Flat thoracic spines have drawn more attention recently, but should we be that focused on this? Is this always a concern?
Here are our thoughts on what it means to have a flat thoracic spine, how to handle it, and when it may not matter.
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#AskMikeReinold Episode 291: Managing Flat Thoracic Spine
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Show Notes
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Transcript
Student:
From Australia says hi guys, big fan of the podcast from Australia. And he wants to know when managing overhead athletes who have a flat thoracic spine, how do you go about assessing whether they potentially would benefit from more thoracic lordosis or thoracic kyphosis in order to improve overhead movement patterns? I appreciate that both have a role in shoulder function. And I’m curious if you think that I should be prioritizing one with this population?
Mike Reinold:
Awesome. Good job, Leah. Okay. So managing flat thoracic spine, and specifically I like how Mitch tied this in a little bit where what we’re trying to accomplish here is overhead movement patterns, right? And somebody that has a flat thoracic spine and, Mitch specifically said, she’ll be working on lordosis or kyphosis. That’d be very interesting. I don’t know. Who wants to start maybe kind of talking about flat thoracic spine? I think that’s something we kind of all probably see to an extent in our athletes. But Mike, why don’t you start talking about just the concept of that in general and your thoughts?
Mike Scaduto:
Yeah, certainly I think it all starts with your assessment process. So for our upper extremity assessment or evaluation, we’re always assessing the scapular thoracic position and the position of the thoracic spine plus the ribcage. Right? We’ll start just looking at someone from behind. I’m looking at where their shoulder blades are kind of sitting on the ribcage and how their thoracic spine is situated. I think some people get in trouble when they are trying to assess the curvature of the thoracic spine. If you only look from the lateral view, you may get fooled sometimes based on how they’re scapula sitting. If they’re anteriorly tipped through their scapula, it may look like they have a really big thoracic kyphosis. Once you get in and palpate that thoracic spine, you can actually feel that it’s pretty flat. And we see that quite a bit in baseball players and that can have an influence as to how their scapula moves.
Mike Scaduto:
I tend to see, I think we all tend to see that baseball players in particular tend to be depressed on their right side. So they have a horizontal clavicle. If you look from the front. The scapula itself sits a little bit more depressed. They have this typically have a flat thoracic spine. And when they go to overly, when they go to elevate their arm, they tend to get a lot of spinning the scapula. They get a lot of upward rotation, but they don’t get a great amount of protraction. So that may be somebody, we see all those things together that we do work on a little bit of thoracic flexion to improve the congruency of the scapula on the ribcage. Help optimize how the muscles interact for that first couple of upward rotation and protraction.
Mike Reinold:
I like that. That’s a good point too, because if it’s not really about what the thoracic spine looks like, it’s how the scapula interacts with the thoracic spine. So that’s obviously the most important part. So that’s a really good point that you added there. Mike. It’s about also assessing how the scapula moves on that flat thoracic spine. Cause I mean, what if the scapula moves completely normal? What if it’s completely fine?
Mike Scaduto:
Right.
Mike Reinold:
There’s no big deal then doesn’t matter. Right. You know, especially if your goal is overhead reach. Right. So yeah. Who else? I mean, I think we all deal with this and this is something I think has had a little bit more exposure maybe on social media the last several years as a concept of flat thoracic spine. Anybody else have just any thoughts in general on this? Who wants to jump in? Dan?
Dan Pope:
I feel like I talk too much.
Mike Reinold:
No, but it’s always great insight.
Dan Pope:
Thanks
Dan Pope:
I don’t know it in my world. You want a lot of thoracic extension and some of the best Olympic weightlifting athletes I’ve seen, they have great thoracic extension, right? It’s phenomenal. They need to stay super upright when they catch a snatch or clean. It’s also super helpful from a jerk perspective. It’s almost always we’re working on trying to gain a little bit more extension in these folks. So at least in my population, I’m almost never working on a lot of thoracic flexion, just from a performance perspective, maybe from a health perspective, make an argument, but to try to gain more thoracic extension is almost always we’re looking for. And I think you’re also looking for kind of extremes it’s, what’s best mobility for Olympic weight lift. There is probably not normal mobility. You probably need to have some excessive range of motion, a lot of places. And I think the thoracic spine is one of those.
