by: Francesca (Frankie) Andrea
I. Description of Motion
Thoracic side flexion is the lateral movement deviating from the midline of the body. It moves the spine either left or right with the thorax in the direction ipsilateral to the pelvis.
Primary Muscles:
Longissimus Thoracis (dorsal primary divisions of spinal nerves)1
Iliocostalis Thoracis and Lumborum (dorsal primary divisions of spinal nerves)1
Secondary Muscles:
Multifidus (medial branch of dorsal rami)1
External Oblique (intercostal and subcostal)1
Internal Oblique (intercostal, subcostal, ilioinguinal, & iliohypogastric)1
Quadratus lumborum (subcostal)1
Rhomboids (dorsal scapular nerve)1
Serratus anterior (long thoracic nerve)1
II. Mobilizing – Increasing Range of Motion
1. With Chair:
A. Standing beside a chair with the left side of your body near to the back of the chair.
B. Grasp the back of the chair with your left hand.
C. The back of the chair acts as a pivot around which the stretch can occur. It allows you to support the body weight and have control over the stretch.
D. Lean towards chair to feel stretch on right side.
E. Keep both your legs straight during the stretch. Do not bend the knees.
F. Keep your body in the frontal plane. Do not rotate.
G. For better postural feedback this technique can be done with your back in contact with a wall.
H. Emphasis should be on lengthening the spine rather than increasing side-bending.
2. Without Chair:
A. Stand with feet together or slightly apart.
B. Raise one arm over head and lean towards opposite side.
C. Feel stretch on side of raised arm. Think of reaching with arm in diagonal plane, rather than hinging at spine.
D. This is similar to chair stretch, but adds greater torque with arm over head.
E. Hold for 30 seconds and release. Repeat for total of 10 times.
3. Over Exercise Ball:
A. Stand split stance next to exercise ball. Have leg closest to ball forward.
B. Roll ball away as you lean hips then torso against the side of it. You can adjust feet to provide sturdy foundation.
C. Bring arm over head to feel stretch on side away from ball.
D. Make sure to have shoulders stacked in same plane.
E. Hold for 30+ seconds. Repeat for total of 10 times.
III. Indications for Stretching
The following are the most common conditions/indications that are supported by literature that require mobilizing or stretching:
Back Strains and Sprains
Adequate warm-up and stretching may prevent onset of back strains and sprains. A back sprain is an injury separate from fracture that results in compromised ligaments. A back strains result in some degree of muscular microscopic tears or over-stretching often from sport or overly strong muscle contraction.1
IV. Strengthening
1. Thoracic Lateral Flexion with Weight
**Note if you don’t have a kettle bell, you can use any household weight—gallon of milk, bag of flour, etc.
A. Stand with feet together or slightly apart.
B. Hold Kettle bell in contralateral hand.
C. Laterally side bend ensuring kettle bell is descending in a straight line to floor. Do not swing arm.
D. Allow kettle bell to reach either knee or mid calf, feeling stretch in opposite side body.
E. The descent provides eccentric strengthening, while returning to an upright position is concentric strengthening of obliquus muscles contralaterally.
F. This should be done 2x15 or 3x10.
G. This exercise can be performed without weight, thus having gravity as initial resistance.
H. To progress: increase weight factor.
2. Modified Side plank:
A. Begin by lying on the floor on your side.
B. Stack one foot on top of the other and prop yourself up with forearm resting on floor.
C. Lift hips off floor and engage abdominals creating a side plank. Keep hips stacked on same plane.
D. Hold for 30 seconds and repeat 3 times.
E. You can stagger your feet for better balance initially, but try and work up to having feet stacked.
F. You can also bend bottom or both knees and maintain plank. This eliminates the weight of legs.
G. To progress increase time to 1+ minutes or try raising top leg towards ceiling while keeping hips stacked.
3. Side Plank Crunches:
A. Begin by lying on the floor on your side.
B. Stack one foot on top of the other and prop yourself up with forearm resting on floor.
C. Lift hips off floor and engage abdominals creating a side plank. Keep hips stacked on same plane.
D. Next, lift hips toward ceiling keeping in frontal plane.
E. Return hips back to initial level of standard plank.
F. Repeat 14 times each side. Perform 3 sets in all.
G. Progress by adding more repetitions per set.
V. Potential Clinical Syndromes or Etiologies
http://www.udel.edu/PT/manal/spinecourse/ThoracicEval/leethorax.pdf
http://www.physio-pedia.com/Thoracic_Spine_Fracture
http://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000259_web.pdf
VI. Additional Web Based Resources
https://www.spinerf.org/sites/default/files/journal/Banton%20Biomechanics.pdf
http://www.methodisthearttoheart.org/thoracic-spine-anatomy
http://www.spineuniverse.com/anatomy/spinal-muscles-1
http://orthoinfo.aaos.org/topic.cfm?topic=a00302
VII. References
1. Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. Lippincott Williams & Wilkins; 2013.