5 Exercises for Rotator Cuff Tears

The rotator cuff is a group of 4 muscles spanning from your shoulder blade to your upper arm (humerus bone).  These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis.  The primary role of the rotator cuff is to center the ball (end of the humerus) in the socket (shoulder blade).  A poorly functioning rotator cuff will result in pain, weakness, altered movement, and disability.  This is common in people with rotator cuff tears.  Thankfully, there are exercises that can help.

Rotator Cuff Anatomy

The tendons of your rotator cuff can become injured or torn by trauma such as a fall.  However, many tears do not involve any trauma.  The incidence of tears increases with age.  The prevalence of tears is between 20% and 30% in people 60 to 80 years old.  However, many individuals with tears of all sizes do not have any pain.

Surgery and Rotator Cuff Tears

The torn tendons may not fully heal themselves.  Surgery repairs the torn tendons.  However, many tendon repeairs re-tear.  Although as high as 20% to 30% of rotator cuff repairs may re-tear, functional outcomes are typically very good following surgery.  However, surgery may not be a viable option for all individuals.  Many people with rotator cuff tears seek non-operative solutions.  Exercise is a proven non-surgical treatment option for many people with small and large tears.

Research Supporting Exercise for Rotator Cuff Tears

A recent study out of Denmark showed 5 months of exercise improved function by nearly 50% in people with large rotator cuff tears.  Strength, range of motion, pain, and quality of life also improvemed in people judged not to be surgical candidates.   Another study from Vanderbilt University showed 75% of patients with full-thickness tears respond well to exercise.  After two years, only 25% of patients in this study chose to pursue surgery.  These studies support the role of exercise as an alternative to surgery for people with tears.

Strengthening Exercise for the Rotator Cuff

So we know exercise can be effective.  But what are some of the best exercises to strengthen your shoulder if you have a rotator cuff tear?  Recall, the primary role of your rotator cuff is to center the ball in the socket to allow your arm to function.  A secondary role is to produce rotational movements of your upper arm.  These rotational movements are necessary for everyday living.  They occur when you reach overhead or behind your back.  Therefore, exercises that activate the rotator cuff and involve coordination with other muscles are best.

Sidelying external rotation is one important exercise that preferentially activates the rotator cuff.  In particular, this exercise targets the infraspinatus and teres minor.  Also, it is best for you to begin this exercise with very light weights. Another lower-level exercise that can be incorporated is the standing row or any of its variations.  The row activates all rotator cuff muscles at a low level along with strengthening the muscles of your shoulder blade.  Rows are performed with a cable, resistance band, or light dumbbells.


Advanced Exercises

Advanced exercises are incorporated after the basics are mastered.  However, not everyone will progress to these more challenging exercises.   Arm raises lying on your stomach activates your supraspinatus and infraspinatus. The most commonly torn tendon of the rotator cuff is the supraspinatus.  Also, diagonal movements train the coordination of all rotator cuff muscles along with the muscles of the upper arm and shoulder blade.



Closing Thoughts on Rotator Cuff Exercise

There are no one-size-fits-all exercise programs suitable for everyone with rotator cuff tears.  An individualized exercise program should be developed by your physical therapist.  The exercise program should be based on a detailed interview and physical examination.  Exercises should then target your specific areas of weakness and your goals.  Contact us if you have questions about how to get started.

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Little League Shoulder: 5 Things Coaches and Parents Should Know

Little League shoulder is an overuse injury that affects the upper arm growth plate in young baseball players.  The image below shows the widening of the upper arm growth plate in a young athlete with Little League shoulder.  Pain in the shoulder or upper arm during throwing is the hallmark sign.  In more severe cases, Little League shoulder causes pain with activities of daily living or even at rest.

Little League shoulder x-ray

Little League shoulder and Little League elbow are treated first with a period of rest.  During this period of rest, physical therapy begins to improve strength flexibility.  Premature closure and fractures of the growth plate have been reported with Little League shoulder.  However, these are extremely rare complications.  Most will eventually ‘‘outgrow’’ the condition with normal growth plate closure.  However, some continue to experience pain during the preadolescent or adolescent years.  In some athletes, this considerably limits participation and can even end their playing career.