Mike Reinold:
Yeah, and if you look at most athletes that need to get into some sort of overhead position, so let’s say, like you said, a snatch, right? Or a baseball player when they’re in max layback of their shoulder, right. That’s not just shoulder motion, that’s thoracic extension. That probably plays actually a significant amount of the percentage of their range of motion. It comes from thoracic extension. So, sometimes thoracic extension in and of itself isn’t necessarily a bad thing. Right? Sometimes I wonder with thoracic extension, if we’re over diagnosing it sometimes. Right? And, maybe it’s not necessarily, the concept of where they’re sitting in their posture. Because there’s lots of things that can change that even like lumbo, pelvic dynamics can change the way your lordosis and your lumbar spine, which would change your kyphosis and your thoracic spine. There’s so many things that put, the thoracic spine, a different position. Does flat thoracic spine matter? If your thoracic spine could move into flexion and extension well. Anybody that’s what….
Lenny Macrina:
I was going to say. That’s what I was going to say is I think we’re talking, about a couple of different things here in which we’ve, I think we’re lumping it into the same thing. Maybe that’s my perspective, especially in the question. Cause if we’re talking about an overhead athlete. Their overhead is here, my they’re at 90 degrees, they’re hands overhead, but they’re at 90 degrees. So their amount of extension that they need, they need it to throw, but they’re never getting up here where the scapula and the thoracic spine actually have to physically extend. It’s when they are throwing, they get the thoracic extension. But I think they’re also very mobile. And so if they are kyphotic, which a lot of our baseball players are, like Mike said. They have underlying mobility, especially the college and professional they’re pitching at that level because they’re so mobile and not just mobile in their shoulder, they’re mobile probably globally.
Lenny Macrina:
And so their ability to get out of that kyphotic position and get some extension to afford them to throw 95 plus. I think is there because they’re so young in mobile. It’s when they start getting 40, 45 and you start losing some of that mobility, but you still trying to be active. I think that’s when we start seeing issues with, yeah they need more extension. Or they’re trying to do overhead stuff like in Dan’s population or even in Dave’s population that’s when you start seeing the issue is probably a little bit more pronounced, at least in my opinion.
Mike Reinold:
Yeah. I like that. What do you think Diwesh?
Diwesh Poudyal:
Yeah, no, I was just going to kind of build on the point that you started with like of, I think that resting posture of that flat T-spine probably doesn’t matter that much. Now, do you need to be able to get into flexion in an active position? Probably right? Even in a baseball player, they obviously get into that layback position with a ton of T-spine extension, even a lot of lumbar extension. But when you’re coming down on your delivery and on your follow through, you need to be able to flex the trunk and come all the way through. Right? So that ability to flex is very important. Do you add a standing posture need to have kyphosis in your T-spine for an athlete? Maybe not. So that’s kind of what I go to. So, when we’re doing some of our, like mad ball throws and stuff, we put people in positions sometimes where we’re going to exaggerate a little bit more of that trunk flexion. And maybe get a little bit more of that thoracic flexion.
Diwesh Poudyal:
Right? And maybe we’ll do some other exercises that are going to promote a little bit more of that reach and a little bit more of that round, maybe at some of our breathing drills early on in our training sessions or maybe some of our crawl patterns we’re really asking people to get a little bit of better of a reach. So they’re not, waiting out with scaps and stuff like that. So I think the ability to flex is important. The ability to Protract like is important. So I think if we just kind of take care of that, the standing posture from what we see, probably not the end of the world.
