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The Scapula and Thoracic Spine: A Classic Love Story To Improve Your Overhead Position

By Dr. Quinn Henoch | In Mobility | on May 1, 2014

If an athlete is to have a strong, pain free overhead position, the shoulder blade and the upper back must have a healthy relationship.  Like any beautiful couple, if there is disharmony, then problems will arise.  The focus of this article will be working to attain full shoulder elevation with a desirable spinal position and minimal compensations in other areas of the body.

A Love/Hate Relationship

The thoracic spine/ribcage is really the dominant partner in this story, as it is literally the foundation for where the scapula resides.  T-spine and ribcage position dictates the function of the shoulder blade in all upper body movements.  Poor position or movement in the upper back yields poor movement of the shoulder girdle.

So, the question is what is ideal thoracic position and movement and how do we get it?

The Importance of Thoracic… Flexion??

Sounds odd, I know, considering the typical idea that a very upright, extended posture is the secret to life.  It is common to hear from athletes and coaches that if an athlete is having trouble with overhead movements, thoracic extension must be improved. Yes it’s true; there is relative extension that occurs in the upper back as our arms go up in the air.  This is especially the case in extreme positions such as an overhead squat.   However, the more I learn from the Postural Restoration Institute (PRI) about the mechanics of the thorax, the more my approach evolves.

Some athletes just don’t seem to respond to traditional t-spine exercises like sidelying or quadruped rotations, or back-to-wall wall slides, no matter how many reps they perform.  It’s likely that they do not benefit from these drills designed to improve thoracic extension, because they are already STUCK IN EXTENSION.  It’s really hard to achieve a motion that you have already maxed out.  BOMB.

Tspine1

This picture demonstrates the type of thing I see in the clinic.  A lot.  This is an upper back that is stuck straight.  This causes several problems.  1) The natural curves in our spine aid to distribute force and mitigate wear on spinal structures.  A straight spine gets to enjoy more compressive forces.  2) A flat thoracic spine makes for a very poor foundation for the shoulder blades to move on.   The scapular winging and tipping that you see in the picture is what happens when you stick a curved shoulder blade on a flat rib cage.  It ain’t a love story at the point.  Those two aren’t even sharing a bed together anymore.  3) Thoracic rotation will also be restricted because locking down motion in one plane, restricts another.  Many other problems arise as well – such as, poorly leveraged muscular attachments, increased extensor muscular tone, etc.

Resting posture (such as in the above picture) doesn’t always dictate movement dysfunction, but I would guess that this athlete most likely had motion restrictions and poor scapular rhythm when going overhead.  In the past, I probably would have given him some exercises to improve tspine extension and rotation and strengthen his serratus anterior to address the winging; or hammered him with tons of horizontal rows only to further increase extensor tone.  All of those things have their place, but perhaps not always as an initial intervention in this case.

tspine2

The reality is that a relative thoracic kyphosis (roughly 40 degrees) in resting posture is normal and optimal for the initiation of proper scapulo-humeral rhythm.  In the picture above on the left, you see a ribcage that is tipped backwards, extending the tspine before shoulder movement even occurs.  On the right, you see a spine in neutral, where the diaphragm and pelvic floor face each other.  In this position, the upper back will extend as it needs to in order to achieve an overhead position, because it has been given back some slack.

So how do we get back to neutral and regain the ability to move our thoracic spine?

A.   Breathe

Classic.  If you’ve been following Ryan Brown and I at Darkside Strength, you probably saw this one coming.  Fully inflating and deflating your lungs with air is like stretching from the inside out.  Nothing will improve rib and thoracic mobility more effectively than expanding your rib cage 360 degrees over and over.  Nothing will create a better relationship with the upper back and scapula, than expanding your ribcage.  Nothing will free up shoulder impingement at the top of a press or jerk like expanding your apical lung.  Expansion.

This video from Bill Hartman at Indianapolis Fitness and Sports Training (IFAST) is a great demonstration of what rib cage expansion should look like.

