Posted on February 10, 2012 by deansomerset

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So in Parts One and Two, I discussed how the anatomical features of the t-spine are so important, and how to see if there was any issues with the mobility and relative function of the area. Today we’re going to go through some corrective strategies that can be used to make it bullet-proof and make people envious of your awesome postural skills. Be careful where you walk, though, because I’ll be dropping knowledge bombs left right and centre. Watch your step.

Correction #1: Breathing Impairments

When I discussed breathing mechanics in the last post, I’m sure I got a few head tilts that lead many people to thinking I’d gone completely off my rocker, but the truth of the matter is that without being able to breathe adequately, everything suffers. I’m sure that listening to someone drone on about breathing is as sexy as watching dishes drip-dry in the sink, but some really smart people will keep telling you it’s important. Paul Check even puts it at the top of his “Functional Totem Pole,” meaning its’ importance is higher than any other systems within your body. To ignore it is to miss its’ importance.

As a result of sitting in n office jobs for years on end, we have a lot of people in the population who have forgotten how to use their ribs to breathe, and as a result they have to rely on their external obliques to pull their diaphragm, their scalenes to elevate their ribs, and wind up taking shorter and shallower breaths than they should, getting side stitches and neck stitches as a result of these areas working harder than normal.

One of the easiest corrective strategies relating to breathing mechanics is to get people to simply tai deep breaths and try to fill their entire lung volume as much as possible. This typically requires sitting up straight and expanding the ribs, pulling the t-spine into slight extension. Another option is to use a bit of biofeedback, wrapping an elastic around the ribs and having the person breathe in with the goal of stretching the band with their ribs.

Sure, you could say that my neck wasn’t in neutral in this video, but the main goal isn’t to try to get posture absolutely perfect, but to feel the ribs expanding against the band to try to get the intercostals to pick up their share of the load.

Another option is to try to get deep inhalation during overhead shoulder work. A simple starting point is to have the person lie on their back and bring their arms straight up overhead while taking in a deep breath.

From here, you could progress to a much more advanced exercise up against a corner. The effect of gravitational loading pushing down against the arms as they come up will challenge the scapular stability in a way that wasn’t present when lying flat on the ground, and will help to teach the scapular rotators how to function in the presence of thoracic extension once again.

Another issue with impaired breathing is the lack of thoracic extension and rotation, meaning the ribs on one side may flex in and get “stuck” for a lack of a better term. A great exercise I’ve used to increase both movements at once is a lunge to an elevated surface (the height is dependant on the relative leg length and hip mobility of the individual).

A funny thing that happens when people start doing this kind of breathing training is that as their intercostals start to work again, they may spasm occasionally and cause the person to have some light coughs, at which point they freak out thinking “what the hell kind of voodoo is this ass-clown doing to me?” and then you have to make the decision to either reassure them that it’s alright or simply mock their inability to breathe.

Correction #2: Kyphotic with Forward Head Posture

This is the standard Mr. Burns posture. This is a functional adaptation that lets the person sit at a computer for extended periods of time, but doesn’t them do too much else. This becomes interesting when you consider the fact that there’s also going to be compensations at the shoulder joint (reduced internal rotation, retraction, and flexion), pelvis, (posterior tilt, externally rotated, tight hamstrings and limited flexion), and even the neck gets involved (reduced rotation).

As a result of this, we need to take more of an integrated approach to mobility, otherwise you could spend the entire session working on stretching one area at a time and never hit them all. This is one situation where big multi-joint movements come in handy, like the sun dog.

Aside from the fact that this video showcases that my hamstrings are the same absolute length as Danny DeVito’s, it’s a great way of getting the hips, shoulders, and anterior lines moving through the saggital plane.

Another beauty I will use with this issue is a cable face pull, which requires thoracic extension, shoulder retraction and some pelvic tilting to get it right.

If the cable isn’t coming right back to your face, you’re not getting the right amount of extension from your spine, which will limit the range of motion of the shoulders. Stick your chest out and think about flaring your ribs into the movement and the shoulders will just fly back.

