By Steven Tran – Sydney CBD Chiropractor
Are you suffering from low back pain or neck pain? Do you have slumped shoulders? Shoulder pain when lifting items overhead?
This could be the result of poor thoracic spine mobility. What is the thoracic spine? What happens when the thoracic spine loses mobility? How to test for thoracic spine mobility? What can your chiropractor do for thoracic spine flexibility? What exercises can I do to perform my thoracic mobility? Today’s blog answers everything you need to know about thoracic spine mobility.
What is the thoracic spine?
The thoracic spine (upper back) is an important section of the spine that is often neglected; it is a common problem area in today’s society as we are more sedentary.
The spinal column is made up of five segments and each segment of the spine has different functions and roles. Below is an image of each section of the spine.
The thoracic spine is made up of twelve vertebrate that starts from your shoulder level down to the waist and it plays a crucial role with the ribcage; protecting your lungs and heart. Although the range of motion in the thoracic spine is small, adequate mobility is required to allow for movement in flexion, extension, side-bending and rotation. Patient who present with lack of mobility in the thoracic spine, commonly have a sedentary lifestyle and/or job.
What happens when the thoracic spine loses mobility?
To have mobility is to have access to move freely and easily through all planes of movement. When the thoracic spine loses its mobility, the lumbar spine commonly picks up the slack and will compensate for the limited mobility the thoracic spine now provides, leading to fatigue of the low back muscles and low back pain. Looking above the thoracic spine, we have the shoulders and neck. A lack of movement in the thoracic spine can create discomfort and pain in the shoulder and neck. Study done by Heneghan et al, 2017, showed that thoracic spine movement dysfunction is linked to pathologies and pain in the neck, shoulder and elbow.
An important role of the thoracic spine is to also assist with neck movement. The thoracic spine contributes to 21% of neck rotation and 33% of neck flexion. This shows us that poor mobility in the thoracic spine can lead to the development of pain in the neck.
The thoracic spine and sedentary lifestyle?
In the modern era, a significant proportion of the populations are affected by sedentary lifestyle. Sitting for prolonged periods has gradually become the norm with workplace, travelling and transportation. Research has found correlations between sitting >8 hours a day and increased neck, shoulder and low back pain.
It is common to find office workers who spend majority of their time sitting hunched forward and with their head jutted forward. Holding this hunched position for several hours per day reduces the thoracic spine mobility.
If you are affected by neck pain, shoulder pain or low back pain, an important factor that may be contributing to your pain may be a lack of mobility in your thoracic spine. To negate this effect from prolong long postures it is important to incorporate physical activities in your busy schedules, as it will promote soft tissue and joint mobility. Working to improve your thoracic spine mobility can not only improve posture, but also reduce pain in other areas of your body.
It is also important to pay attention to signs of fatigue and discomfort while working. While seated, muscles are activated to help support and upright posture. Over time these muscles can fatigue, which may lead to inappropriate postures and compression can affect mobility as well as impede the flow of blood, impinge nerves and injure soft tissue. Thus taking frequent micro breaks every 20mins to perform light stretching at your desk is also important.
How to test for thoracic spine mobility?
Here are 3 simple self-assessment tests you could try to see if you lack thoracic mobility.
1. Seated Wall Angel
The seated wall angel test looks for a combination of your ability to lengthen muscles of the shoulders and mobility of the thoracic spine. In the seated position we limit involvement of the low back and hip. Thus allow you to rule in or out deficits involved.
- Sit with lower back close to wall, allowing natural low back curve
- Raise both arms overhead with thumbs facing towards wall
- Slowly slide arms down the wall maintaining contact to below height
- Return to 90 degree shoulder height, rotate palms down while not allowing shoulder blades to come off wall
- Rotate back to wall, raise arms over, return to start position
If the client present with poor thoracic spine mobility, what we could see are;
- Significant arch in the low back
- Excessive rib flare
- Forward head carriage / Chin jutting
- Elbows / Wrist bent to touch the wall
2. Supine Flexion Test
The supine flexion test looks for your ability to lengthen the shoulder muscles and capabilities of the thoracic spine. In the supine position, minimal stabilization is required from the body. Thus allow better movement as muscles are relaxed in this position. This test will help indicate a muscle length problem or thoracic extension deficit.
- Laying on your back (supine position) with legs together and hips and knees bent, with the feet flat on the floor. This will limit hip flexor involvement, reducing compensation and allows the pelvis to be in a more neutral position during testing.
- The client will then reach both arms out to 90 degree of shoulder flexion with elbows locked out.
- Next, while keeping elbows locked out, try to raise your arms in front of you until the are completely overhead.
3. Thoracic Rotation Test
The aim of this test is to identify whether there is a rotation restriction. Rotation through the thoracic spine facilitates stability of the cervical spine and optimizes function of the lumbar spine.
- Assume a quadruped position, on hands and knees.
- To isolate rotation to the thoracic spine, client needs to sit the hips on to the heels and place forearms on the ground.
- The client places one hand behind the head and attempts to rotate just the thoracic spine in the direction of that hand
- Repeat on other side
The client should demonstrate approximately 35 degree of rotation in each direction from this position. If the client has a rotation limitation in the thoracic spine, it is challenging to compensate for in this position.
What can your chiropractor do for thoracic spine flexibility?
Your chiropractor or other health professional will perform a series of range of motion, muscular and orthopaedic testing on the thoracic spine and surrounding joints. Your chiropractor will try to reproduce pain and/or identify your movement restrictions and explain your diagnosis to you.
Treatment with hands on therapy such as spinal manipulation and muscular release will aim to restore normal joint range of motion in the thoracic spine. Prescription of advice and exercises specific for you and your thoracic spine will also be performed.
What exercises can I do to perform my thoracic mobility?
Check out the video below to learn more about the three simple exercises to improve thoracic mobility. Try them out at work to take breaks from sitting in a static position. If you are working a sedentary job, it is important to take movement breaks as often as possible.
- Heneghan et al 2017 – What is the effect of prolong sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting. https://www.ncbi.nlm.nih.gov/pubmed/29730619
- Tsang SM, Szeto GP, Lee RY. Normal kinematics of the neck: the interplay between the cervical and thoracic spines. Man There 2013;18:431-7