Neck pain can be debilitating and limit your quality of life. It may impact your ability to drive, participate in activities you enjoy, and enjoy activities with your family. Luckily physical therapy can have profound impacts on reducing disability and limitations associated with neck pain. Evidence for strengthening of your neck muscles including the longus capitis and longus colli as well as manual therapy provided by a licensed physical therapy can help improve your neck mobility and even improve numbness/tingling in your arms associated with neck pain.
A Case Study using Exercise for Neck Pain
In a clinical case of a 28-year-old individual with neck pain and left arm symptoms, a physical therapy program consisting of manual therapy directed at the mid back, neck, and left arm reduced pain and improved the overall quality of life in just 10 visits of therapy services. The patient also benefited from stretching exercises for the cervical musculature and strengthening of the longus capitis and longus colli. Treatments to improve the mobility of your nervous system can help decrease the numbness/tingling you may experience with neck pain, this is known as a cervical radiculopathy.
See a physical therapist today if you are experiencing neck pain with arm symptoms associated with a cervical radiculopathy to determine if you can benefit from physical therapy treatment, even without a referral from a physician. The physical therapist is trained to determine if treatment is indicated, ask your local therapist today.
-Dr. Steven Ferro, PT, DPT
Cleland, J. A., Whitman, J. M., Fritz, J. M., & Palmer, J. A. (2005). Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. Journal of Orthopaedic & Sports Physical Therapy, 35(12), 802-811.
The position and mobility of the thoracic spine directly affects the amount of overhead shoulder movement available. A more erect and mobile thoracic spine and rib cage will result in greater overhead range of motion. A slouched posture or stiffness in the thoracic spine and rib cage will result in a loss of range of motion reaching overhead. Excessive thoracic kyphosis, or a slouched posture, may alter the position of the shoulder blade and impair muscle activation patterns both of which contribute to limited overhead function and shoulder pain.
Approximately 15 degrees of thoracic spine extension mobility is required for full overhead motion when lifting both arms such as when performing a barbell overhead press. Full 1-arm elevation requires approximately 9 degrees of thoracic extension. Thoracic spine rotation is also crucial for rotational sports such as baseball where a large amount of power is transferred through the trunk. A baseball pitcher who lacks thoracic spine rotation will compensate by increasing movement and stress through the shoulder and elbow joints.
Strength is foundational for optimal shoulder health but thoracic spine mobility is often a neglected area when athletes attempt to maximize their overhead shoulder function. Therefore, exercises targeting thoracic spine extension and rotation mobility should be included in any rehabilitation or performance enhancement program seeking to optimize shoulder function. Instead of jumping to restore shoulder mobility with bands and balls, try these thoracic spine mobility exercises first.
Bench T-Spine Mobilization
This is my favorite exercise for restoring thoracic spine extension. It also provides a nice stretch to the lattisimus dorsi muscle which can also limit overhead mobility. The exercise begins by assuming a kneeling position facing a bench. Place your elbows on the bench in front of you holding a PVC pipe or dowel with the palms facing up. Sit back, pushing your buttocks towards your heels, keeping your spine relaxed, until you feel a stretch in your upper back. For an added stretch you can bend your elbows further past your head. Hold this position, and exhale fully. Reverse the motion to return to the start and repeat the desired number of repetitions.
Thoracic Extension + Rotation (Reach Backs)
Begin this exercise by sitting back on your heels, face down, with one hand behind your head and the opposite forearm resting on the ground in front of you. This position minimizes available movement in the low back and maximizes movement to the upper back. From this position rotate your elbow up to the sky while exhaling. The opposite forearm remains in contact with the ground. Return to the starting position and repeat for the desired number of repetitions before switching to the opposite side.
Foam Roll Thoracic Extension Mobilization
This exercise can be a challenge to perform correctly. Most end up extending through the lumbar spine and not the thoracic spine. Begin in a lying position over a foam roll. Place the hands behind the neck supporting, but not pulling on, the neck. Raise the buttocks off the ground and roll the upper back up and down the foam roll. Identify a sensitive, stiff, or tender area and then drop the buttocks down to the ground. From this position perform small extension movements by lifting the elbows up towards the ceiling. Be careful not to overextend at the lower back.
Thoracic Spine Windmill
This is my “go to” exercise to restore thoracic spine rotation. Begin on your side with both arms outstretched in front of you. Place a foam roll under your top leg with the knee and hip bent to 90 degrees. The bottom knee and hip remain extended throughout the exercise. Reach forward with your top hand and then complete a large circular windmill motion as you rotate your entire upper body. Keep reaching as if you were attempting to lengthen your entire arm. Follow your hand with your eyes to ensure proper thoracic spine and rib cage movement. The top knee and leg should remain in contact with the foam roll throughout the exercise. Perform the desired number of repetitions and then repeat on the opposite side.
Standing Thoracic Rotation Mobilization
The standing rotation exercise is ideal to incorporate into a pre-workout dynamic warm-up. From a standing semi-squat position place one arm between your thighs just above the knees. This position will block unwanted hip and pelvic movement. Next, rotate the body upwards towards the sky by following your open hand with your eyes. At the top of the movement, exhale before returning to the starting position. Perform the desired number of reps and then repeat on the opposite side.
After performing these mobility drills it is important to work on strength and endurance of the thoracic muscles. Also, manual therapy to the thoracic spine and rib cage has been shown to accelerate recovery and reduce shoulder pain immediately and for up to 1 year. Maintaining or improving thoracic spine mobility is imperative for any active individual who regularly functions overhead. Manual therapy, mobility drills, and strength/endurance exercise targeting the thoracic spine can lead to significant gains in overhead function for athletes and the general population. These 5 mobility drills can be easily integrated into any pre-workout warm-up routine or as part of a home exercise program.