Little League shoulder most commonly occurs in overhead athletes between the ages of 11 and 16 years.  Thirteen years is the most common age at which players move to a larger diamond.  This requires a longer distance for pitches to cross home plate.  Therefore this is the period where coaches and parents should most closely monitor youth athletes for early signs of pain.

Read on to learn about the 5 keys to returning your already injured baseball player back to play safely.

#1 Little League Shoulder is Occurring with Increasing Frequency

The increasing frequency of Little League shoulder is due to overuse and throwing with arm fatigue.  This trend is due to greater numbers of pitchers participating in competitive leagues and doing so at increasingly younger ages.

Increased velocity is also a likely contributor.  Year-round participation, participation on multiple teams in a season, the influence of private pitching coaches, and ‘‘showcase’’ events all contribute to increased stress to the maturing athlete.  It is imperative that coaches and parents monitor players in accordance with Little League pitch count recommendations.  Players should also take at least 3 to 4 months per year off from pitching.

#2 Little League Shoulder Treatment Always Includes Rest from Throwing

Baseball Phases of Throwing

During the late portion of the arm-cocking phase of throwing, there are considerable forces acting on the shoulder. These forces can damage the cartilage of the growth plate and play a role in the development of Little League shoulder.  The only way to remove the stress and allow the injury to heal is to stop throwing.  The longer players throw with arm pain, the longer the pain will last.

Therefore, the initial treatment plan for Little League shoulder always consists of rest from throwing.  This period lasts 2 to 4 months.  The pain usually resolves within the first month of rest.  However, premature return to throwing often leads to recurrence of pain.  About 25% of injured players experience a recurrence of pain within 6 months of resuming throwing because they return too soon.

#3 Begin Physical Therapy for Little League Shoulder 

Physical therapy is initiated early to normalize shoulder range of motion and to begin a progressive strengthening program.  Side-to-side shoulder differences in arm rotation ROM contributes to shoulder pain and recurrence of Little League Shoulder.  Physical therapists evaluate athletes with Little League Shoulder in order to address these risk factors.  The cross-body stretch is one exercise that targets posterior shoulder tightness that contributes to loss of motion in overhead athletes.

Strengthening the rotator cuff and shoulder blade muscles is important to build arm strength while resting from throwing.  Rotator cuff weakness is a risk factor for shoulder and elbow injury in adolescent pitchers.  Youth baseball players that do not demonstrate full pain-free strength of the rotator cuff muscles should not return to throwing.  Sidelying external rotation and prone horizontal abduction exercises target the posterior rotator cuff muscles.  These are typically weak in young throwers.  It is also important for athletes to strengthen the lower body and core musculature.  Weakness in these areas results in increased stress transferred to the throwing arm.

#4 Complete a Return to Throwing Program  

Structured interval throwing programs allow for a safe transition back to play.  These programs replicate game conditions in a progressive and safe manner.  Individual differences exist.  Programs are tailored to the injured athlete’s physical and emotional needs.

Rushing the throwing program will lead to a recurrence of symptoms and a delayed return to play.  Also, early long toss throwing should be progressed slowly due to increased rotational forces imposed on the healing growth plate.  Communication between the medical team and coaching staff is important to ensure the success of the interval throwing program.

#5 Correct Flaws in Pitching Mechanics Before Returning to Play

Before returning to unrestricted play, injured athletes should have their throwing mechanics assessed by their coach.  In particular, the rate of trunk and pelvis rotation during the acceleration phase of throwing has been linked to shoulder injuries in youth baseball players.