A more advanced correction would be something like a lateral lunge and overhead driver, which locks the pelvis in place and slightly tilts the spine forward, making the shoulders and t-spine work harder to pull up to a vertical position.

This one may look all nice and easy, but give it a try next time you’re in the gym, and you may hate life for those few seconds when you realize that you’re tighter than a drum skin.

Correction #3: Lack of Rotation

This is one that a lot of people don’t tend to work in very well, often using their lumbar spine to do rotational work instead of the thoracic spine. Top it off with the fact that a lot of gym based exercises work in the saggital plane and you don’t get many people who can rotate well. The reality is that rotation is one of the most important movements in sports, as well as in daily life. Try walking without having some degree of rotation come from your spine, and you’ll quickly look like Mr. Roboto.

One of the easiest exercises to use would be a bent over rotation, working on getting the ribs to rotate through the movement instead of the shoulder joint.

A somewhat more passive version of this movement, where there isn’t the effect of gravity to counter during the rotation, is the side lying rotation using a foam roller to support the pelvis and prevent the lumbar spine from rotating through the movement.

Correction #4: Weak Posterior Shoulder

This one is a common issue with a lot of people, not just office workers. An easy way to think about it is to compare how much you can bench press to how much you can chinup. Odds are like most people you can probably bang out more weight on a bench press than you can when performing chinups (if you can bench your body weight and can’t do a chinup, you need some help, dude). Let’s say you weigh 180 lbs and can bench press 224. You should also be able to perform a full chinup with a 45 pound plate dangling between your feet to have somewhat of a semblance of balance between your push and pull strength.

One of the big coaching cues I give to everyone when it comes to pulling, especially if they have any issues with spinal flexion or forward head position, is to push your chest through your hands, not simply to bring the hands to your chest. This makes the focus more towards getting that extension needed while also altering the scapular position to get better recruitment of the back muscles involved.

Second, when pulling try to draw your chin straight back. You shouldn’t drop your chin to your collar bone or look up, but simply pull it back in a straight horizontal line. This “packing the neck” movement helps to retrain the cervical extensors to stretch out and gets the deep flexors to kick it up a notch.

SO pulling movements will typically have to be taken back a step or six to make sure the posture is bang-on perfect, and that compensation don’t start ruining all the good work you’re trying to do.

Additional to pulling movements, there has to be some stability generated when the arms are away from the center of the body, which is where an alteration on a pallof press comes in handy.

The shoulders have to pull back to resist the forward direction of the cables, and be stable enough to move up and down the entire time while sticking your chest out like a boss.

The key to any of these corrective strategies is to identify the anatomical aspects that are initially affected through a systematic assessment, and then to determine what course of action you want to take to see specific improvements. You could give anyone these exercises and they may work or they may not, it all depends on whether they have the specific need to benefit from them, and whether they perform the movements correctly. This is where trainers have to become detectives, not just cheerleaders.

For more information on the thoracic spine, as well as a whole bunch of other really cool areas of the body that should be trained, check out Post Rehab Essentials today and get your learn on for the weekend. Seriously, what else do you have going on?

 

 

 

Posted on February 8, 2012 by deansomerset

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In case you missed Part One of this soon-to-be-classic series on the thoracic spine, click HERE to get your mind sufficiently blown apart to see what the functional anatomical importance of the mid back and ribs can mean to the ability to get jacked and swole like a mo fo. For those who are lazy and don’t want to click the link, I’ll summarize it in the points below:

1. It’s stupid important

2. Click the link, would ya?? Jeez, do I have to do everything around here?? Kidding, kidding. Hey, you’re alright.

So today we’re going to go through some of the steps I use for assessment on the thoracic spine, as well as what you should pay attention to and what doesn’t really mean much at all.

