When we think about staying flexible and mobile, one area of the body that I focus on with a lot of my patients is the mid-back, or the thoracic spine. This is the part of your spine between the neck and lumbar region, where our ribs are attached. Taking care of this part of your back is more important than you might think—it doesn’t just keep your back happy; it plays a huge role in how well your neck, shoulders, lower back, and hips move as well. When determining what may have caused an injury or area of pain to develop, or when looking at ways to optimize movement for a particular sport or activity, whether the issue is at the thoracic spine itself or an adjacent area, in physiotherapy we usually need to assess how all these parts are connected and move together.
Imagine your body as a well-oiled machine, where each part needs to work smoothly with the others. Your thoracic spine is one of the central gears in this machine. If it’s not moving well, it can throw everything else off. A flexible mid-back means your neck and shoulders can move more freely, and that your lower back doesn’t have to pick up the slack.
The thoracic spine has a few key directions of movement: flexing forwards, extending back, twisting, and bending side to side. Sometimes we may move in a combination of these directions, such as into extension and rotation when we reach back to throw a ball overhead. Each of these movements helps in different activities. For example, if you play golf or tennis, being able to twist your torso well is essential. Gymnasts and swimmers need to bend and move side to side smoothly. In weightlifting, although we often focus on spinal stability and “stiffness,” a lifter also needs to be able to extend the thoracic spine sufficiently enough to allow for full overhead mobility.
Stiffness in the thoracic spine can also affect our ability to expand our ribs as we breathe, and can leave us prone to postural pain and discomfort, or the pain associated with having a ‘rib out’ (note: this is a well-known term for rib or thoracic region pain and discomfort, but the rib isn’t actually out of place when this happens!). Understanding all of these potential relationships between your thoracic spine and the rest of your body helps us to better target your exercises to your goals for recovery or optimizing performance.
Why is the thoracic spine so often a problem area? Consider how many of us spend our days: sitting at a desk or chair and looking into a screen, our spines flexed forward. Even if we stay active with sports, getting outside, or going to the gym several days a week, most of us still spend considerable amounts of time each day sitting with our back rounded forward in a flexed position. If we don’t take the time to maintain our mobility in the other directions—extension, rotation, and side flexion, and combinations of these directions—by moving through our full available range of motion on a regular basis, we gradually lose access to them. As we often hear: if you don’t use it, you lose it.
On the flip side, if your mid-back moves well, it is easier to stand tall and straight (although emotions, energy levels, confidence, and mental presence all play this too), and it allows for more freedom of movement and control throughout the adjacent areas like your shoulders, low back, and hips.
That all said, the relationship between thoracic spine mobility, or the quality of movement in any area, for that matter, still depends on the individual and is highly nuanced. For someone who only wants to sit for most of the day, including during their free time, a stiff thoracic spine may never become an area of concern. If they decide to join a bootcamp fitness class, however, they may find that they struggle more and may have to be careful in progressing things too quickly. For example, the rotator cuff and muscles that help to move and stabilize the scapulae may have to work harder compared to the person with more freedom of movement.
Other times a loss of thoracic mobility may work to someone’s benefit— such as an adaptation to the activity they spend most of their time doing. I once worked with a cello player whose spine had become stiff in a slightly rounded and twisted position, which was the position they sat in while playing their instrument, meaning it required less energy for them to play. It just didn't translate well to their other hobbies, such as lane swimming. The human body is capable of adapting to each of our unique builds and alignments, far more than most of us appreciate, and there are some individuals who perform well despite limited thoracic mobility. As with everything else in physio, the relevance of how one area moves always depends on the person and situation.
Taking that into account, I still believe that most of us can benefit from improving or at least maintaining our existing thoracic mobility, but I am usually reluctant to make posts on my website or social media accounts that advertise “the best” mobility or strengthening exercises for any specific part of the body, including the thoracic spine. What works well for one individual might not work for you depending on where you are starting from with respect to your mobility, your awareness of your body while you move, and what history of pain or injury might be present. The best mobility routines for the thoracic spine are those that are tailored to the individual and instructed with care and attention.
Keeping your mid-back mobile is about so much more than just avoiding back pain. It’s about your body working as a harmonious whole. If you’re exploring ways to improve your thoracic spine mobility on your own, there are lots of resources out there. Remember to start slowly, listen to your body, and work within the limits of mild discomfort. Don't force things to move more than what they're ready for; focusing on quality over quantity and intensity, wins the game here.
If you’re seeking a personalized thoracic spine mobility routine crafted by a movement expert, or if you’re curious about how your thoracic mobility may affect your pain or performance, don’t hesitate to reach out. Book a consultation today, and let’s work together to create a plan tailored to your unique needs, helping you achieve optimal health and performance. Let’s keep your mid-back moving and enhance your overall well-being together.