Baseball Pitcher

Hip-to-shoulder separation refers to the position of the hips relative to the shoulder just prior to the front foot contacting the ground.  With ideal pitching mechanics, the hips are facing home plate and the shoulder continues to face towards third base in a right-handed pitcher.  This allows for the optimal transfer of force from the core to the throwing arm.  As fatigue increases, the hips and shoulder begin to rotate in unison resulting in an open hip-to-shoulder separation.  The loss of power generation results in increased stress placed upon the shoulder and elbow.  To reduce shoulder stress, this flaw must be corrected.

Closing Thoughts on Little League Shoulder

Little League Shoulder usually resolves with 3-4 months of rest but symptom recurrence may occur.  It is important to not rush back to throwing before range of motion and strength have returned.  Correcting pitching mechanic flaws and a progressive throwing program is also required before fully returning to play.

Even after returning to play, close monitoring of athletes for at least 1 year is recommended to ensure the prevention of recurrence. Finally, current guidelines regarding pitch counts, rest, and activity modification should continue to be emphasized for long-term health.

If your youth athlete is experiencing symptoms of Little League Shoulder, contact your doctor or physical therapist.  Parents, coaches, and the medical team will work together to guide the young baseball player back to 100%.

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Shoulder Strengthening Exercises for Elbow Pain

Are you experiencing lingering elbow pain?  Have you experienced elbow pain in the past and are unsure why?  Weakness of your shoulder muscles and stiffness in your upper back might be contributing to these elbow injuries.  Shoulder weakness and upper back stiffness are common in athletes (baseball players, tennis players, and swimmers). Most of us in general population have the same problems due to frequent sitting.  A sedentary lifestyle and a less than optimal exercise program is likely contributing to your elbow pain.

Tennis Elbow Pain and Shoulder Weakness

Tennis elbow, also known as lateral epicondylitis, is a common tendon disorder which occurs in both tennis players and the general population.  People describe pain on the outside of their elbow aggravated by gripping or lifting activities.  Treatment to only the elbow is often unsuccessful or leads to only temporary improvements.  Common treatments that produce minimal lasting benefits include medications, injections, braces, ultrasound, laser, or electrical stimulation.  Often, muscle weakness at the elbow and neighboring areas are contributing to the persistent elbow pain.  Research suggests there is an association between posture and shoulder muscle weakness in people with tennis elbow.

Research shows a link between tennis elbow and muscle strength of the serratus anterior, lower trapezius, and middle trapezius.  Poor rotator cuff strength is also linked to tennis elbow.  These muscles are important for orienting and positioning the shoulder blade during functional activities involving the arm.  Poor strength or endurance of these muscles results in overload to the elbow and wrist muscles.  Strengthening the scapular stabilizers is an important part of rehabilitation for patients with tennis elbow.  Targeting the middle and lower trapezius muscles using dumbbells lying on your stomach is an excellent starting point.

Baseball Players and Elbow Injury

Youth baseball players, ages 6 to 12, with a rounded upper back are 2.5 times more likely to sustain an elbow injury.  Exercises that restore mobility in the thoracic spine and strengthen the muscles of the shoulder blade are important to address these problems.  Loss of mobility in the thoracic spine from a rounded back position will limit a baseball player’s ability to achieve the late cocking phase of throwing.  Often, these athletes will compensate at their shoulder and elbow in order to achieve the cocked position.  Over time, the increased forces at the elbow will overstress the soft tissue and bone leading to injury and pain. The windmill is a great exercise to improve posture and upper back mobility.

Scapular muscle and rotator cuff weakness is associated with throwing-related elbow and shoulder pain in youth baseball players.  Also, baseball players with ulnar collateral ligament injuries show decreased strength of the infraspinatus and subscapularis.   Similarly, weakness of the supraspinatus muscle is linked to serious arm injury in high school baseball players.  These rotator cuff muscles stabilize the shoulder joint during throwing.  Weakness at the shoulder will increase stress further down the chain at the elbow.  Baseball players should perform regular arm care exercises which target the scapula and rotator cuff muscles.  Examples of these exercises include shoulder external rotation and diagonal patterns with a band or dumbbell.

