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!
jessephysio 
Excellent knowledge sharing.
These were so helpful! Thank you very much for sharing.
You really make it seem really easy with your presentation but I in finding this matter to be really
one thing that I feel I’d never understand. It kind of
feels too complicated and very large for me.
I’m taking a look ahead for your next put up, I’ll try
to get the dangle of it!
Simple effective assessment and the exercises really caused a reaction in my muscles.
I really have difficulty mobilising this area of my body and I am studying a physical therapy.
It is hard to find a rehabilitation system to accompany my therapy that does not cost a fortune and that is truly effective.Some form of Functional Movement seems to be appropriate. But it also seems easy to saturate clients with Functional Movement.As a therapy, it can be complicated and demanding.Perhaps for the assessment part, Functional Movement is appropriate. What Gray Institute has to offer is perhaps good value for assessments.I have my doubts at the moment though when it comes to rehabilitation. Particularly for Mum and Dad clients. Elite athletes may be a different matter.But how many of those client’s can most of us get? Not many I would suggest.
Gray Cooke I will read him eventually, but I have my doubts there too. You (Jesse) have covered so much ground to get to where you are,(academically), and no doubt as a practicing physiotherapist.
I will read some of your other posts. I hope you may provide me with the answers I need.
Regards ,
Colin Holloway.
I have had thoracic back pain for two years. It seemed to start out of nowhere. I have tried PT, acupuncture, massage,chiropractic, and lidocaine injections and had very little improvement. I have started seeing an osteopath who has been using manipulation for the last six months. While it has helped, my pain persists. It is worst at night. I can barely change sleeping positions as the pain and tightness keep me from moving. Once I get up in the morning and start moving, the pain decreases. I can live with the pain during the day but I just can sleep at night. Any recommendations for sleep positions?