Research Commentary: Thoracic Spine Interventions

Do you spend the majority of your time sitting around? Does your upper or mid back often feel stiff throughout the day? A stiff thoracic spine can contribute to other dysfunctions in adjacent regions including neck, shoulder, lower back, hip, and so on. Our bodies are like a chain, where each link represents our joints and different segments. One weak link will lead to excess stress and/or forces on other areas, which can increase the risk for injuries or pain. The thoracic spine is one of the most critical components of the kinetic chain. Issues in this region can not only affect your posture and movement, but also your breathing! But how do we know this?  Is there research supporting it and what’s the best way to intervene? 

After a brief search we discovered the concept of regional interdependence (how one area of the body can affect another) is prevalent, but thoracic spine exercise prescription in clinical practice, especially for athletes was not. After multiple searches through different databases, it was concluded that there is a multitude of exercises and manual interventions being used today.  Various techniques include thoracic spine joint mobilizations, manipulations, and range of motion exercises addressing postural limitations are used in clinical practice to address thoracic spine dysfunction. However, there’s limited-to-poor evidence investigating thoracic spine exercise prescription including the four spinal ability dimensions of mobility, motor control, work capacity, and strength.  Heneghan et al (2020), provided a systematic review and narrative synthesis to develop a clinical framework for thoracic exercises used in practice with an appraisal to the four spinal ability dimensions. Exercises consisted of “static and dynamic spinal displacement classified according to their parameters of function or nonfunction; segmental; pillar or whole body; dissociation or stabilization” (Heneghan, 2020). While further research is still needed to evaluate the validity, reliability, and effectiveness of exercise outcomes; we can say there is a basis for continuing to investigate and address thoracic mobility issues.  As evidence-based professionals, lack of evidence on thoracic spine exercise leaves us to rely on our peers, our professional body, and patient outcomes until a more in-depth research body is developed. 

Reference: 

Heneghan, N., Lokhaaug, S., Tyros, I., Longvastol, S., Rushton, A. (2020). Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ Open Sport & Exercise Medicine, 2020;6:e000713. DOI:10.1136/ bmjsem-2019-000713

Co-written by Student PT: Caroline Castro