Thoracic  Spine:  Mobility  and  postural  control  Beth  Scalone,  PT,  DPT,  OCS    The  thoracic  spine  is  an  overlooked  but  important  component  to  rehabilitation  of  the  not  only  mid  back  complaints  but  neck,  shoulder  and  lower  back  injuries.    Adequate  thoracic  spine  mobility  is  essential  to  not  only  good  posture  but  functional  movements.  Improving  mobility  and  restoring  postural  control  of  this  area  should  be  part  of  the  exercise  and  rehabilitation  programs  for  all  these  areas.        Remember  to  follow  the  simple  rule  of  stretch  what  is  tight  and  strengthen  what  is  weak  when  implementing  corrective  exercise.    In  many  clients,  the  pectorals  muscles  are  tight,  mid-‐thoracic  spine  is  stiff  and  the  thoracic  extensors  combined  scapular  motor  control  muscles  are  weak.    The  following  are  some  basic  stretching  and  mobility  exercises  for  the  thoracic  spine  to  incorporate  into  your  rehabilitation  programs  and  wellness  classes.      Breathing:  

Research  (Izumizaki  2006  and  Obayashi,  2012)  has  demonstrated  that  deep  breathing  and  respiratory  muscle  strengthening  exercises  improve  rib  cage  mobility  and  reduce  thoracic  kyphosis.    It  is  important  to  facilitate  posterior  lateral  rib  cage  expansion  with  manual  feedback  and  verbal  cues  during  inhalation  for  optimal  lung  inflation  and  thoracic  spine  mobility.    A  simple  way  for  the  client  to  practice  at  home  is  to  breath  into  an  elastic  band  wrapped  around  the  torso.    

 Pec  minor  (pool  side  or  mid  pool)  Posterior  tilt  the  scapula  with  manual  pressure  at  the  inferior  border  of  the  scapula  and  superior  lateral  pressure  on  the  anterior  aspect  of  the  shoulder.    Performed  unilaterally  supine  or  sitting.  To  increase  the  stretch,  cue  the  client  to  turn  body  slightly  away  from  you  and  exhale.            

Pec  minor/  major:  client’s  back  against  the  wall,  therapist’s  hands  are  providing  a  retraction  force  with  their  hands  on  the  anterior  aspect  of  the  chest/  pectoralis.  Once  stretch  is  felt  in  the  pectorals  have  client  externally  rotate  arm  placing  the  back  of  their  hands  on  the  wall  and  squeezing  their  shoulder  blades  back  and  down.    Have  the  client  gradually  bring  arms  up  into  abduction  without  losing  the  contact  of  their  hand  on  the  pool  wall.    Add  to  the  stretch  have  the  client  exhale  forcefully  this  will  bring  the  rib  cage  down  and  add  to  the  stretch.    

 

 

                   Sitting:  trunk  rotation  Sitting  with  good  postural  alignment,  hands  together  in  front  of  the  body  and  knees  together,  

rotate  trunk  keeping  nose  lined  up  with  hands  (neck  stays  in  neutral).    You  should  feel  the  stretch  in  the  mid  back.    Be  sure  to  keep  the  knees  together  otherwise  the  pelvis  will  unlock  and  the  stretch  will  be  in  the  lower  spine.  Cue,  “get  taller  as  you  rotate”.            

Standing  wall  touches:  Stand  with  your  right  side  close  to  the  wall  (about  3-‐4  inches  away),  place  your  right  leg  in  front  of  your  left.  Keeping  your  pelvis,  knees  forward,  turn  your  trunk  to  the  right  touching  the  wall  with  your  hands.      Ideas  on  having  fun  and  working  balance  and  coordination  at  the  same  time  while  increasing  thoracic  spine  mobility.    

•   Walking  with  hands  up  at  chest  level  perform  high  knee  lifts,  turning  the  body  towards  the  same  side  as  the  lifted  knee.  This  can  be  done  with  a  partner  or  along  the  pool  wall.    Add  upper  extremity  reaching  at  various  angles  to  challenge  the  balance  and  coordination.  Increase  postural  control  challenges  by  balancing  a  kickboard  or  other  item  on  your  head.      

•   Tandem  stance  trunk  twist:  tandem  stance  and  turn  body  toward  front  leg  reaching  arms  out.  Increase  challenge  with  head  following  and  looking  at  arm  reaching  backward  or  close  eyes.    

 Gaining  postural  control  and  thoracic  spine  extensor  strength  can  be  done  in  a  progression  from  back  against  the  wall  to  back  on  wall  with  noodle  (or  portion  of)  along  spine  to  mid  pool  and  walking  backwards.    

     

 

•   Wall  posture  with  deep  neck  flexor  activation  (head  nod)  and  arm  motions  including  low  I,  T  and  W  (add  noodle  along  back)    

•   Low  I,  Y,  T,  W  with  drag  force  equipment  such  as  glove,  aqualogics  or  aquaflex  paddles.    •   Isometric  holds  against  manual  resistance  of  the  low  I,  Y,  T  or  W  while  walking  forward  

or  backwards.      For  those  not  familiar  with  the  I,  Y,  T  and  W  exercise  they  are  essentially  for  scapular  motor  control  (stabilizing  muscles  lower  and  mid  trapezius)  where  arms  are  held  at  side  (low  I)  out  in  about  45  degrees  of  abduction  (low  Y),  at  90  degrees  of  abduction  (T)  and  abduction  and  external  rotation  (W).    The  key  is  to  initiate  the  motion  with  scapular  retraction  and  not  shoulder  extension                    Low  I                                            Low  Y                                                                                        T                                                                              W                

                 

 

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