T-Spine Mobility: Why It’s Important
When we consider t-spine mobility, it’s important to remember the average adult spends around 45 minutes a day commuting to and from work. Then we spend up to an incredible 11 hours a day on digital media, including activities like watching TV, surfing the internet on our phones, and working on computers.
We usually do these activities sitting down, rounded through the thoracic spine, which can wreak havoc on our posture and put stress on the rest of the body.
In this collection, we’ll take a look at what some of our authors consider important about t-spine mobility, and what they do to help their clients and patients.
T-Spine Anatomy
As we discovered from Eric Beard (Thoracic Mobility video):
“We have different segments within the spine. But the thoracic spine has different segments as well. That might change how we address these areas with soft tissue techniques or mobilization techniques because the structure itself is different.
“If the structure is different, the function is different. When it comes to flexion and extension, we have a high degree of mobility in the lumbar spine and a high degree of mobility in the cervical spine.
“We have a good amount of lateral bending at the cervical spine—about 70 degrees of lateral bending. But where we run into trouble is, we should get about 45 to 60 degrees of transverse-plane rotation at the thoracic spine. Most people don’t move really well there.
“They don’t rotate very well, and that’s our topic—thoracic mobility, t-spine mobility.
We Make Up The Rotation in The Lumbar Spine
“Most people make that rotation through the lumbar spine. As we stack those segments, the lumbar spine only has about 10 to 12 degrees cumulatively of rotation. If I’m facing front and these are my lumbar vertebrae, this is about 10 degrees of rotation. That’s all we have in the lumbar spine.
“We should be getting about 45 to 60 degrees from the thoracic spine. If we’re closed there and can’t rotate to the thoracic spine, the burden falls down lower in the spine.
“Lo and behold, most of our disc injuries are down at L5-S1 and L4-L5. They are taking up movement lower as compensation for lack of mobility through higher up. Not only are they a different structure, but also a different function.
“What we want to promote is the ability to extend our thoracic spine, but we really want to go after the rotation.”
T-Spine Mobility Affects Shoulder Range of Motion
In Sue Falsone’s Cervical Thoracic Junction video, she tell us how t-spine mobility affects shoulder motion:
“If we have a patient or a client who is missing end range shoulder motion, our tendency is to stretch the shoulder. But often when we’re missing that end range motion, it’s got nothing to do with the glenohumeral joint.
“It’s got nothing to do with the shoulder. It has everything to do with the cervical thoracic junction and our upper t-spine mobility. That’s the area that needs to be addressed.
“As we continue to stretch and overstretch the shoulder, we’re just going to create a hypermobility in this region, never really addressing the hypomobility in this region. When we’re talking about the cervical thoracic junction, it does need to have some relative rigidity in this area.
“I know that seems counterintuitive to everything I just said about mobility, but that’s not the case. It needs to have relative rigidity. That’s what I’m talking about.
“We’re looking for it to be more rigid than the lower cervical spine. It needs to have more rigidity than the lower thoracic spine, and it needs to have more rigidity compared to the scapula as it moves on the thorax.”
Mobility before Stability
Gray Cook always begins with mobility before looking for a stability or strength problem. In What’s Behind a Mobility Problem, he states:
“When you apply the parking brake, you just allocate stiffness in a region. That stiffness can cause you inefficiency. I want you to be completely aware of this. If we attack that stiffness without wondering why it occurred in the first place or what’s behind it, we could be opening up a bigger problem than we currently have.
“Limited mobility keeps us out of movement patterns and keeps us out of certain activities. Restoring that mobility could easily allow those activities to be possible, but do you deserve to have those activities?
“Somehow, nature robbed you of the ability to explore range of motion in your ankle or your thoracic spine or your hips or your shoulders. We can restore that mobility but shouldn’t we first understand why the mobility was lost in the first place?
“It’s very easy to talk about trauma and muscle guarding and fear and pain but how about the mobility problems that are no longer complicated with pain?”
Imbalance of Flexion and Extension
Perry Nickelston considers the t-spine the biggest linchpin in the body. From his Movement Linchpins lecture:
“The thoracic spine is supposed to have a lot of motion in extension and particularly in rotation. When you walk, you’re supposed to rotate in the thoracic spine. Most people don’t rotate in the thoracic spine and then have too much motion that now has to go in the lumbar spine or the hip swing, and then up in the neck.
“There are a huge number of players that come into locking down the thoracic spine. You have the balance between the oblique muscles on each side, the abdominals, the transverse abdominis, the lat and also the quadratus lumborum muscles.
“I’m going to cover the two big players, the Yin and Yang—the spinal erectors that bend us backward and the rectus abdominis muscles that bend us forward, the flexors and extensors. If you have an imbalance in flexion and extension, the body isn’t going to want to move because you’re not stable in the central core. It’s going to lock down the t-spine to make you stable.”
