The Stubborn Thoracic!!

Now I know we’ve all come across a stubborn thoracic spine before. I’m not a big one for worrying about posture.  However, sometimes it’s pretty clear even when static that you have a battle with a  stubborn thoracic spine on your hands!

Though occasionally you get one that is stiff and very straight. It is much more common to see them stiff and stuck in flexion. For now we won’t worry about what injury/pain condition is present, we’ll just look at the stubborn thoracic.

Why is a Stubborn Thoracic So Common?

Why they get so stiff and stubborn is interesting. I guess things get stiff for a lot of reasons. Maybe because of lack of use? Maybe because of too much of one type of use? I always thought it was because gravity pulls us into flexion and never gives up!!

Stiff joints, changes in soft tissues, adaptive response? Whatever the reason, we need strategies to combat a stubborn thoracic.

The Physical Side of a Stubborn Thoracic

I’ve written a few times on my strategies here. I love using type I and type II motion of the thoracic. It’s a great strategy and for the vast majority of people will free up some range in the most stubborn thoracic.  The strategy is basically to combine frontal and transverse plane motions in different ways. Type I motion being frontal and transverse are different (e.g. left LF with right rotation). Type II motion being frontal and transverse are the same (e.g. left LF with left rotation). To read more on this see Thoracic Motion: Type I/II.

There’s also a fair few manual and soft tissue therapy techniques that can get things moving a little, but ultimately I want movement in function.

The Non-Physical Side of a Stubborn Thoracic

I think a large part of my job as a physio is based in the coaching realm. I’ve thought this much more since being enlightened by Andrew Nicholettos on an understanding of pain. I want people to move, to not be afraid to move. To have variety in their movement lives.

My sensitivity to movement and loading was definitely lowered by my time at Ospreys. Seeing what those guys could go through and what we could put them through in rehab was an eye opener. What the body can tolerate even in an injured state is massive!

I remember when I first started back in private practise after my last season and being shocked when people were asking if they could return to the gym? Your pain is 1/10, you are 4 months post a very mild injury….you have no more chance of injury than before…YES you can do 15 minutes on a cross trainer!!!

I joke a little, but it is a serious point, particularly with a stubborn thoracic. You want movement variety, which means you need to reduce the fear of movement and increase the confidence. For me this is the key. The manual therapy, soft tissue work and exercises can definitely help you get there. However, eventually they are going to have to move…and stay moving!!

Building confidence in moving with basic exercises at first, then start moving them closer and closer to their end goal of function. Then when the time is right they can return to their desired function. During the treatment time it’s also key that they begin to understand what is going on and how their ongoing behaviour both physically and mentally can affect them…if you get that right you are on to a winner 🙂

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