Most clients and patients that come into my office and many other offices or gyms throughout the world lack thoracic mobility. Some of them may sit at a desk for hours upon hours at a computer in the typical desk jockey posture.
photo credit: http://hawaiianlibertarian.blogspot.com/2014/01/cubicle-farming-desk-jockeys.html
We all know the negative side effects of prolonged sitting on not only orthopedic health but also on other bodily systems. There is nothing wrong with working on trying to improve a client or patient's thoracic mobility. Improved thoracic mobility can help in various areas of the body including:
As I have eluded to before, one area of the body can improve a completely different region of the body due to the concept of "Regional Interdependence."
Regional Interdependence, according to the Journal of Orthopedic and Sports Physical Therapy (JOSPT), is "the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint."
This is also related to the Joint by Joint Approach by Mike Boyle and Gray Cook.
photo credit: nicktuminello.com
So back to the discussion of thoracic spine mobility. First off, we need to assess thoracic spine mobility. There are a few ways that it can be assessed.
The discrepancy with measuring it in sitting is that there is the effect of gravity and having to sit in an upright position to move throughout the excursion of the ROM.
Second, it is easy for people to attempt to "cheat" this test by rotating through their lumbar spine or by moving their lower body in an attempt to increase rotation.
A better way to assess true thoracic rotation is in quadruped. First, have the patient or client go on a table or on the ground. Instruct them to bring their feet and knees together and sit back on their heels. Once their are on their heels, place one forearm at mid-line on the ground and the other arm behind their back, as shown below.
Once the person is in this position, you are going to instruct them to twist as far as they can while maintaining their arm and lower body on the table/floor. By being in quadruped position, it forces the lumbar spine to be "locked" and therefore the rotation cannot come from anywhere but the thoracic spine.
One cue or trick, that I got from Miguel Aragoncillo, who got it from a SFMA course, is to tell the person, who is performing the movement, to imagine that they are in a tunnel and that one wall of the tunnel is right next to their hip and the other wall is next to their opposite shoulder and hip. Tell the client not to bump into the walls when twisting.
What this cue does is that it helps to limit any type of compensation by side-bending through the lumbar or thoracic spines, etc.
So once you have the person all set, ask them to twist as far as they can. Normal values for thoracic rotation are 50 degrees. Instead of trying to eye-ball it, use the Clinometer App on the Iphone or Android to assist in measuring.
Place the base of your phone at T2-T4 on your thoracic spine.
So, now that you have measured the client's thoracic rotation, how does it look?
If it is 50 degrees or above side to side, then we are good to go. If they are a rotational sport athlete (baseball, lacrosse, softball, volleyball, etc.), upwards of 70 degrees is usually ideal.
What if they have less than 50 degrees of rotation bilaterally or to one side?
Then we must have to have them foam roll their thoracic spine, have some type of thoracic manipulation done by a chiropractor or physical therapist, or perform some type of thoracic mobility drill!
Not so fast!
Just because someone lacks normal or full Active Range of Motion (AROM) in thoracic rotation does NOT mean they need to improve their thoracic spine mobility.
We need to assess it PASSIVELY!
Key Points for Assessment:
If someone still has less than 50 degrees for general population/70 degrees for rotational sport athlete, then they may need to have some type of manual therapy done by a physical therapist, sports chiropractor, or massage therapist. If you are a coach, then use some type of thoracic mobility drill.
Mobility drills can include:
But...what if the client or patient has FULL or NORMAL passive thoracic rotation as shown in the video above???
Do we still want to mobilize their thoracic spine?
Do we still want to do mobility drills?
The answer is no.
This particular client or patient does NOT lack mobility. They lack STABILITY. They lack the ability to access the ranges of motion that they have.
Imagine you have a car. The car drives really well when the E-brake is off. The car doesn't run so well when the E-brake is on.
photo credit: http://auto.howstuffworks.com/auto-parts/brakes/brake-types/emergency-brakes.htm
Well, imagine when you have the normal amounts of mobility, but you can't access those ranges of motion. Your body is putting the E-brake on.
The timing, sequencing, and motor control of the muscles surrounding the spine and inner core (diaphragm, multifidi, TA, and pelvic floor) are not firing properly. In turn, the big prime movers (Paraspinals) are trying to stabilize as well as be prime movers. This is causing a decrease in active ROM versus exhibiting normal passive ROM.
So, what do we do to fix this?
Thoracic Spine Stability Exercises
Stability for the thoracic spine can come in various forms. Here are a few examples below:
Quadruped Assisted Thoracic Rotation
Tall Kneeling Kettlebell Trunk Rotations with Breathing
Courtesy of FunctionalMovement.com
Bird Dog Arms/Legs
The Bird Dog Assisted Arms/Legs is known as a core exercise, but it is great for improving the stability and motor control of the arms, legs, and trunk. By improving stability at the trunk, it can allow the thoracic spine to move better.
Bird Dog Resisted Arms/Legs
Two people may present with poor thoracic spine stability aka poor active thoracic rotation. One person may respond better to a Quadruped variation and another may respond better to the Tall or Half Kneeling variation. Perform the corrective that elicits an improvement in their active thoracic rotation. Make sure to test before and after a corrective to see if it actually improved.
Give these a try if your thoracic spine ACTIVE mobility is limited!
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