T-Spine Mobility: Planes of Motion
Sue Falsone also recorded a lecture for us on the t-spine and t-spine mobility, where she explains:
“The thoracic spine is oriented in all three planes—in the transverse, the sagittal and the coronal plane. It can do rotation, flexion and extension, as well as side bending. The vertebrae are set up for side bending, but the connection between the rib and the vertebrae blocks that side bending. There isn’t a lot of side bending at the thoracic spine. This is not because the vertebrae cannot handle it, but because of the connection between the rib and the vertebrae.
“Look at rib mobility during breathing, where we have really two different directions. One is a lateral movement, sometimes described as a pump handle. Think about taking a deep breath in—those ribs are moving a little bit laterally. They are moving really anterior-posteriorly, like a pump handle.
“Now take in a deep breath, and the rib is going to elevate itself up and back down. These ribs need to have mobility to them. They need to be able to spin, and the connection at the costotransverse and the costovertebral joints needs to have a little bit of mobility.
“Basically, the rib spins within those joints in order to create some mobility as we breathe. That happens in the anterior posterior direction and that happens in the lateral direction.
Bucket Handle Movements
“Consider the lower ribs—these are what we call bucket handle movements. Think of a bucket with two handles. That’s exactly what happens as we take in a deep breath. The ribs really need to move anterior and posterior as well as laterally. These ribs need to have a lot of mobility as we’re breathing, and this is going to affect the mobility between the rib and the vertebrae. This is going to affect how one vertebrae of the thoracic spine is moving on the other.
“Rib mobility is really important to general thoracic mobility as well.”
Stability Is Important Too
While most of us understand the need for t-spine mobility, Evan Osar is also a big fan of stability in the thoracic region.
“We’re discussing having an efficient thoracic stabilization strategy. We are defining this as using the optimal amount of effort required to achieve a functional goal, while minimizing the stress placed on the soft tissue and bony structures.
“Is your client able to use the right muscles at the right time to stabilize the thorax in an optimal manner required to accomplish the functional task while placing the least amount of stress upon the soft tissue, bony and joint structures?
“To illustrate this definition of an individual’s strategy, let’s compare the strategy of performing a barbell squat versus the bodyweight squat. What would your client need to do to stabilize the thorax prior to the lift to establish the optimal thoracic stabilization required to efficiently lift the weight without incurring any soft tissue or joint injury?
“First, they want to ensure the thorax is properly aligned over the pelvis. Next, they’ll activate the core and breathe into the abdominal cavity to ensure optimal intra-abdominal pressure. Finally, they’ll position themselves under the bar, un-rack the bar, set up and perform the lift.
“This is a high-level activity requiring a high level of bracing strategy.
Different Strategies, Same Mechanics
“Let’s compare this strategy to a bodyweight squat. Similar to the support squat, the client will ensure the thorax is properly aligned over the pelvis. They’ll breathe three-dimensionally and maintain this three-dimensional breathing throughout the squat pattern. They’ll position their legs in the appropriate position and begin squatting.
“What’s the difference? The bodyweight squat is a relatively low-level activity for most people, and the strategy will be different than the one they use for a high-level strategy—in this case, the barbell squat. The client doesn’t have to perform the same pre-activation bracing to support the spine or over-contracted gluteals at the top of the pattern.
“In the bodyweight pattern, the focus is on grooving the pattern and guaranteeing the client can complete the task using as little effort as possible. It’s the same mechanics, but a different strategy. We must help our clients use an appropriate strategy for the task at hand in order to develop efficient movement patterns.”
Tension in The Upper Quarter
Sue also covered the cervical-thoracic junction in a lecture, in this section talking about tension, saying:
“From a prime-mover standpoint, we have the sternocleidomastoid in this region. We have the scalenes. We have the trapezius, the levator scapula, the rhomboid major and minor, the serratus posterior, not to mention the intercostals. I’m sure I’m forgetting one or two in there. There are a lot of muscles that are in and around this area. This is an area where the patients and the clients come to us complaining of a lot of tension.
“What is tension? Tension is really a misinterpretation of movement. Eric Franklin talks a lot about how tension is really a misinterpretation of movement. It comes about when the physical system is geared to move, but nothing is happening. We’re prepared to move. We want to move. the physical system is ready to go, yet nothing is happening.
“Tension gets created and built up in these muscles.
“There’s also an emotional aspect of tension, especially in this upper quarter. We start to get anxious. Then we get frustrated. Next we get tired. That whole area creates tension as we’re trying to figure out how to become less stressed. How do we combat the situation that’s facing us? Tension is occurring in that area.
“That misinterpretation of what’s about to happen is creating that tension.
