Research as shown that manipulation to the thoracic spine can be beneficial for neck and shoulder pain (see articles HERE an HERE). So it only stands to reason that improving mobility at this crucial area of the spine can be helpful for a large group of orthopaedic complaints. Neurophysiological rational aside, getting more ROM through the thoracic spine has impact on areas upstream and downstream the body. If we look at the joint by joint approach, we see that the the cervical and lumbar spine are primarily designated areas of stability (sort of…), and the thoracic spine is the mobile area of the spine (again, kind of…). If we develop stiffness in the upper back, common sense tells that the areas above and below will have to compensate to achieve functional ROM. This is why so many people who drive a lot get neck pain…if you’re torquing out your neck to look at your blind spot because you can’t rotate through your upper back you will get neck pain.
I will be honest in saying that 99% of the people I treat will have their upper back mobility assessed via the SFMA model to some degree. Plantar fascists, PFPS, carpal tunnel…they all get their spinal mobility looked at. I may not always address it right away but it will be looked at. I just think it’s good clinical practice to get an overall sense of how someone moves and try to find non-painful dysfunctions before I jump into treating the painful area (yes, I treat the site of pain…and so should you!)
Here is a BRIEF video explaining how I assess upper back ROM using an SFMA framework.
For clients who have persistent lower back, neck or shoulder problems I usually send them home with at least one of these 3 exercises depending on what I find as being the biggest problem and what the patient can effectively do on their own. These are exercises that help maintain the gains made in therapy and for the most part, clients actually report the exercises “feel good” to do…which helps with compliance.
1) Open Books
2) Quadruped (on all 4′s) thoracic rotations with variations
3) Foam Roller Thoracic Extensions
I’m always looking for better and easier exercises that patients will like doing and that will help them with their chief complaint. I have had success with these 3 and hope to learn many more as time goes on. I hope these help you in your clinical practice. Please share what upper back exercises you like giving your clients as the best way to learn is through sharing knowledge.
Thanks for reading!