Clinical reasoning framework for thoracic spine exercise prescription in sport

  1. As the link between the lumbar and cervical regions, the thoracic spine is a critical component of the kinetic chain during sport. However, it is not well studied in the scientific literature.
  2. This systematic review searched the available literature as well as social media to create a compendium of thoracic spine exercises for athletes. The authors categorized the exercises based on four intended adaptations: mobility, motor control, work capacity, and strength.
  3. The search resulted in a list of 38 thoracic spine exercises. The list, including intended adaptation and additional commentary, can be found in the full text of this paper (freely available).

BACKGROUND AND OBJECTIVE

The thoracic spine is a critical component of
the kinetic chain during sport. It serves as the link between the lumbar and cervical regions as well as the connection to the upper extremity. It also provides the majority of rotational range of motion through the trunk. However, compared to the lumbar and cervical regions, the thoracic spine has received less attention in the scientific literature. A previous study classified spinal exercises based on four intended adaptations: mobility (i.e. range of motion), motor control (i.e. stability), work capacity (i.e. muscular endurance), and strength (i.e. force production capacity) (1). The purpose of this systematic review was to create a compendium of thoracic spine exercises for athletes and categorize
the exercises based on the four intended adaptations.

back’, ‘upper back’, etc. For each exercise that they identified, they categorized it as either
a mobility, motor control, work capacity, or strength exercise. Within those categories, they also differentiated between static and dynamic exercises as well as weight-bearing and partial weight-bearing exercises.

RESULTS

The search resulted in a total of 38 exercises (18 from the scientific literature, 18 from YouTube, and 2 from Facebook). The number of exercises per adaptation was 9 (mobility), 7 (motor control), 15 (work capacity), and 7 (strength) (see Table 1).

The intended adaptations and descriptions of all 38 exercises are freely available in the full text of this paper. The overall level of evidence was deemed low quality as a result of being derived mostly from expert opinion. Several of the exercises are demonstrated in the video.

The thoracic spine provides the majority of rotational range of motion through the trunk.

METHODS

The authors searched several databases as well as social media for exercises that target the thoracic spine in adult athletes. Search terms included ‘thoracic spine’, ‘t-spine’, ‘mid

Proper function of the thoracic spine is likely important
for overall spine and upper extremity performance.

Table 1 – Thoracic Spine Exercises by Adaptation

LIMITATIONS

In addition to the usual databases (PubMed, Google Scholar, etc), the authors expanded their search to include social media, which generally is not considered a trustworthy source of evidence. However, the authors chose this strategy for
two reasons. First, there is a lack of information on thoracic spine exercise prescription in the scientific literature. Second, including social media may better represent the breadth of exercises practitioners use in the field. Despite their efforts, the authors did acknowledge that their exercise list is not exhaustive.

CLINICAL IMPLICATIONS

According to the theory of regional interdependence (2), proper function of the thoracic spine is important for overall spine and upper extremity performance. This systematic review produced a useful compendium of exercises targeting the thoracic spine. This resource includes the intended adaptation for each exercise (mobility, motor control, work capacity, or strength) as well as additional descriptions and commentary for each exercise. Practitioners should refer to this adaptation- based list to prescribe thoracic spine exercises.

While the included exercises are ostensibly thoracic spine exercises, they do not necessarily target the thoracic spine in isolation. Inevitably, the lumbar and cervical spines will be involved to a greater or lesser extent depending on the exercise. For some exercises, as athletes improve their kinesthetic awareness, they may be able
to better target the thoracic region. Many of the included exercises involve the upper extremity

+ Study reference

(to create a longer lever arm) and/or kneeling postures (to limit motion of the lumbar spine).
As such, some exercises may be contraindicated for certain patient populations (e.g. early-stage upper extremity rehabilitation). In addition, given the limited scientific evidence, practitioners should be aware that the effectiveness of these thoracic spine exercises for rehabilitation and injury prevention is largely unknown.

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