All Posts tagged thoracic spine

Thoracic Spine Posture Evaluations, Part 7

Patients often ask me, “What causes bad posture?” I often hear myself answering with something like, “How many hours do you spend at work each day?” The patient responds with, “On average, about eight to 10 hours,” to which I say: “During your work time, you probably sit unconsciously in a slumped posture and in improper body positions.

Some people just engage in repetitive movements. Either way, this can create muscle imbalances leading to poor posture.” For those patients who really “get it,” I might add, “I think that the mind and body communicate and that psychological distress from work, family, finances (or whatever else I have heard them share with me) shows up in our posture.”

Would you agree that poor self-esteem and depressive symptoms are displayed in our posture? Another cause of poor posture is a lack of a variety of movement in our activities of daily living and overall poor flexibility. In essential ways, our unique cultural, mechanical and spiritual histories are part of what affects overall posture and health.

Last year, I was given the opportunity to teach a thoracic spine rehab course. I had never been to a “thoracic spine seminar,” let alone put together eight hours of teaching material on the subject. The seminar could have been called, “The Thoracic Spine – The Forgotten Area Between the Lumbar Region and the Cervical Region.” I continue to learn the compelling interconnection between the thoracic spine and the cervical and lumbar regions.

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Difficult Thoracic Spine Case Suggestions

Keep assessing globally and aim to find the key link. 

That said, some of the patterns that have worked require more optimal core integrity….essentially normalizing the core. Not muscle specific but an adequate and appropriate balance of activity based on the load or demand placed on the system. Proximal stability (maintenance of expiratory position and cylindrical core activation) in the presence of distal mobility (extension movement of the hip)

Diaphragmatic breathing

Dead bug

Kneeling ball rollout

Plank walkout 

Y-T-V drills

Push up variations

Once saggital stabilization is established, rotation moments are then assessed and challenged.

Make sure the T-L junction has good motion and that there is no, and I mean zero malposition of the pelvis.  Rule out any tight hamstring issues or anterior pelvic tilt from tight quads, which either way leads to chronic shortness of the iliopsoas. Iliopsoas has a huge number of attachments in the trunk to flex the hip without falling over, but when short, in standing, it pulls the lumbar and last thoracic vertebrae forward and down.  Look at the whole ribcage – take your finger and palpate between every rib and find active intercostal trigger points. No one hardly ever does this for clients…a lot is missing in between those ribs related to Tsp.  

You get my point – keep looking globally, work locally at the T-L junction, the intercostals, more psoas. Maybe the hamstrings and quads. Make sure the person learns what a stable pelvis feels like and facilitate/strengthen muscles to keep it there.

PS. I have good news. I was invited to teach in Brazil on Nov 10-13.


What’s wrong with sitting?

I typically see:
tight hip flexors, hamstrings, calves
tightness through the external hip rotators, leading to restriction in hip joint range
limitation of lumbar spine extension
stiff thoracic spine
protracted and elevated scapulas with weak lower trapezius and serratus anterior
tight and weak posterior rotator cuff
poked chin posture with associated weak deep neck flexors and overactive upper trapezius, levator scapula and rhomboid muscles.

Prolonged sitting has also been linked to hamstring strains. The lumbar spine stiffness associated with sitting leads to altered neural input into the posterior thigh, the theory goes. This can manifest as increased muscle tone of the hamstrings, which will alter the length-tension relationship and increase the risk of strain.

Hunched postures cause thoracic spine stiffness, shoulder imbalance and winged scapulas.

Each of my clients is encouraged to correct their posture, perform a daily flexibility program and take a look at the ergonomics of their work-stations to help them regain the alignment and muscle balances that are essential for them to achieve their best health.