Below is the program that puts you on the road to being an overhead superstar – or at the very least, help you clear up some of your nagging shit.

90/90 Breathing

If you’re new to the breathing game, start with the supine 90/90 drill in the next two videos to get the pattern down.

The balloon is an amazing tool used to teach you how to efficiently engage the musculature needed to stabilize the trunk, and to teach you how to create and release pressure voluntarily.  The carry over to breath control under the barbell is phenomenal.  Only catch:  DON’T PINCH OFF THE BALLOON WITH YOUR TEETH OR HANDS.  Stick your tongue to the roof of your mouth in order to maintain pressure.  The arm variations help to further open up the chest wall.  The hip lift/posterior tilt works to inhibit extensor tone in your back.  Use hamstrings for this, and NOT rectus abdominis.

**Key Points**

  • Begin with an exhale to set rib position.
  • Use the minimal, not excessive, amount of oblique contraction to keep lower ribs down during inhale
  • Exhale fully through mouth without clamping down on your rectus abdominis (6 pack muscle).
  • Pause 2-3 seconds before inhaling again.
  • Inhales and exhales should be relatively effortless.  Limit straining.  Relaxed neck.  Expand chest 360 degrees

Quadruped Rockback or Seated With Reach

Now we look to bias some flexion in the upper back, in order to create that congruent platform for our shoulder blades, with drills I’ve picked up from some sharp peeps.


**Key Points**

  • The more you can rock back the better.
  • Remember, you’re exhaling into flexion.
  • Reach and flex, but don’t strain.

tspine3

tspine4

The seated version, if rockback is not possible.  Reeaaachhhhh and rounddddd

Wall Supported Squat with Reach and Balloon

This is an interesting one.  Looks kind of like a pooping dog.  Which is sort of the point.  Exaggerating a position where your pelvic floor and diaphragm are parallel to each other does wonders for the trunk and pelvis in regards to inhibiting extensor tone.  You may not only feel a loosening of the upper back after performing this drill, but your hips flexors may feel looser as well.


**Key Points**

  • The active reaching with the arms activates scapular musculature (such as serratus) further improving the congruency of the scapula to the ribcage.
  • These exercises are truly designed for the whole system.  In fact, a proper overhead shoulder position starts at the PELVIS.
  • Once all of the above is established and performed competently, NOWWW you perform your favorite tspine corrective exercise.  There are tons – sidelying rotations, quadruped rotations, bretzle, etc.  Go to the Darkside Youtube page for several.  The rule is, you have to use your BREATH to increase the ROM.   At least one full inhale and exhale at end range.

2.  Unloaded Active Shoulder Elevation

Now that you have worked to improve thoracic mobility, let’s add some active shoulder elevation to lock it in those improvements and while addressing scapular motion.  One that I use often is the wall slide – facing the wall.  The focus here will be shoulder elevation and scapular upward rotation and elevation around a stable, neutral trunk.


**Key Points**

  • Actively pressing your forearms into the wall as you elevate will help congruency of the shoulder blade to the ribcage.
  • Don’t jam into range you don’t have, or compensate by arching your lower back.  Go to your barrier, take a full breath, and come back down.
  • A slight shrug at the top may help you to clear some range and aide in scapular upward rotation

tspine5

He demonstrates enough thoracic spine extension to hold the weight overhead, but not an excessive amount.  Low back neutral, upper back slightly extended.  Love you Lu

3.  Tissue Lengthening

For some of you, the previous drill may not pose any issues.  You may be able to achieve full shoulder elevation while maintaining a neutral spinal alignment.  If that’s the case, move on to step 4.  For many of you, however, the previous wall drill will yield a substantial decrease in range of motion.   Much of that restriction you may feel in the area of the lat.  Now is a good time to perform a little lengthening soft tissue.  You’ve now used a movement pattern to identify a limitation, instead of arbitrarily stretching everything.  Below is drill that will lengthen, not only the lat, but also the lateral chest wall.


