Anatomy Corner: Thoracic Spine

The majority of spine-related issues addressed in physical therapy are either low back (>53%) or

neck (>27%) related (1). However, that doesn’t mean the rest of your spine, the thoracic spinal

segments, can be ignored!

Your thoracic spine is 12 segments long, each connecting to a rib on both sides. Because of these

ribcage connections, your thoracic spine is not as free to bend forward or backward as your neck

(cervical spine) or low back (lumbar spine), but it does contribute around 30 degrees of rotation to

each side, three times as much as from your lumbar spine (2)!

So why pay attention to your thoracic spine? Unlike your cervical and lumbar spine, whose

curves point forward, your thoracic spine’s curve points backward; sitting in the middle of your

spine, it completes the accordion-like system that allows your spine to absorb impact. Losing

mobility in this area can significantly decrease your postural control, your respiratory capacity, and

your ability to hold your gaze forward without overloading your neck muscles.

Optimizing mobility in these spinal levels can relieve low back and neck pain in addition to

addressing mid-back or ribcage issues, and can help with a variety of other postural, breathing, and

even shoulder mobility issues! Here’s a summary of some of the research:

• Manual mobilization to the thoracic spine by a physical therapist improved pain for patients with chronic radiating low back pain, with a larger effect than lumbar stabilization exercises alone (3).
• Physical therapy clinical practice guidelines include recommendations for improving thoracic mobility in addressing both chronic and acute pain in both the cervical and lumbar spine (4,5).
• Chronic neck pain and decreased respiratory strength both correlate with decreased thoracic spinal mobility (6).
• In patients with shoulder impingement pain, thoracic mobilization and extension exercises improved pain and mobility across the shoulder girdle (7).

So how do you get started?

The above research points to a combination of manual mobilization and mobility exercises as the

most effective means of increasing thoracic range of motion. But here’s a self-assessment and an

exercise that you can begin with even before you get in touch with your PT for a more official

evaluation:

Hands-and-knees Thoracic Rotation test

From an all fours position, lower yourself to your forearms (elbows on the ground). Put one hand

behind your head* and turn your ribcage, shoulders, and gaze as far toward the ceiling as you can

get. Repeat on the other side – if you felt stuck along the way, and especially if you could rotate

significantly less to one side, congratulations! You need to improve your thoracic spinal mobility!

*You can keep your arm straight to your side if you have shoulder pain in this position.

Open book stretch for thoracic rotation and extension (video below):

Try the exercise in the video link – and then check back in with the Hands-and-knees test after

performing the open book daily for two weeks.

We hope you feel a change for the better!

By Joanna Binney