The numbers of people suffering from chronic back pain and neck pain due to extensive work at a computer or hovering over a mobile device is increasing rapidly. In today’s modern world more people are becoming sedentary, spending at least 10–15 hrs a day at work, in the car, at school, and home in a position of bad posture, that results in stiff hips and stiff thoracic spine. Stiffness in these two joints is a disaster to our joints as we need both of these areas to provide great mobility, in particular with rotation as used in walking. Lack of mobility at these two areas creates problems for joints above and below as the body searches for alternative methods to move. We have been so conditioned to react to injuries by using pain relief methods, as opposed to looking at WHY you got the problem in the first place. The thoracic region is so unique in that it really can create problems all throughout the body but it will not suffer with any pain, and go completely undetected with most treatments. In this article, I am going to explain exactly what happens when you lose thoracic mobility, what causes it, and what you can do to get it back.
What Is The Role Of The Thoracic Spine?
The main function of the thoracic spine is to hold the rib cage, and protect the heart and lungs.
It also provides 2 critical movements.
1.Extension of the rib cage in order to lift our arms overhead.
2. Rotation of the trunk for movements like walking, throwing a ball etc.
It is important to understand the different function of each of the segments of the spine to see how it’s role differs to the others.
The spine serves two main functions:
Stability: The back is a stable base for the whole body, allowing us to stand upright, absorb shock when we walk or run, and protect the spinal cord (part of your nervous system that runs down the inside of the spine).
Mobility: Because the spine is made up of lots of small segments, all connected with muscles, tendons and ligaments, it is very mobile, allowing us to move in all directions.
Basically the spine helps you to stay still and to move.
Problems arise when there is too much of either stability or mobility, or the wrong kind of either (such as sitting still for too long, bending in awkward or extreme ways), will start to unbalance the complex structures supporting the spine. This can set off a chain reaction that can lead to stiffness, tightness, weakness and pain. Each of the main structures of the back can generate its own kind of problems when things go wrong.
Spinal vertebrae.
There are 24 individual vertebrae (bone segments) in the spine:
7 cervical (neck) vertebrae
12 thoracic (mid) vertebrae
5 lumbar (low) vertebrae
The skull, which should weigh 6kg to 8kg in an adult, sits on top of the neck, which is the most mobile section of the spine.
I underline “should”, because in nearly every postural examination we take with back pain or neck pain related clients, the head is often double or even triple it’s own weight due to an excessive forward head posture developed from poor postural habits such as sitting too long. This combination – the weight of the head and the mobility of the neck – can lead to neck problems.
Below the neck bones is where the thoracic vertebrae, to which the ribs attach. Below the thorax are the lumbar vertebrae of the lower back. These are the largest segments of the spine, because they have to hold up and support the greatest body weight and require great degree of stability.
Below the low back sit two more bones: the sacrum and coccyx (tail bone). Attached to the sacrum are two large pelvic bones to which the legs attach, via the hip joints.
What you often find is that the thoracic spine tends to remain pain free even though it has become dysfunctional and the areas above (neck) and below (lumbar spine) end up suffering chronic pain.
You will find the video below gives you a detailed explanation of this.
What Commonly Happens To The Thoracic Region
As mentioned in the beginning, our modern lifestyle has contributed to us losing our mobility at this part of the spine, making it rigid and stiff.
Technology has provided many great things for modern living that makes our lives easier, but one could argue it has almost gone too far and made life so easy and made us lazy. Years ago a lot of time and money was spent with ergonomic workstations to eliminate postural problems created from sitting behind computers. Unfortunately, many people rarely work behind workstations these days as the flexibility of lap-tops, tablets, IPAD’s, and mobile phones have changed the way we work.
Inactivity is ruining our health and we must constantly move to prevent degeneration of our joints like the thoracic spine.
This is a disaster to not only how we move, but also how we breathe and stabilize other joints of the body. When we adopt positions for endless amounts of time, day after day, week after week, year after year we begin to “fuse” parts of our spine together. The picture below sums up why so many people develop thoracic stiffness. The amount of time spent in these positions is immense, and if there is nothing to counter this endless amount of repetition it becomes permanent, hence using the word fused! This is why many now rate sitting as bad as smoking!
Mobile phones in particular are a real concern with the amount of time people spend looking down at the phone is considerable. Recent estimates showed that at least 77% of the world’s population has their own mobile phone and many studies have been conducted to study the correlation between using mobile phones for texting and both, neck and shoulder pain.
Check out this research study results on this for more information.
What makes this even worse is poorly prescribed exercises and using poor technique placing even more compression into the spine.
The spine is a strong, durable, and yet a flexible structure designed not only to transmit force, but also allow a variety of movements in all planes of motion. However, when the amount of these forces exceed the spine’s capability to withstand being squashed by various postures we repetitively adopt, or the dysfunctional way that we move, you will find pain is not far away.
Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This places your spinal joints and nerves under pain-causing pressure. All you need to break you is repetitive exercises like crunches that encourage the trunk to flex even further.
When your body exceeds its threshold of force into the thoracic spine we begin to lose important movements, and need to find alternative methods to complete them. And this is where injuries are born!
This is how it works.
As the thoracic spine loses it’s ability to extend you have two choices.
Ignore the fact you cannot extend correctly, and force the shoulder to find more mobility instead. When this happens and you lift your arm overhead, your humerous bone is unable to effectively stabilize the ball in the socket, and begins to mash tendons, ligaments and eventually starts smashing into the top of the shoulder.
Bang, now you have the early stages of a shoulder impingement or rotator cuff tear. It does not happen with one movement, but thousands of poor ones evolving due to compensation. Add on top of that scapula dysfunction and all types of trigger points and compensation that develop into neck pain as a result, this is not a good alternative.
Try to make up for the lost thoracic extension by using your lumbar spine to extend more instead. The lumbar spine is very easily damaged if it loses it’s mobility. Injuries like facet joint sprains, SIJ dysfunction and even disc bulges are very common here.
Both situations are less than ideal, but you the body has no choice. It has to find another way, and it always will. It won’t worry if it is a good choice, it will only choose the one it can do.
Loss Of Thoracic Extension
Below is a picture showing an example of good extension versus a loss of thoracic extension, and it is clear to see how this can both be a risk for shoulder or lower back injury.
You definitely would not want to do shoulder press with a person in a posture like this!
Sports or occupations that require overhead movement is how people will very easily develop a nasty chronic problem in the neck, shoulder or lower back from lack of extension. And many treatments will focus on these areas leaving the thoracic stiffness to remain in place!
Loss Of Thoracic Rotation
But it is not just extension that is lost, rotation also suffers and in most cases this is much bigger problem.
We need rotation to do the simplest of tasks such as walking, turning to look over your shoulder when reversing the car out the driveway, or looking to cross the street. But because we have taught the body how to stiffen the area that is the only area that can do this, we now have to cheat, we have to find another way. We also lose power with our arms without rotation.
Think of throwing a ball with your feet standing still. How far can you throw? Not far right? This is because you have no rotation. Your legs and your hips are definitely needed, but the thoracic region also plays a pivotal role in rotating the trunk for efficient power transfer.
This is where many of the common injuries in golf and tennis for elbows, shoulders and lower back can be traced back to a lack of thoracic mobility. Other joints overworking and blowing themselves out trying to find more power as there is an energy leak at the thoracic spine!
Below is a video of how this relates to a golf swing.
Shortly I will provide you with a ton of exercises to assist you with this but first we need to discuss how thoracic stiffness affects your breathing.
Thoracic Stiffness Affects Your Breathing
This is really bad news for anything that changes your breathing will affect everything from how well you sleep, to posture, and even metabolic function, and how well your body can digest food.
Breath and posture are intimately linked. Good posture creates the best body mechanics for optimal breathing. Conversely, poor posture will lead to inefficient and laboured breathing that creates tension in your shoulder muscles (secondary respiratory muscles). Poor posture will change ALL movements and eventually lead to chronic tension, pain & fatigue! Often in the neck and shoulders first before changing other parts of the body. Everything will be sacrificed in order to get a breath.
Forward Head Posture is the most common thing to see first.
You can go and get a massage every day of the week to get rid of your tight shoulders and neck muscles, but it will do nothing while you continue to breathe poorly.
If your thoracic region is heavily depressed your rib cage cannot expand correctly breathe. We begin to change our breath cycle to get more air and when we do this we now change how we stabilize. The respiratory system has a dual function – we know it acts as a way to get air, but it also serves as a stabilizer system. The diaphragm is primarily a respiratory muscle and secondarily a stabilizer muscle. Because we have an altered rib cage our stability system is also compromised, and again exposes us to injury.
And again this will often go completely unchecked as therapists go about treating symptoms.
While it is impossible for me to provide you with exactly the right exercises for your specific needs I will give you a series of exercises and tests to use to help identify where to start.
Step 1: Address Trigger Points & Release Tight Muscles
This is the most logical place to begin with most people, but in many cases will do very little to free them up. I like to use these drills in combination with steps 2 & 3.
Watch the video below on how you can use trigger point release.
Step 2: Correct Thoracic Extension
There are several drills I might use and it can take considerable time to improve the strength of the weakened muscles so care must be taken in this stage. The video below shows you several simple drills that progress to more strength based exercises to help.
Also the use of deadlifts and squats can really help which I will discuss in the later steps.
Step 3: Improve Thoracic Rotation
Again there is many exercises I might use here, but some of the simplest ones are the best.