As Dan John Reminds Us, The Body Is One Piece
“The other thing that creates tension in this region is the body likes homeostasis. And it will do just about anything it can to continue to go into a homeostatic balanced state. Think about the anatomy from the tongue, the esophagus, all the way down into the stomach, into the duodenum, into the large intestines and small intestines, the rectum. All of this entire tube is just one big, long tube; there are no breaks in it.
“How many of our clients or patients have a flaccid stomach? We’re constantly working on core stability and core stabilization exercises and abdominal work. We try to get people to improve the center of mass to improve the stability and control of the center of mass in that region. If that area is flaccid, the opposite area is going to have more tension in an effort to create homeostasis.
“When the lower part of this tube is more flaccid, the upper part of this tube, including the gut and the esophagus right up through the tongue, are going to have more tension. This can be associated with stomach GERD. It can be associated with hiatal hernia-type stuff.
“It can be associated with all the internal things we really don’t take into account. But if you start to look at the body as a whole, all of these things are going together. They’re happening together.
People Who Are Stressed Have Problems Here
“We see this pattern often. People who are very stressed, who have a lot of tension in this area, who have a lot of headaches and a lot of issues, they also have hiatal hernias. They have trouble digesting, and have gastric reflux. There are all these other things going on with them—not all the time, but quite often.
“As we’re looking at our training programs, so many of us are already focused on core stability, control of the center of mass and center of gravity. That’s a huge part of the programs. If we continue to give some stability to that area, the cervical thoracic region is going to relax. It’s going to have a decrease in tension.
“That increase in tension at the cervical thoracic region is happening because the body is trying to make up for something. The body is always going to find a way to get things done. If it needs a central point of stability in order to move, if it’s not happening at the center of mass down in the lumbar spine, where is it going to go? It’s going to go up to the cervical thoracic junction and try to make that the pivot point and the center point for movement.
“Tons of tension is created and along with it a lot of pain.”
Bruegger’s Maneuver
Jeff Tucker talks a lot about the t-spine too. Here’s an interesting bit many of us may not be familiar with:
“I like to introduce the Bruegger’s Advice to patients who have thoracic spine issues. Bruegger’s advice or Bruegger’s maneuver means to sit at the edge of a chair, abduct and slightly externally rotate your legs.
“Allow your abdomen to just protrude and then push your sternum forward and up. Tuck your chin slightly. Externally rotate your shoulders, so your hands are with the palms forward. Feel the pelvis rolling forward and the lumbar spine lordosing. This is a really good resting posture.
“You can do the same maneuver with Therabands. Google the Bruegger’s maneuver with a Theraband. This is one of my favorites. I prescribe this many times throughout the day. It’s a self-stretch, self-mobilization of the thoracic spine, and a nice micro break.”
Breathing and T-Spine Mobility
Mark Cheng works on breath a lot too, especially for t-spine mobility as well as increased extension to offset what he calls the ‘seated death’ of flexion in our modern life.
“Breathing is the only vital process we can voluntarily control. Because of that, it’s amazing how people don’t appreciate breath in terms of its importance, especially in core functionality. When we work on breath control in how we breathe, it re-trains the ceiling and the floor of the core, which are both diaphragms.
“Not only is it the diaphragm that sits underneath the lungs, but also the bottom diaphragm—the pelvic floor.
“The pelvic floor is crucial because everything neighboring or attached to it shares some fascial connection. It shares not only the areas of the lower back and hips, but also the quads through the upper leg, as well as the knees and all the way up into the ribs.
“It’s important how we train and optimize the pelvic floor, not only in terms of its importance with bowel functioning, but much more. Whether the pelvic floor is hypertonic or hypotonic—meaning a pelvic floor that can’t contract enough—both are problematic.”
Thoracic Limitations Affect the FMS Shoulder Test
Sue Falsone also talks about t-spine mobility in her shoulder video:
“Say we have a female athlete who scores a ‘1’ or a ‘2’ on the Functional Movement Screen and cannot get the hands to touch behind the back. We need to compare that to the range of motion when lying down.
“Then we lay her on her back and look at her range of motion. She’s got normal external rotation and normal internal rotation on the table. Yet maybe she has a ‘1’ or a ‘2’ or a major asymmetry in her shoulder mobility test. That tells us something.
“When she has normal rotation on the table, but a poor shoulder mobility test on the FMS, it has nothing to do with the glenohumeral joint. It has to do with thoracic rotation and thoracic limitations, lack of t-spine mobility.”
Not enough t-spine snippets? Check out more of our articles related to the thoracic region.
- Eric Beard: Thoracic Spine Impairment and Dysfunction
- Evan Osar: Forward Shoulder Posture and Scapular Retraction Exercises
- Sue Falsone: Cervical Thoracic Anatomy
- Eric Beard: Thoracic Spine Disassociation