Mike Reinold:
Yeah. It makes sense. And I feel like we say that a lot about posture now is that, static posture in and of itself is just a very piece of the puzzle. Probably a small piece of the puzzle, the starting point of the puzzle. But, we don’t make a lot of clinical decisions just based on just resting static postures it’s about how they move. So like Mike said, it’s about how their scapular move on their thorax. And like Diwesh said, it’s about can they get in and out of the right movements with their thorax that they need in their sport. Lisa, what about you? I mean, as our rowing specialists, obviously thoracic extension seems, like we’re talking about overhead, but you know, rowing is more horizontal and got to be a ton of flat thoracic spine issues in your world. Right? What do you think?
Lisa Lowe:
It kind of can go both ways, sort of. Like people can end up with really flat thoracic spines if they use like a ton of scap protraction to get into the like catch position. But a lot of rowers rest with more excessive kyphosis. Just because of continuously trying to like sit and reach forward. But it all still goes back to the same that we’ve been talking about is that I really more so care if they actually can move their spine into other positions. And that’s where usually it’s really, really hard for them to reverse their thoracic spine into extension. If there’s somebody who has trouble with like thoracic spine mobility. And usually just gaining like even a teeny bit of that, like their ability to get their scapula in the proper positioning and be more connected through their shoulders, into their hips, kind of comes a little bit with just gaining some of that thoracic spine mobility.
Lisa Lowe:
So it all is similar of what we’re saying, but just a different sort of like resting posture. Typically, some people like Mike was saying, you’ll see that their thoracic spine truly is a little bit flatter. And it’s more of the kyphotic kind of illusion is from their scapula. But a lot of people, it is actually a pretty decent thoracic spine curve.
Mike Reinold:
So, would you do anything different? So if somebody came to you and obviously they’re a rower. And trust me, I think this conversation applies to everybody, not just rowing because I think a horizontal push and pull is a very fundamental movement pattern that all humans do just during daily activities. But, if somebody came to you as a rower, do you look at their thoracic flexion and an extension and then say, heck like you don’t have that much thoracic flexion. So you’re going to have to Protract your scaps more? Does that impact how you work with your athletes Lisa?
Lisa Lowe:
Oh, a hundred percent. Yeah, yeah, yeah, absolutely. I mean, and especially with like rib stress injuries and all that kind of stuff in rowing, if they’re thoracic spine and the ribs don’t move well, then they’re just like opening the door for more overload in that area. And especially since rowing is unique in terms of like you are loading like a really strong, horizontal push pull kind of combo, upper lower body, with very, very high levels of breathing, kind of at the same time, because it like races, you’re breathing really, really hard while you’re pushing and pulling really, really hard. Having that thoracic spine mobility to support like good breaths and to be able to maintain a good core position and all that kind of stuff. It’s super important.
Lisa Lowe:
So it’s definitely something I zero in on quite a bit when I have a new rower come in and that I check in on a lot with the rowers that I work with over time, because if they start to lose that mobility, if they’re someone who has it, then it’s also kind of usually assigned to me that they’re like a little bit on the overtrained side and that they need to spend a little bit more time kind of rebalancing that too.
Mike Reinold:
That’s great.
Lisa Lowe:
It’s pretty important.
Mike Reinold:
Yeah. That’s almost like how we look at the arms and our athletes, with the throwers, right? You’re looking at thoracic mobility almost in your athletes to see their overload status. So, Mitch, I think like in summary, I think our the main point to get across here is that flat thoracic spine in and of itself may not matter. Right? But it’s more about it’s not the starting point, but it’s their ability to move throughout space. And don’t forget that interacts with limbo, pelvic, and then that interacts with scapula thoracic. You have to put that all together. So hopefully that helped.
Mike Reinold:
Hopefully I think next time you see somebody with a flat thoracic spine, you don’t just jump straight into like a protocol for the person with a flat thoracic spine. And maybe you kind of dig it out a little bit deeper to see if that is the interventions that they need. So anyway, great question. If you have something like that, head to mikereinold.com, click on that podcast link and you can fill out the form. In the meantime, please subscribe apple podcast, Spotify rate, and review us. We really appreciate it. We’ll keep doing these episodes. Thank you so much. See you on the next one.
