FRANK GILROY– Senior Physiotherapist MSc MCSP
KELSEY BRETHOUR– MSc Physiotherapist Student
ANATOMY
The thoracic spine’s main function is to support the rib cage and protect our heart and lungs. Mobility in our thoracic spine allows us to extend our rib cage in order to lift our arms overhead and to rotate our trunk during movements such as walking.
The three main muscles that help to extend the thoracic spine are:
The Erector Spinae
Three columns of muscle (spinalis, longissimus and iliocostalis) that are located along each side of the spine from the pelvis to the base of the skull. Also help with lateral flexion and rotation of the spine.
Mid Trapezius
Located superficially on each side of the thoracic spine and divided between upper, middle and lower sections. In regard to this exercise programme, the mid trapezius is of primary focus and it serves to retract the scapulae.
The Rhomboids
Deep to the trapezius muscles are rhomboid major and minor muscles connecting the scapulae to the thoracic spine. They function to retract and support the scapulae.
PHYSIOTHERAPY AND PREVENTION
- The most important change an individual can make is to improve their posture and correct any bad habits. People develop bad posture over many years.
- Stretches and mobility exercises to Increase movement in thoracic spine.
- Thoracic extension strengthening exercises to build endurance.
THE LINK BETWEEN THORACIC IMMOBILITY AND POSTURE
Our modern-day lifestyle of excessive use of technology has created a problem forcing us into a slumped position. This poor posture consists of protracted scapulae (rounded shoulders), forward head posture and an abnormal thoracic spine curvature (kyphosis). This prolonged position lengthens and weakens the scapular retractor muscles (rhomboids and mid trapezius) which encourages rounded shoulders, creating a vicious slouching circle.
Poor Postural Alignment:
Good Postural Alignment:
*** The following exercises are not appropriate for patients with Osteoporosis. We would advise that this exercise programme is supervised by a Physiotherapist or Medical practitioner. ***
STRETCHES
In order to achieve strengthening of thoracic muscles it is important to increase the mobility in your thoracic area first.
The following stretches should be undertaken before you begin the strengthening exercises. Each stretch should be held for 30 seconds. Each stretch should be carried out 2 times a day, 5 days a week.
1. Kneeling Thoracic Extension Stretch
- Place elbows on a steady surface interlocking your hands behind your neck.
- Sit your hips back on your heels while dropping your chest towards the ground.
- You should feel a stretch in your mid back.
- Perform 2 sets holding for 30 seconds each.
2. Thoracic Rotation Stretch
Option 1:
- Lie on one side with your hips and knees bent to 90 degrees.
- Keeping legs in this position, rotate one arm across body aiming to bring arm and upper back flat onto the floor.
- Perform 2 sets per side holding for 30 seconds at a time.
Option 2:
This is a convenient stretch that can be carried throughout the day while at work, if prolonged sitting is involved.
- Sitting in a chair, rotate your spine as to look behind you.
- Place your hands on the outer part of the chair to the side you are rotating towards to deepen the stretch.
- Perform 2 stretches on each side, holding for 30 seconds at a time.
3. Front Stretch
- While standing raise clasped hands over your head.
- Once you feel a stretch in your core hold that position for 30 seconds and perform 2 times.
4. Side Stretch
- While standing lift one arm over your head towards the opposite shoulder.
- Once you feel a stretch in your side hold that position for 30 seconds and perform 2 times.
MOBILITY EXERCISES
Mobility exercises should be carried out 2 times per day, 5 days a week. Your Physiotherapist will be able to offer further advice and additional mobility exercise as required.
1. Thoracic Rotations
- While holding a stick at shoulder height, rotate to one side while keeping your hips facing forwards.
- Movement should come from your spine and not your hips.
- Complete 10 repetitions on each side slowly and with control.
- This may be done either in seated or standing position. See below…
Option 1: Starting Position (Seated)
Option 1: Ending Position (Seated)
Option 2: Starting Position (Standing)
Option 2: Ending Position
STRENGTHENING EXERCISES
The following exercises will help correct your bad posture and the rounding of the thoracic spine. The aim of these exercises is to improve your ability to retract your scapula (pull your shoulder blades back).
These exercises should be held for a longer period of time to build up endurance in the thoracic extension muscles, and should help you to strengthen the muscles in your back.
Keep in mind that it will realistically take up to 12 weeks to improve your posture and strengthen the extensor muscle groups. If any exercises are causing increased discomfort, please this discuss with your Physiotherapist – who will be able to offer additional guidance.
Whilst doing the following strengthening exercises:
- Keep your shoulders pulled back and down.
- Keep your head in alignment with your spine.
- Ensure your body remains in a straight line.
You should be supervised by your Physiotherapist when completing your exercises for the first time.
Phase 1 – ‘I’ Lift
- Lie face down on a Swiss ball/Stable Surface so the ball/surface is under your hips.
- Straighten your arms and place by your side keeping your thumbs facing up.
- Squeeze your shoulder blades together and down.
- Perform 3 sets of holding for 1 minute with 1-minute rest in between sets.
- Repeat your exercises twice a day, five days a week. Once you have achieved the above goals you can progress to Phase 2.
Phase 2 – ‘T’ Lift
- Lie face down on the Swiss Ball/Fixed Surface so the ball/surface is under your hips. Straighten your arms out to the side at a 90-degree angle with thumbs facing up.
- Squeeze your shoulder blades together and down.
- The goal is to perform 3 sets of holding for 1 minute (with 1 minute rest in between.)
- Repeat exercises twice a day, five days a week. Once you have achieved the above goals you can progress to Phase 3…
Phase 3 – ‘V’ Lift
- Lie face down on the Swiss Ball/Surface so the ball/surface is under your hips.
- Straighten your arms out in front of you and ensure arms are in line with your ears.
- Squeeze your shoulder blades together and down.
- Perform 3 sets of holding for 1 minute with 1-minute rest in between sets.
- Repeat your exercises twice a day, five days a week.
Once you can comfortably achieve Phase 3, you can go back through each phase incorporating a light pair of dumbbells whilst continuing to increase the weight when necessary.
Remember to always have good sitting or standing posture whenever possible, especially when using a laptop/computer or watching tv.
You can see Frank or any of the team at Hampden Sports Clinic…
You can see
References
CHO, J., LEE, E. & LEE, S., 2017. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial.(Report). BMC Musculoskeletal Disorders. [online] 18(1), pp.525. [viewed 17 March 2020]. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1889-2
HENEGHAN, N., BAKER, G., THOMAS, K., FALLA, D. & RUSHTON, A., 2018. What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting. BMJ Open [online]. 8 (5), [viewed 17 March 2020]. Available from: https://bmjopen.bmj.com/content/8/5/e019371.long
JOSHI, S., BALTHILLAYA, G. & NEELAPALA, Y., 2019. Thoracic posture and mobility in mechanical neck pain population: A review of the literature. Asian Spine Journal [online]. 13(5), pp.849–860. [viewed 17 March 2020]. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1889-2
SOAMES, R., PALASTANGA, N. & RICHARDSON, P., 2019. Anatomy and human movement : structure and function. 7th ed. Edinburgh: Elsevier.