Two Tips for T-Spine Mobility

In today's world, our thoracic spines get no love.  Here is a lateral view of the spine so that you can see what area I am referencing:

The thoracic spine is our mid-back onto which our rib cages attach.  It is prone towards loss of motion due to our sedentary, desk-bound lives.  In addition to our time spent slouched forward at our desks banging away at our keyboards, we have thrown in our hand-held devices.  Now, when we're commuting home from work, we're reinforcing that forward head, forward shoulder posture often seen when sitting.  Over the course of time, the thoracic spine can get stiff and kyphotic (rounded forward).  I call it "going back into the technological womb.  In utero, we are flexed.  Then, as we develop through our motor milestones, we gain the ability to extend.  Modern life is undoing all that hard work we did as babies and toddlers.

So, why does thoracic spine mobility matter?  As mentioned, our rib cages are attached to the t-spine.  Good mobility in our thoracic spines will help make breathing easier.  Pretty important, right?

Another reason that it's important to maintain good t-spine mobility is to optimize healthy shoulder movement.  Our shoulders are ball-and-socket joints.  Think of a golf ball on a tee.  Optimal health of that glenohumeral (GH) joint and the rotator cuff (four muscles that control how that golf ball rotates on that tee) relies on proper mechanics of the scapula (shoulder blade) as it relates to the rib cage on which it sits.  I tell my patients that their scapulothoracic joints must be mobile yet stable platforms from which to "launch" their ball-and-socket GH motions (flexion/extension, abduction, internal rotation, external rotation, horizontal abduction/adduction).  The scapulothoracic joint is the "core" of the shoulder.  If one cannot move the thoracic spine well, then the scapula will have trouble getting into the ideal positions necessary to maintain healthy GH joints.

Try this experiment to see what I'm talking about.   Stand up and stand tall.  Now, raise your right or left (healthy) arm up overhead as far as possible.  See how far you can raise it by watching yourself in a mirror.  Next, take your arm and reach behind your back as you attempt to touch your opposite shoulder blade.  Ideally you'll be able to reach far enough to at least touch the inferior angle with your finger tips.  Now, try slouching forward at your mid-back and repeat those same two movements.  Was it more challenging?  Did you get as far?  Probably not.  This is an example of how a stiff, kyphotic thoracic spine can negatively impact shoulder movement.

Another reason one should want to maintain thoracic spine mobility is so that your lumber (lower) spine won't have to overwork.  When your body begins to lose mobility in an area where it ought to otherwise have it, then it will simply seek that mobility elsewhere in the kinetic chain.  Your bodies are great at compensating in order to get you from A to B.  It will sacrifice form for function.  However, while it's impossible to declare, "Because you move this way, injury X is bound to happen," it is safe to say that optimizing healthy movement patterns will help reduce your risk of injury.

For you folks out there who are desk bound, who have low back pain, or who are having trouble with your shoulders, please consider addressing your thoracic spine.  It is a big player in a lot of musculoskeletal pain and dysfunction.

Here are two quick and easy drills you can do to help keep your thoracic spines healthy:

FOAM ROLLING THORACIC SPINE

WALL FALLS FOR THORACIC SPINE

Give them a try, and use them in good health.

When Can I Work Out Again?

I don't consider myself to be an overly conservative physical therapist.  It would be easy (and somewhat lazy) for me to simply ask my patients to rest while they heal.  But people come to see me (or other health care providers) because they want to be proactive about expediting their return to pain-free function.

As a physical therapist, I employ modalities and interventions that aim to decrease my patients' pain and restore their motion, motor control, and normal function.  But one of my most important roles is to identify and correct the root of what caused the injury/pain in the first place.  In many cases, the location of pain does not correlate with the cause.  To quote from Thomas Myer's Anatomy Trains, "In a crime, it's the victim that cries out, not the criminal."  What that means is that people can often get to work right away addressing the impairments that may have caused their pain in the first place.  It's an important concept known as "active rest."

Patients always want to know when they can return to their sport/activity/exercise routine.  I totally get that.  I would want a time table too.  But it's impossible to give definitive time lines.  Nobody has a crystal ball to read the future.  One thing that I am always imparting on my patients is to take the long view.  I little bit of activity modification in the short term, while frustrating, will lead to long-term meaningful results.  Remember, this does not mean complete rest!

Patient's who are unwilling to dial back their training volume and/or modify their routines should not be surprised when their injuries continues to flare up.  It's akin to picking at a scab.  Just when your body has laid down scar tissue, you go right back to aggravating it with the same offending activity.  One must recognize that you can't just "push through the pain."  Rather, modification is called for.

This modification can come in many forms.  Here are some examples:

-Complete avoidance of a specific activity (without absolute rest)
-Bracing/taping/strapping
-Decreasing load with resistance training
-Limiting ranges of motion
-Working in different planes of motion
-Decreased training frequency/volume
-Working on other non-painful joint dysfunctions in the kinetic chain
-Making ergonomic changes at work and home
-Use of an assistive device
-Use of modalities such as heat/ice
-Use of anti-inflammatory medications
-Dietary changes to enhance healing

One of the simplest pieces of advice I give on a daily basis is, "If it hurts, stop!"  Pain is a warning sign of a threat either real or perceived.  You would be wise to heed that warning.  In the clinic, I discuss pain as "yellow light discomfort" vs. "red light pain."  The former entails experiencing a low level of discomfort that does not get worse, or even improves, through repetitions of a given exercise.  The latter entails intense pain felt immediately when commencing an exercise or that quickly ramps up through a set.  That "red light pain" is a definite STOP sign.  Ignoring "red light" pain with a "no pain/no gain" approach is not a wise course of action.

So, if you find yourself in pain, don't avoid seeking attention for it out of fear that you'll be asked to completely stop all activity.  You're better off finding out why it occurred in the first place, and then developing an action plan to deal with the cause.  Remember, MOST rehabilitation courses will allow you to take an active role in your recovery rather than that of a couch potato.  The goal is to get yourself moving without pain as quickly as possible.  You just have to be smart and patient about it.