Thoracic Mobilty

Part 2: How to Measure and Quantify It

                There are several different ways to check and see if thoracic mobility is adequate and symetrical. In most cases it will be quantified by a rotation-extension assessment. Testing the motions unilaterally in this manner allows the identification of side-to-side asymmetries. Asymmetries can be due to structural or functional factors or a combination of the two and are a predisposing risk for injury. Structural factors causing assymetry, such as scoliosis, are less likely to be affected by corrective exercise interventions than functional factors. However, if these two factors coexsit, corrective exercise can play an important part against preventing further structural decline. Normal thoracic rotation should be roughly 45-50 degrees.

                A quick and easy way to assess thoracic rotation that can be used almost anywhere and if you are by yourself is the Seated Rotation assessment as described in Gray Cook’s Athletic Body in Balance. As demonstrated in the video below, with this test you simply sit facing a doorway with your back straight and rotate to either side. A passing grade is given if the dowel touches the wall, remains in contact with the chest, and the spine remains straight and upright. If there is any pain with the movement, no grade is given for the test and a medical professional should be consulted.

                This simple self assessment can show whether or not thoracic motion is limited, and corrective exercises can be based on this finding alone to address the limitations. However, there are several other slightly more involved assessments for the exercise or rehabilitation specialist used to narrow down what exactly is limiting the motion. The Selective Functional Movement Assessment (SFMA) uses a system that basically uses a series of breakouts to narrow the issue down into either a mobility or stability/motor control problem. A mobility problem can be caused by an tissue extensibility dysfunction (TED) or a joint mobility dysfunction (JMD). TEDs look at multiarticulate muscles (muscles crossing more than one joint) and could include active or passive insufficiency, neural or fascial tension, trigger points, scar tissue, hypertrophy, and muscle shortenining. Examples of JMDs would be dislocation or subluxation, fusion, adhesive capsulitis, osteoarthritis, and muscle spasm or guarding.  The limitation could also be caused by stability or motor control problem which means that the motion is there but the stabilization necessary to perform it actively is compromised somewhere. A stability/motor control problem takes into account proprioception, coordination, the central and peripheral nervous system, joint and postural alignment, and stabilizer strength measures.

                With all of the following assessments, as well as most of the exercises for improving thoracic mobility, the hips will be maintained at an angle equal to or greater that 90 degrees. This motion locks out the lumbar spine and ensures most of the movement is coming from the thoracic spine. If pain is noted with any of the following tests seek the help of a medical professional. Only after the pain is gone can movement patterns be improved as pain changes everything. There is no way of knowing whether or not the pain is causing the movement problem or the movement problem is causing the pain, it is a dead end until the pain is addressed.

The first assessment to be performed is termed the Lumbar-Locked Active Extension/Rotation(External Rotation) . Have the patient/client get into the quadruped position on a treatment table and sit back butt to heels. One hand is placed behind the head while the opposite forearm is place on the table. Have to individual rotate as far as they can toward the arm behind their head while maintaining the position of the legs and hips. Tell the client/patient to attempt to get their elbow pointing toward the ceiling. Repeat to the other side and compare. The angle of the top shoulder should reach at least 50 degrees relative to the table, and the elbow should be clear of the chest.

                If the previous test is limited, perform it again except this time have the patient put the top hand behind the lower back. This test is called Lumbar-Locked Active Extension Rotation (Internal Rotation). Repeat on each side and compare. Again an angle of 50 degrees relative to the table should be reached. If this test is still limited, next perform Lumbar- Locked Passive Extension/Rotation (Internal Rotation). To do this have the patient in the same position with one hand behind the back in internal rotation and the opposite forearm resting on the table. Have the patient relax and then passively rotate the patient’s top shoulder up and back to the limit of rotation.  The angle should reach 50 degrees. Repeat on the other side and compare.

                The Active Extension/Rotation(External Rotation) where the hand was behind the head presents a challenge to the shoulder girdle as well as the thoracic spine. If this movement was limited and when the client performed the Active Extension Rotation (Internal Rotation) where the hand was behind the back, it was normal, assume thoracic spine mobility is adequate and there is a problem in the shoulder girdle that needs to be addressed. If the Passive Extension/Rotation (Internal Rotation) was normal and the Active Extension Rotation (Internal Rotation) was limited, assume there is a stability or motor control problem. If the passive test is limited the limitation is due to rotational tissue extensibility or joint mobility problem.

                Now that the limitation has been narrowed down to either a stability/motor control or mobility problem we can give specific corrective exercises based on either category. In part 3 I will get to the fun part give a number of corrective exercises for each category as well as some tips get the most bang for your back from each of them.