**Key Points**

  • This should be felt along the entire lateral chest wall, from shoulder to near pelvis
  • Use the inhale to improve the stretch and further expand the ribcage
  • Return to the wall slides, and see if range of motion was improved

4.  Loaded Shoulder Elevation

With the above protocol, you’ve improved your breathing pattern, increased thoracic position and mobility, and improved scapular mechanics during shoulder elevation.  With a solid pattern, we can now load movements.  We like to start people in a half kneeling position, because it is easier to keep the lower back neutral.   Here are a couple exercises that will facilitate the desirable amount of upward rotation of the scapula, extension of the thoracic spine, and ultimately help to improve your overhead positions for heavier barbell training.

Half Kneeling Press

Half Kneeling Landmind Press

Program

  1. Supine 90/90 breathing: 60 sec
  2. Supine 90/90 breathing with hip lift, balloon and arm overhead: 4 sets of 4 breaths
  3. Rockback breathing with active elbow reach and roller under ribs (if tolerated):  4 sets of 4 breaths
  4. Favorite thoracic mobility drill:  2 sets of 8 to 10
  5. Lat stretch:  2-3 sets of 30 secs or until a change is made
  6. Wall slides straight forward and scapular plane (make a Y):  1-2 sets of 10 each
  7. Half kneeling press, and/or landmind press:  1-2 sets of 6-10 each

Depending on the amount of sets you do for certain exercises this will take 10-20 minutes.  Give yourself a few weeks to become competent with these drills.  Watch the videos and read the key points over again.  I realize there are A LOT of cues; but they are important, so take your time becoming familiar.  Add this program as a warmup for your heavy overhead days for a few weeks, and track changes.  Add and subtract exercises as you mold your corrective program to what works best for you.  However, the overarching concepts should remain.

If you’re one of the people that’s hammered your T-spine with corrective drills or you’ve experienced nagging shoulder pain that doesn’t seem go away, give these concepts a shot.  Get your shoulder blade and rib cage to love each other again.  Feel free to post comments or questions below.

Thanks to Bill Hartman and IFAST, Postural Restoration Institute, and Liz Messina from MarkFisherFitness for their contribution to this article.

Related Articles: Stabilizing the Scapulae for Overhead Pressing by Dr. Pat Davidson

The Best Damn Squat Mobility Article, Period by Dr. Quinn Henoch

Quinn Henoch has a Doctorate of Physical Therapy from the University of Indianapolis.  He is the head of rehabilitation for Darkside Strength and Core Sports Performance in Louisville, KY.  He also works for the Kentucky Orthopedic Rehab Team managing orthopedic and sports related dysfunction.  Quinn played football at the Div 1-AA level at Valparaiso University as a defensive back.  He has also competed in track and field, Crossfit, and powerlifting.  Currently, he trains full time as an Olympic weightlifter and has qualified for the 2014 American Open, as a 77kg lifter. 
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12 comments
Kevin Gibbs
Kevin Gibbs

Hi. I would love to understand the balloon thing, but I can't get it - how the heck do you blow air with your toung at the top of your mouth? Also, I can't keep the balloon in my mouth without holding on to it with my teeth or hands - how is this done? Thanks.

Tony Book
Tony Book

Really loved this article.  I find so many patients struggle with lifting their rib cage vertically which contributes to numerous postural and movement dysfunctions including cervical curve reversal, excessive lumbar hyperext, poor shoulder/hip diagonal patterning.  I have heard of the PRI, but instead decided to take DNS from the Prague school of Manual Medicine.  I found it not very applicable in the clinic.  What are your thoughts on PRI??

NikosPsara
NikosPsara

Is this also useful for client who have flat thoracic spine at diff rents segment? Example I have a client who has a flat t-spine from t1-t4...

CodyPlofker
CodyPlofker

Loved this article, as well as all of your others Dr. Quinn. I am a weightlifter myself, and after months of neglecting PRI because I wasn't sure how to apply it I am finally diving in. Signed up for myokinematic restoration for home study. It just started to make too much sense to ignore; especially with everybody I look up to in the industry practicing their concepts. 


