Thoracic Mobility

Part 3: Corrective Exercises

There are tons of ways to address thoracic mobility or stability, and below are just a handful of options that I have come into contact with. Don’t try to use all of them every day -- instead try a few of them and find out what works for you and/or your clients/patients. One corrective might work great for a certain individual, but might not do anything for the next person. Look for improvements, and if they are not occurring try something else.

Mobility Correctives

I will list these exercises from what I feel are the most basic to what are more advanced variations. With all mobility correctives the hip will be flexed to or above 90 degrees on the side to which rotation is occurring, and with some exercises both hips will be flexed. Once again, this locks the lumbar spine into position so movement must come from the thoracic spine. A packed neck is an important part of all these exercises. This is also called a “chin tuck,” and in specific terms is a combination of cervical extension with capital flexion. If you are unfamiliar with this movement check out this article: http://charlieweingroff.com/2010/11/packing-in-the-neck/. Breathing must also be addressed. Don’t hold your breath during these exercises: relax and try to use deep diaphragmatic breathing. Movement proficiency can be demonstrated by attempting to cycle a deep breath at the end ranges of rotation with these exercises. If you are unable to hold the end position while cycling a breath, there is still some work to be done.

These first two primarily address thoracic extension limitations and are great for improving posture.

"Peanut" Crunches

This drill uses two tennis balls taped together making a “peanut”. Start by finding your bottom set of ribs, then place the ball just above that so one half rests on either side of the spine. Use a small mini-crunch movement and return your head to the floor after every mini-crunch. Hands should come forward at a 45 degree angle. Perform around 5 or so crunches, and then slide down about a half roll and work your way up to about the level of your shoulders. Stay out of the cervical and lumbar areas; this is not what is trying to be targeted.

Roller Crunches

This is a similar exercise to the peanut crunch if all you have is a roller. I like using the peanut better, though, as many people tend to use too much lumbar extension when performing this drill. You must concentrate on getting the motion from the thoracic spine while keeping the lower back stable.

        The next series of corrective exercises are performed in the side-lying position. This position minimizes stability requirements as gravity does much of the work to drive the rotation. Leg position can be varied in any of these drills as long as the hip is on the side to which rotation is occuring is flexed above 90 degrees. In addition the bottom arm can be place straight out, overhead, or used to hold the top knee in place. The first time the exercise is performed, gently placing your hands on the shoulder and guiding the patient/client through the movement is a great teaching tool. The PNF principle of Oral-Facial drivers can be used as cues. The eyes should drive the movement, cue this by telling the patient/client to "look into your ear." Also, cue them to push the tongue into the side of their cheeck toward the side of rotation. This may seem strange at first, by give it a try -- it works. Cue also to "exhale as you turn" to get more motion.

Rib Roll

Grab around your ribcage and attempt to pull your ribs up and over as you rotate.

The next two exercises should be used in cases where the client/patient also has deficits in glenohumeral external rotation. That is where the Active Extension Rotation (ER) assessment was limited and the Active Extension Rotation (IR) assessment was normal.  The thoracic rotation should drive the scapular retraction and depression, which in turn should drive glenohumeral external rotation. The eyes and the head should follow the hand with both drills as well.

Side-Lying Extension Rotation

This exercise uses the PNF priciples of diagonal  movement patterns crossing the midline of the body. 

Side-Lying Windmill

Kettlebell Variations

Here are a couple of unique kettelbell drills from Joe Bonyai -- make sure you check out the corresponding article for these drills at http://empower-ade.com/2011/06/kettlebell-exercises-that-i-do-not-use/.

These next two are seated exercises requiring a mix of stability and mobilty in order to complete. The chair might work better for a lot of people if just getting into the cross-legged position provides too much of a challenge for them, or if they belong to the older population.

Seated Rotation

Seated Rotation - Lateral Flexion

The following exercises use the quadruped position requiring a mix of mobilty and stabilty as the movement becomes resisted by gravity. The first takes the shoulder complex out of the picture, and the second adds it in to make the exercise slightly more involved. There are a couple of cool PNF tricks to try with these exercises that will help the person get some extra rotation if they are struggling with the movement. The first would be to just put a foam roller or ball between the knees and have the patient/client squeeze the ball as the exercise is performed. The second would be to have them make sure the bottom hand is flat on the ground, fingers sligtly spread, and then for them to squeeze their fingers together and resist you as the movement is performed. Both of these use the PNF principle of irradition through which resistance in one stronger pattern of the body promotes overflow to a weaker pattern.

Quadruped Extension-Rotation w/ Internal Rotation

Quadruped Extension-Rotation w/ External Rotation

Bent Over T-Spine Rotation

I like this drill because you also get some extra static work to reinforce the hip hinge pattern.

These last four exercises challenge stability and should be used once improved mobility is demonstrated. They are performed in the developmental sequence from quadruped, to half-kneeling, to lunging, to standing; each requires slighly greater degrees of stability to successfully complete.

Quadruped Diagonals (Bird Dog)

Mike gives a great description of the Birddog in this video.

Half Kneeling with Trunk Rotation

In this position, make sure the shoulder, hip, and knee are in vertical alignment, the back foot's toes are tucked under, and the chin is tucked. Try to stay nice and tall while performing the exercise.

Walking Lunge with Trunk Rotation

Hands may be positioned behind head or reaching overhead. Be careful not to take too big a forward step so that the knee remains directly under the shoulder and hip. Cue to keep the hips motionless during the rotation.

Single-Arm Row with Trunk Rotation

Squat stance, split stance

Stand facing a cable column or band in a 1/4-1/2 squat stance or split stance with knees slightly bent. With one arm, pull the band/cable back into the side while turning the head, eyes, and shoulders. While pulling the band/cable to the right, turn to the right, and vice versa. The shoulder blade should be pulled back and down. Make sure rotation comes through the thoracic spine while keeping the lower half stable.