This exercise is an excellent test for it cannot be cheated on and helps to identify exactly what quadrant of the thoracic region is most rigid. It is one of the few times a test is a great exercise as well and is perfect for someone with neck pain as it helps to loosen the rigidity in the spine in the least aggressive manner.
Wood-chop exercises are a great strength based exercise that I would also use a lot but to start with the exercise below is a much more simplified and easier drill to start with.
Step 4: Scapula Stability
This step is crucial to ensure the thoracic spine does not compensate out to these joints again. Poor movement compensations, even though they create pain become encoded into how our brain makes us move. A bit like a virus in a software program, and these joints may continue to lose too much stability out of habit. You must address the stability at these joints and force the thoracic to provide the mobility.
The exercises to improve scapula stability can be really messy at times but one of the best drills is the wall slides that helps to activate the serratus anterior and lower trapezius muscles that are critical for scapula and shoulder stability.
Watch the video below to see two examples of this exercise.
Step 5: Improve Pelvic Stability
You might be thinking what has the pelvis got to do with the thoracic region?
The effect poor hip and pelvic positions create on the head and neck cannot be ignored so it is important you have a series of tests and assessments to determine what you may need. This would be the second biggest mistake people make by only focusing on the area in pain and forgetting that the head and neck are only one part of the puzzle.
To explain how the pelvis can create forward head posture take a look at the picture below created by Alois Brügger, a Swiss neurologist. He used the idea of a cogwheel to describe the inter-dependability of the spine on itself. He encouraged patients to adjust the lower cogwheel—the pelvis—into a clockwise position, allowing the chest and head to follow into good posture.
You can read more about this in the article about forward head posture.
This means you need to use exercises that encourage core stability and good pelvic positioning.
There are a lot of exercises to use that can help here but one of the easiest to implement is the lower abdominal strengthening exercise shown below.
Step 6: Learn How To Move Correctly
Last but not least is learning how to move correctly. Sounds pretty easy doesn’t it?
Unfortunately, this is anything but easy and the one thing I can tell you with absolute certainty is that I very rarely see a person pass all of our movement checklist.
Many of us have developed poor movement patterns and do not even know it. We are running compensatory movements all the time. If we do not identify poor movements and correct them, everything we just did will be wiped out as soon as we start moving again. We have to show the body the correct way of mobilizing and stabilizing while we move in order to be pain free and perform to our potential.
This is a big subject in it’s own right as I am sure you can imagine.
Below I have provided you with a detailed video to explain what to look for.
The main patterns of movement to focus on usually with poor thoracic function is obviously the rotation pattern, but also the pushing movement.
It is very common to see weakness and dysfunction within this movement due to the poor capability of the thoracic spine to provide a stable base for the arms to execute pushing movements. This helps to explain why so many people develop pain and injury with pushing exercises like the bench press or overhead press.
The muscles of lower trapezius and serratus anterior muscle becomes inhibited and eventually weakened when the thoracic develops rigidity leading to a host of problems. These two muscles play a pivotal role in keeping the scapula attached to to the thorax and in optimal alignment. And also providing the upward rotation and posterior tilt needed for optimal stability. Without these muscles firing together correctly, your body will find another way and this is when postural adaptions occur such as the winging of the scapula, stiffness, trigger points and ultimately pain will surface at the end.
In Even Oscar’s book “Corrective Exercise Solutions For Common Shoulder & Hip Injuries” , a must read, he provides a table of what happens when stability muscles are inhibited.
There are a lot of other exercises I would obviously need to use to complete the job but I think you get the idea of how to approach this part of the body. It will take a lot more than just a few stretches or a massage to treat the underlying problem of weakness.
You cannot just throw a stack of strength exercises at it either as this will very easily create a multitude of pain. If you follow the steps outlined above you should start to feel you are making good progress. once you have done that you could try some of the exercises shown in the video below. Just a word of caution that these are some advanced strength exercises so you would not want to start with these.
Do You Need More Help?
If you are suffering with shoulder pain, neck pain or lower back pain right now you can get our in depth online programs by going to the ONLINE SHOP. These programs include over 60 exercises with instructions and step by step programs for guiding you through the process of correcting your injury at the source.
Summary
I hope this article gives you some great insight into an area of the body that is rarely looked at, but when you drill down you begin to see it is at the source of your problem. This is very much a modern problem with the invention of technology forcing us into this poor flexed over posture. We must recognize the need for using corrective and preventive based exercises to address this increasingly common problem, and stop treating symptoms.
Always remember prevention is much better than a cure.
If you play rotational sports or have an occupation that requires overhead tasks this article will give you stacks of great information about how you can stay pain free.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
Scapula Injuries in Sporting Athletes – By Sports Injury Bulletin
Muscle testing & function – By Kendall, McCreary, Provance, Rogers, Romani
The Vital Glutes – By John Gibbons
Movement – By Gray Cook
Corrective Exercise Solutions for the hip and shoulder – by Evan Osar