Before we dive into the ins and outs of the assessment, you have to take into consideration the relative age of the person and the health of their spine. Where lumbar discs tend to be thicker on the anterior side and thinner on the posterior side, causing the spine to tilt into a natural lordosis, thoracic discs are the reverse, thicker on the back and thinner on the front, meaning there is a natural kyphosis. This is important to note because as we age the discs tend to lose their height and begin to become less tilted, winding up in more of a flat position relative to each other. This can cause the spine to go deeper into a flexion bias as it loses mobility, which may not be something it can regain.

So if someone comes in in their 50′s they aren’t going to typically have the mobility of someone in their 20′s, especially if they have worked a sedentary job for the past 30 years.  Therefore any assessments performed have to consider that “normal” range of motion in some people may be completely different than in others, specifically concerning age. While a young girl in her 20′s could probably get 45 degrees of thoracic rotation, her mother may only get about 20 degrees yet present with no actual impairment.

As mentioned in the previous post, the three main functions of the thoracic spine are to provide attachment points for the ribs (breathing), anchor the scapula, and mobility for the majority of spinal movements like bending, extending and rotating. We’ll focus on movement capacity for the first part of today.

Mobility

If the spine doesn’t move through the T-spine, it has to move from somewhere else, such as the lumbar spine, which often causes a spinal hinge with flexion and extension movements.

 

 

 

 

 

 

 

 

This hinge could also come from the hips not going through flexion and extension properly, which can muddy the waters when trying to determine the root cause of dysfunction. At the end of the day, if the movement is impaired focus on fixing the movement by working on everything that could contribute instead of trying to figure out which muscle or which singular joint is the problem. It makes for a lot less headaches.

Add to this the fact that the thoracic spine is responsible for about 75% of the rotational capacity of the spine. If the t-spine doesn’t rotate, the lumbar spine has to, and cervical rotation may also seem impaired, such as when shoulder-checking in the car or doing a double-take when that hot girl/guy (depending on who’s reading this) gives you the wink and a gun as they walk on by.

There’s a few ways you can assess the movement capacity of the T-spine, but they all come down to either active or passive assessments. Passively you could check the mobility of each individual vertebrae and figure out if one isn’t gliding properly or if there’s any tender points on specific ones, but most of the time that info isn’t really all that relative for a trainer and best left for clinical interpretation and treatment. I prefer to use passive movements to get an idea of movement quality, and then check to see if there’s any impaired patterns when the influence of gravity or co-contraction isn’t there to interfere.

Don’t mind the cheesy techno music playing in the back ground. Unless you like that kind of thing, and in that case bust out the glow sticks if you feel like it.

For this assessment I’m checking to see if the spine bends evenly all the way up, or if there’s a point where the movement is localized  or restricted. Ideally, the spine should bend to about 45 degrees, evenly distributing movement along the entire length, and should be fairly equal on both sides. Remember though that age will play a role in reducing mobility.

With this one I’m checking to see if he can get extension through the entire length of the spine instead of just through the thoraco-lumbar junction, if he has good bilateral rotation and if any movement causes pain.

Active assessments are a little different. From an integrated perspective, it’s pretty tough to get a thoracic test that will only involve the T-spine and not let some other body part compensate, which is why I find a lot of the gross assessments that look at multiple joints good as screens but not very reliable for assessment purposes. For instance, take using a lumbar-locked rotation:

This has a couple moving parts that can interfere with the reliability of the test. First, if the individual has reduced hip flexion mobility, their spine will kick into a bit of flexion to make up the difference, which will alter the level of flexion in the thoracic spine, which will limit the rotational capacity of the area. Second, if the shoulders don’t have great internal rotation range of motion, the scapula is going to tilt at a different angle, making the thoracic spine flex again to make up the difference, and altering the accuracy of the test. Also, if someone is getting the majority of their rotation from the thoraco-lumar junction or from a lumbar hinge, the test won’t determine where the movement is coming from, just the overall degree of movement present.

One assessment I like more for its’ ability to test what I’m trying to look at is a 3-point rotation.

