Thoracic Spine Mobility: Evaluation

by Dr. Brock Vosberg on June 19, 2014

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Continuing our series of blog posts on “Breaking Down the Squat,” we now look at key deficits that are preventing us from performing a proper squat. We will be showing you some of the functional screens we use in our clinic, and how they aid in the evaluation process. Dr. Nate and I were always taught to identify the “Texas-sized findings” during these types of screens. The Texas-sized finding for this blog is looking at a lack of thoracic mobility and how we would decide which areas would require more attention clinically.

First off, why do we need thoracic mobility? One of the biggest benefits of proper thoracic mobility would be joint load sharing. If you are not getting adequate motion through the thoracic spine, your body will still try to get through the desired motion and you will likely compensate through the lumbar or cervical spine. A great functional starting point for screening out decreased thoracic mobility is the Wall Angel.

The Wall Angel is performed by leaning the patient against a wall with their heels about 6 inches out. They attempt to keep their head and arms against the wall. The arms are held in a “U” shape as pictured below. The patient is then instructed to pretend like their hands are nailed to the wall as they bend their knees and slide down the wall. A pretty simple functional screen to administer, but it provides a ton of information.

Starting position: Head, hands, arms, and back against wall.                                                                                   Starting position: Head, hands, arms, and back against wall.

 

We dissect what dysfunctional movement may occur using this screen from the top on down. First, looking at head position. Is the patient able to keep their head affixed to the wall as they slide, or does it jut forward? A head that juts forward is one that is likely unable to extend through the upper back. Next, are the hands and shoulders rolled off the wall? This observational cue points toward a patient that is more rounded forward in posture. This may be do to an inability to extend through the thoracic spine, tight chest musculature pulling the shoulder forward, or a combination of both. Finally, the last stop on this functional train is lumbar spine or low back position. Can the patient keep their lumbar spine flat against the wall? In cases with a decrease in thoracic extension it looks like you could fit the struggle bus between the pat

ient’s low back and the wall. The lumbar spine is quick to compensate for a hypomobile thoracic spine. By arching through the low back you obtain “pseudo thoracic extension.” This presentation in reality usually needs lumbar spine stability and thoracic spine mobility, but that is a discussion for another day.

Fail: Hyperextension the the lumbar spine. Make way for the struggle bus!                                                                               Fail: Hyperextension the the lumbar spine.

 

The evaluation for thoracic spine mobility is fairly simple. In our clinic we observe functional movements to gauge how patients are moving in their day to day lives and it provides a dynamic look at their biomechanics.

Fail: Hands and head coming off the wall.                                                                                         Fail: Hands and head coming off the wall.

 

This in turn gives us clinical leverage from a treatment prospective ultimately leading to better and more efficient outcomes for the patient. We will be covering treatment strategies in our next blog, “Thoracic Mobility Treatment and Exercises.”

HOW THORACIC EXTENSION EFFECTS THE SQUAT:

Looking back at “Breaking Down the Squat: Mobility Issues Part II,” we need to evaluate how thoracic spine extension would effect the squat. One of the first things you would notice with limited thoracic mobility would be a high bar carry on the back. Another common compensation would be a large forward lean during the descending phase of the squat. If you see the latter during a squat your next evaluation step is to perform the Wall Angel. If the Wall Angel is successfully performed, thoracic mobility is adequate and other evaluations (which will be covered in later posts) should be performed to find the true culprit. Until next time, remember to work hard, play harder and expect more when it comes to your fitness and healthcare.

Disclaimer: Remember that this series should only serve as an adjunct to your healthcare professionals examination. We are are not your doctors and have not examined you; therefore,  the above should not serve as medical advice. Please do not hold us liable for taking our advice as we have just advised you not to.

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