Many of the overhead athletes, including rock climbers and surfers, who come to Sea to Summit Physical Therapy in Boulder, Colorado, are seeking treatment for shoulder or low back pain. While investigating root causes for these concerns, a common theme arises: a lack of thoracic mobility.
The thoracic spine consists of the 12 vertebrate (T1 to T12) to which the ribs attach.1 This structure protects the lung and heart and also serves as the kinetic center for many of the movements required for overhead sports: reaching, twisting, bending (back/front/side), and even breathing! Indeed, the thoracic spine provides articulation for the scapula and its stabilizing muscles as well as for the intercostal muscles and the erector spine muscles. Movement of the diaphragm (which attaches to the ribs) during breathing is accompanied by thoracic extension.2
If the thoracic spine does not move enough (is hypomobile), it can affect the overhead athlete in several ways. The athlete may have decreased shoulder mobility due to altered positioning of the scapula, or decreased shoulder stability due to imbalance in the shoulder girdle muscles – both of these situations may lead to shoulder pain and tendinopathies.3
Decreased thoracic spine mobility can also affect the athlete’s low back and lower extremities. Imagine the climber with limited overhead reach secondary to thoracic hypomobility: that climber will obtain the necessary extension movement elsewhere; often from the lumbar spine. This pattern is seen in all sports that require reaching or twisting – if the thoracic spine is lacking, the forces will we transferred up to the shoulder and neck or down to the low back and even the hip, knee, and ankle.
Physical therapy manual therapy and exercises interventions are frequently used to improve thoracic mobility, decrease pain, and decrease risk of injury to other body parts. Some common thoracic mobility exercises include thoracic extension on foam roller and sidelying thoracic rotation.4 These can be progressed to different positions and with resistance in order to better achieve sport-specific mobility needs.
These recommendations do not replace medical consultation and advice from a qualified practitioner. If you are experiencing a shoulder or spine injury or would like to learn more about improving your thoracic spine mobility, you may benefit from individualized physical therapy with Dr. Sarah Burkhardt.
or email sarah@seatosummitpt.com with any questions!
- Menzer, Heather MD; Gill, G. Keith MD; Paterson, Andrew MD. Thoracic Spine Sports-Related Injuries. Current Sports Medicine Reports 14(1):p 34-40, January 2015. | DOI: 10.1249/JSR.0000000000000117 ↩︎
- Jung SH, Hwang UJ, Ahn SH, Kim JH, Kwon OY. Does mobilisation of the thoracic spine using mechanical massage affect diaphragmatic excursion in individuals with thoracic hyperkyphosis?. J Back Musculoskelet Rehabil. 2022;35(3):517-523. doi:10.3233/BMR-210143 ↩︎
- Ruiz, Jeffrey PT, DPT, OCS, SCS; Feigenbaum, Luis PT, DPT, ATC; Best, Thomas M. MD, PhD, FACSM. The Thoracic Spine in the Overhead Athlete. Current Sports Medicine Reports 19(1):p 11-16, January 2020. | DOI: 10.1249/JSR.0000000000000671 ↩︎
- Heneghan NR, Lokhaug SM, Tyros I, Longvastøl S, Rushton A. Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ Open Sport Exerc Med. 2020;6(1):e000713. Published 2020 Mar 29. doi:10.1136/bmjsem-2019-000713 ↩︎