The degree of involvement of the shoulder and hip is greatly reduced in this one, which means there’s a better chance that any impairment found will actually be coming from the T-spine instead of an accessory from somewhere else.

To assess extension, I tend to find the best method is just to use a foam roller and see how the movement capacity holds up.

Holding the head with the elbows forward allows the cervical spine to be stabilized so that extension only happens at the t-spine instead of through the neck.

Breathing

This one doesn’t get the credit it deserves, but breathing is an incredibly powerful and simple way to assess someone’s thoracic spine and any potential impairments in their ribs or core function. The common posture we see in North American society is what I call the Mr. Burns syndrome, where the shoulders are rounded forward, the back is hunched, and the head is slightly forward, all leading to compression on the ribs and a limited extensibility of the intercostals and a desire to take over the entirety of Springfield.

The easiest way to see if the ribs are impeded is to just get someone to take a deep breath and see what moves and more importantly hat doesn’t move. The three major areas of mobility will come from the scaliness (ribs shrug up), the intercostals (ribs expand out), and diaphragmatic (abdomen distends). Ideally, with a full breath all three parts should fill with air, and fairly equally on both sides.

Deep breathing should come from all areas, and if it’s restricted, that area can create problems. I should mention that there’s a big difference between deep breathing and breathing deeply, as can be summarized by the concept of meditation. In meditation your goal isn’t to fill the entire volume of your lungs, but rather to allow air to flow into the lungs and relax your mind and body, which is the concept of breathing deeply.

Deep breathing is where you try to fill your lungs to the brim with air, which requires different mechanics to get the extra volume and needs to involve the intercostals and scalenes. Breathing deeply has a big focus on the diaphragm, whereas deep breathing tries to use everything. If a runner tries to use just their diaphragm, they’re going to get a side stitch from their obliques cramping from all the work they have to do, so deep breathing would be optimal when used for higher intensity exercises that demand more air.

Scapular Movement

If the t-spine is restricted, the most common direction of scapular movement dysfunction is through overhead extension and internal rotation. As a result, one of the easiest tests you can use to determine mobility is to lay horizontally and bring your arms overhead.

Pointing the thumbs towards the floor and trying to get the biceps to brush your ears makes this more taxing to the extension capacity of the thoracic spine and can take away any potential sources of compensation at the shoulder joint. Once someone can do this, they can move on to something like a floor slide, and if that’s easy on to a foam roller slide.

A great way to look at extension with rotation during compound movements is to use a 1-arm overhead squat. The two arm overhead squat is pretty tough to do, especially if someone is somewhat locked up in their t-spine, so this variation lets you look at whether it’s a global extension problem or a one-sided extension problem.

An interesting thing to note is that while these can be used as very powerful assessments, they can also make up the bulk of the corrective exercise program that would be used in case there was dysfunction present.

Putting it all together

One question I get asked a lot with regards to assessments is how much detail do you need to make a good assessment, and how long should one take? It always has to relate back to their main goals and concerns. For instance, if I have someone come in with a shoulder injury and they want to lose weight, we’ll look at what I can do to get them to lose weight and then look at their shoulder, whereas if their first concern is their shoulder, I’ll go through a full assessment on trying to figure out what may be causing their shoulder to have problems and forego assessments that would look at the ankle or knee for instance.

I always start with broad assessments, such as an overhead squat. This gives me a lot of general information about a lot of different segments of the body and lets me tailor other more specific assessments that I can use with a read that may be of concern. Using the shoulder example earlier, if the person has a bullet-proof overhead squat and there’s no pain, I could conclude that it’s not necessarily a joint mobility issue, but may be more of a strength or structural balance issue, or even repetitive strain from some activity causing the problem, so from that I wouldn’t need to go through a bunch of movement tests on them.

So once you have an idea of whether there is an issue with breathing, extension, rotation or lateral flexion, as well as if there’s an impediment of shoulder or pelvic mechanics, you can start putting together a program to address those specific issues in the most deliberate manner possible. We’ll discuss that all at the end of this series.

