

Written by Dr. Quinn Henoch

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.

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.

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.