Over the past years, there has been a lot of talk about the importance of thoracic mobility. According to some research, when there is a thoracic mobility issue the suggestion is to treat that dysfunction first before other movement dysfunctions.
When it comes to shoulder dysfunctions, I always recommend checking the thoracic spine. During shoulder movements, the scapula should stabilize onto the ribs, which connect to the thoracic spine. If the thoracic spine is dysfunctional, then the scapula will have issues stabilizing and restricted shoulder movements may occur.
In this case, I will consider treating the thoracic spine first. This is because cleaning up the thoracic spine may clean up the shoulder movement, especially if it is a painful movement. During assessments, I have had clients complain of shoulder pain, and when I assess the shoulder, there is adequate movement and mostly pain free movement. However, when I test the thoracic, I find limited movement. At this point, it is important to establish if there is a stability or mobility issue. If the client cannot perform the movement actively, but I can get him there passively then there is a stability issue. If both active and passive fail, then we know there is a mobility dysfunction. After treating and restoring movement in the spine, most times the shoulder can become more functional. Thus, the clients did not have a true shoulder issue. I just saved the client and myself a lot of time on the table, and we can now focus on other dysfunctions and stability training.
In the above scenario, I will treat the thoracic first. Erik Dalton mentions “. . . that one of our main goals is to level the head and the tail.” It is important to use this method every time. Depending on how restricted everything is, sometimes that may be all we can do. So, I recommend following the thoracic spine idea as well. One thing is for certain–where there is limited movement, you can bet there will be compensations for the joints above and below. Why? — Simply because the brain must get the movement, so it will borrow it from somewhere else, and of course, that is when the painful patterns begin.
If there is thoracic dysfunction, you may also notice in a client’s arm swing during their gait. Some runners will train with arm swing crossing across the body creating a pump, which can easily cause a crossover gait. You may see adduction in the hips as well. If your scapula is set backwards to create that pump to bring your arm across the body, you’re going to create some impingement at the glenohumeral joint. So, the only way to get around that must be scapular protraction and thoracic rotation to get the arm across the body.
When thoracic rotation is dysfunctional, there will be more scapular protraction to get the arm across. This could lead to a dysfunctional leg swing as well. So, instead of educating the client in arm swing, we should use techniques to increase rotation and extension in the thoracic. Use manual therapy techniques on muscles like the lats pectorals trapezius, and then coach and educate the client on thoracic rotation and stabilizing the scapula during shoulder movements. When this occurs, you can also check dorsiflexion of the ankle and hip extension.
Remember–do not chase the pain! Most times, where pain is located is the source and not the cause. Treat the cause, educate the clients, and you may find the source of pain dissipates.