF, Amor B. Pseudovisceral pain referred from costovertebral arthropathies. Twenty-eight cases. Spine (Phila Pa 1976) 1993 May;18(6):790-795.
• ↑ Hamberg J, Lindahl O. Angina pectoris symptoms caused by thoracic spine disorders. Clinical examination and treatment. Acta Med Scand Suppl 1981;644:84-86.
• ↑ Blake C, Garrett M. Impact of litigation on quality of life outcomes in patients with chronic low back pain. Ir J Med Sci 1997 Jul-Sep;166(3):124-126.
• ↑ Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. New Zealand: Accident Rehabilitation; Compensation Insurance Corporation of New Zealand, and the National Health Committee, Ministry of Health 1997.
• ↑ 8.0 8.1 8.2 8.3 8.4 Cleland JA, Childs JD, Fritz JM, Whitman JM. Interrater Reliability of the History and Physical Examination in Patients With Mechanical Neck Pain. Arch Phys Med Rehabil 2006 10;87(10):1388-1395.
• ↑ Flynn TW, Cleland JA, Whitman JM, Users’ Guide to the Musculoskeletal Examination. Cerviothoracic spine examination. Evidence in Motion, 2008. p72-102.
• ↑ 10.0 10.1 10.2 10.3 Heiderscheit B, Boissonnault W. Reliability of Joint Mobility and Pain Assessment of the Thoracic Spine and Rib Cage in Asymptomatic Individuals. Journal of Manual and Manipulative Therapy 2008 12;16(4):210-216.
• ↑ Potter L, McCarthy C, Oldham J. Intraexaminer Reliability of Identifying a Dysfunctional Segment in the Thoracic and Lumbar Spine. J Manipulative Physiol Ther 2006 4;29(3):203-207.
↑ Physical Therapy Nation. Lindgren’s Test for First Rib
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3 thoughts on “Thoracic Mobility

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