Closing Thoughts on Strengthening the Shoulder for Elbow Pain

Strengthening the shoulder is an integral part of rehabilitation from an elbow injury.  Perhaps, more importantly, these exercises can reduce the risk of elbow injury before the pain starts.  Strengthening exercises for the elbow and wrist are also important considerations.  However, the shoulder and upper back regions are often neglected when it comes to improving elbow function.  This is one reason why elbow injuries and pain often persist longer than expected.  Human movement is more complex than isolated muscles or joints.  Therefore, exercise programs should integrate the entire body in order to restore or optimize function.   Give these 5 exercises a try and let us know if you need some extra help.

5 Row Exercise Variations to Strengthen Your Shoulders and Core

If you are interested in strengthening your core and shoulders you should be performing some type of row exercise variation.  The row exercise is a pulling movement that involves bending your elbow, extending your shoulder, and pulling your shoulder blade back.  The row challenges the muscles of your upper back.  These are your trapezius, rhomboids, and erector spinae.  It also activates the muscles of your core and low back.

When you do the row exercise in standing you train your entire kinetic chain from your lower body, through your trunk, and into your upper body.  This article shows you 5 different row exercises to train your shoulders and core.

Why the Machine Row Exercise is Not Ideal

It is common for people to do rowing exercises seated with exercise machines.  This is fine if you are first learning the movement pattern.  However, seated machine rows do little to challenge your core or lower body.  You have much better options if you are an athlete, have a history of injury, or if you are simply looking to take your workout to the next level.

row exercise

If absolute strength is your goal, heavy barbell or dumbbell bent-over rows are your best options.  However, these row exercise variations require coaching and practice to perfect proper technique.  Performing heavy rows with improper technique makes you susceptible to low back or shoulder injury.  Again, there are better options, especially if you have a history of injury.  Instead, try the following 5 row variations and see which ones work best for you.

Standing 1-Arm High Cable Row

Set up a cable system with the cable slightly above the level of your head.  Stand in a lunge position with your left foot in front of your right.  The majority of your body weight is on your front leg with your knee bent about 45 degrees.  Start with your palm down gripping with your right arm extended out in front of you.  Pull the cable, bending at your elbow, straight back towards your trunk while maintaining a neutral spine.  Be sure to emphasize scapular retraction.  This refers to pulling your shoulder blade back and slightly down.  Also, avoid shrugging your shoulders or arching your low back.

This exercise challenges your core by activating your trunk muscles to resist rotation as your arm and scapula produce the movement.  This makes the 1-arm high cable row a good option if you are looking to train anti-rotational trunk muscle endurance.  This high-cable position and lunge stance set-up also result in favorable muscle activation patterns of the lower and upper trapezius.  This is important if you are an overhead athlete or have a history of shoulder problems.

Cable Lawnmower Pull

This exercise begins with your trunk flexed and rotated to the opposite side of your exercising arm.  The hand of your exercising arm starts at the level of your other knee.

To begin the movement, rotate your trunk toward your exercising arm while extending your hip and trunk to a vertical position.  The exercise ends with your arm at waist level with your shoulder blade retracted as if placing your elbow in your back pocket.  Pause for 1 or 2 seconds then slowly reverse the movement returning to the starting position.

The lawnmower pull is a multi-joint functional exercise performed in a diagonal pattern replicating many movements in sport.  The exercise incorporates the transfer of force from your lower body through your trunk to your upper body.  It activates your trapezius and serratus anterior muscles at low to moderate levels.  These muscles are important for maintaining shoulder health in overhead athletes (i.e., baseball players) and those with a history of shoulder pain.  The exercise can be performed with a cable system, resistance band, or dumbbell.

1-Arm Band Rotational Row

Set up a resistance band anchored at your waist to belly button level.  Position your front leg with the foot facing towards the anchored band.  Your rear leg will begin facing the same direction but must be free to pivot once the exercise commences.  Your right arm begins extended and the majority of your body weight begins on your left leg.

The movement occurs with the simultaneous coordination of an upper-body row, trunk rotation, and weight shift to your rear leg.  Pause in the end position for  1 to 2 seconds before reversing the movement in a slow and controlled fashion.