Salute. 

Elosingelo
Elosingelo

Can we still work on Pull ups and other vertical pulling/pressing exercises? While fixing our overhead position? I have APT and scapula winging

timbo8
timbo8

Do you think these exercises can contribute to fixing anterior pelvic tilt and poor squat form?  A lot of info on stretching hip flexor and activating Glutes but very little mention of upper back.  As an example I have pretty decent hip mobility strong core but my squat forces me into APT.  To do an OHS with an upright torso is at this point impossible.  I just ran through this routine and squatted with freedom I have never felt before.  I am not sure I can contribute it all to this routine because I have put a huge emphasis on hip mobility as well as ankle mobility.  Wondering if this would make sense anatomically. 

Kevin Gibbs
Kevin Gibbs

No problemo, Quinn. I actually tried that multiple times and realized that that's the only real possibility. Anyhow, gotta say that I do like these exercises. I'm currently doing the second 90/90 and the rounding your back thingy.

how many reps should I do and how many times per week? When would it be appropriate to progress to the next ones? Thanks a bunch.

Quinn Henoch
Quinn Henoch

@Kevin Gibbs Sorry that I wasn't very clear about that Kevin.  Your tongue is at the roof of your mouth during the inhale.  When you exhale, the tongue will not be at the roof of your mouth anymore.  You may hold on to the balloon with your hand, you are just not allowed to pinch off the air with your fingers.  Keep the balloon open the entire time.

Gerard MS ATC
Gerard MS ATC

@timbo8 Quinn is on point and I would also stay away from stretching your hip flexors all together, hamstrings too.  Look up postural restoration institute (PRI) pelvic restoration exercises to reposition the hips.  This will put the muscles at the appropriate length and allow for better function.  In addition, as an active person with seemingly advanced but traditional education (like most of us) you have probably blown through your anterior hip ligaments.  Stretching the anterior hips will only put you into more of an anterior translation at the AF joint.  Strengthen the left hamstring, left adductor magnus and left glute med.  strengthen the right glute max (all from isolation exercises) and your everything will improve and prevent injury.  Posterior tilt those hips, breath and get to neutral.. best of luck.  

Quinn Henoch
Quinn Henoch

@timbo8  This can absolutely have an impact on your pelvis.  The ribcage and pelvis are not mutually exclusive.  Although your core may be "strong" in the sense that it can withstand a lot of force, if you are being thrown into anterior pelvic tilt uncontrollably, then your core is out of sync.  The idea is that this routine starts you in the direction of restoring neutrality throughout the axial skeleton and pelvis, and puts the diaphragm and core musculature in a more advantageous position to fire correctly and on time.

Quinn Henoch
Quinn Henoch

@Kevin Gibbs Great to hear you are benefitting from the drills.  Sets and reps just depend on the athlete.  I've prescribed as much as 5 sets of 5 breaths, and as little as 1-2 sets of 5 breaths.  I would recommend starting with more sets initially.  These can be performed as many times a week as you would like.  They are great for before, during, or after workouts.  People also benefit from performing them in the morning when they wake up, or at night before bed.  Progress through these types of drills when they can be performed with minimal effort.  If you feel like you are straining, continue with that drill and work on relaxing the muscles that do not need to be tense - like your neck and upper traps.  

Kevin Gibbs
Kevin Gibbs

@Quinn Henoch  @Kevin Gibbs

Thanks again, Quinn. Sorry for the slow response - hadn't noticed this. 

I've been doing 2x10 and I did notice that I'm straining. But I seem to be able to relax more, so I think I'll try to progress.

If I may ask you a few more questions, I'd be very glad. Firstly, can this be truly fixed or are these moves meant to make it a bit more mobile - e.g. can I actually regain kyphosis?

Secondly, pulling moves seem to hurt me a bit. Especially arched back pull-up. So, any way around this?

Thanks a bunch.

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