If you want to get more assessments and ways to make the world more awesome, you should pick up a copy of Post Rehab Essentials today. It has over 50 different assessments and corrective exercise strategies for various injuries and explains how to use assessments to begin your programs.

 

 

Posted on February 6, 2012 by deansomerset

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Last week was an epic fail on the blogging front for me, which makes me look like a raging clown-punchers for leaving all my peeps hanging. My bad. Hopefully today I’ll be able to make up for it by giving you some solid info on thoracic spine functional anatomy, assessments and exercises. Because this is going to be so epic, I’m going to break it up into a three-parter, which means you’ll be able to digest it all much more easily, because much like a block of cheese it’s best to get information in small quantites over a longer period instead of gobbling it all up in one sitting.

Please be aware that displaying this information to others may result in a significant increase in attention paid to you by members of the opposite sex (or same sex if you swing that way), and might also lead to feelings of superhero-ism and invincibility. With great knowledge comes great power, so make sure you wield it responsibly, or at least in a way that gets you more dates or lets you earn mad skrilla, yo.

 Functional Anatomy: Why The Hell T-Spine Mechanics are Important

Here’s the gist of functional anatomy. I’m not going to bore you with the details of how many degrees of rotation each vertebrae has (7-9 degrees), or the bony components that make it kick ass, or try to make myself sound super-serious and book smart (poop), because it’s more important to know what the hell all of that means when it comes to getting your swole on and preventing you from having a soul-draining injury for the rest of your life from not training like a jack-bag. Sound good? Thought so.

The T-spine has three primary roles: attachment point for the ribs; attachment point for the scapula; and mobility for the ability to flex forward, extend backward and rotate. We’ll talk about each three today, as well as what components need to be involved with a training program or assessments.

The ribs attach to the entire length of the thoracic spine, which is one of their defining physical features compared to other segments of the spinal column. The ribs are interconnected by intercostal muscles, and under the direct influence of the respiratory muscles like the scalenes, diaphragm, rectus abdominis, and to a lesser degree the remainder of the core musculature.

One aspect that gets over-looked by a lot of trainers or therapists is the role of breathing in upper body function (as well as lower body, but we’ll cover that later). Think of Janda’s classic Upper Cross syndrome: he states that the upper body has a definable pattern of tightness and shortness in the pec minor and cervical extensors, and long and weak lower traps and deep neck flexors. That’s all well and good, but working on re-aligning this imbalance really doesn’t benefit people all that much. I fell into this thought process with a lot of clients a few years ago, and got almost no results with them, which showed that this wasn’t really the problem, was it?

Without a doubt, Janda was decades ahead of his time, but this isn’t a complete picture of the common postural dysfunction. It doesn’t take into account the role of the ribs or breathing mechanics on the posture. If the intercostals are tight and the diaphragm is depressed (we see this in skinny people with a bit of a belly, especially in the upper abdomen), they literally won’t be able to get their spine to straighten up to get the shoulders to move properly or to get their neck into neutral alignment.

When the intercostals contract, they pull the ribs together and cause the T-spine to flex. Held chronically in this position, they won’t be a major player in respiration, meaning the entire role has to be performed by the diaphragm. You can see this in a postural assessment when someone breathes and the only part of their body that moves is their abdomen. Normally, there should be an expansion and collapse of the upper ribs, lower ribs, and abdomen with deep breathing, meaning all the muscles of respiration are working the way they should. Here’s an example of someone who did all her breathing through just her upper ribs, not through the diaphragm or lower ribs. Coincidentally enough, when she ran she would get cramping through her upper ribs and collarbone as those respiratory muscles worked like crazy to keep her sucking air.

When one center isn’t doing its’ job, the others have to pick up the slack. This is one reason people get side stitches or neck cramps when performing hard anaerobic work: their ribs aren’t moving properly and either their respiratory muscles get overworked (scalenes for the neck cramping, and diaphragm & external obliques for the side stitches).

Now let’s say someone has a lean to one side and an obviou