This row variation is ideal for rotational athletes such as baseball players.  It incorporates the coordinated activity of your lower body, trunk, and upper body.  Controlling the eccentric, or negative, part of the exercise is important.  This exercise also teaches weight transfer and weight acceptable from your rear to lead leg and vice versa.  Be sure to perform the exercise from both sides to avoid reinforcing any side-to-side asymmetries which are common in athletes.

Suspension Trainer Row

Anchor a suspension trainer, such as a TRX, in an overhead position.  Grasp both handles with your arms extended.  Position your feet in front of your body spread slightly wider than shoulder-width apart.  Your body should be maintained in a neutral position with your head, trunk,  and legs forming a straight line.

Perform the row movement and pause at the top position for 1 to 2 seconds before returning to the start position in a slow and controlled fashion.  Maintain your trunk in a rigid position throughout the exercise. To increase the challenge of this exercise position your feet further away from your upper body to assume a more inverted position.

The inverted position in the suspension trainer row exercise elicits high activation of your abdominals,  latissimus dorsi, upper back muscles, and hip extensor muscles (glutes and hamstrings). This exercise produces lower levels of lumbar spine muscle activity.  This is due to lower spine loads incurred from the suspended position.  These factors make the suspension trainer or inverted row a good option for people with a history of low back pain.

Dumbbell Renegade Row

Hold 2 dumbbells and assume a push-up position with your feet spread slightly wider than shoulder-width apart.  Align your head, trunk, and lower body in a straight line and maintain this position throughout the exercise.

Initiate a row with one arm while maintaining stability through your trunk and lower body.   Control the descent of the load back to the floor.  Be sure to alternate sides with each repetition.  Light loads are recommended when first learning this exercise.

The push-up position utilized in the renegade row increases challenges to your abdominal muscles.   Furthermore, 1-arm row variations have been shown to elicit greater oblique abdominal muscle activity compared to rows performed with both arms simultaneously.   This is a more advanced row variation.  It may be best to start with cable or suspension rows before embarking on the renegade row.

Incorporate Row Exercise Variations into Your Workouts

There are many variations to the rowing exercise.  We have described only 5 here.  For beginners, it is best to start with cable row variations and suspension trainer rows.  The lawnmower pull and rotational row are more complex movements that require total body coordination.  Thus, these exercises are more challenging to master.  To really challenge the core and shoulder stability, the renegade row is a higher-level option.

The most important points are that you choose the most appropriate variation for your level of training and that your technique is as close to perfect as possible.  If you would like help getting started, call your physical therapist and set up an appointment.

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Lower Trapezius: Exercises to Improve Overhead Shoulder Mobility

The lower trapezius muscle plays an important role in moving and positioning the shoulder blade (scapula) during overhead sports.  The lower trapezius spans from the lower 6 thoracic spine vertebrae to the upper portion of the scapula.   Along with the middle and upper portions, the lower fibers comprise the large trapezius muscle of the upper back.   The lower trapezius, upper trapezius, and serratus anterior muscles work together to upwardly rotate the scapula.  This function is important to position the arm during overhead function such as the cocking phase of throwing a baseball.  This muscle is often ignored when it comes to developing resistance training programs for athletes.

Role of the Lower Trapezius in Sport

Poor thoracic spine posture or loss of thoracic spine extension places the lower trapezius at a disadvantage to fulfill its role as a scapular stabilizer.  Therefore, exercises that restore thoracic extension are often included in programs that train the lower trapezius.  Delayed lower trapezius activation has been demonstrated in overhead athletes with shoulder pain.  Weakness of this muscle has been implicated with upper extremity injuries in baseball, swimming, and tennis.

Exercises performed with the arms below shoulder level elicit very little lower trapezius activity.  In order to optimally activate the lower fibers, movements that facilitate scapular upward rotation with depression should be performed.  The lower fibers are aligned at an approximate 135-degree angle from the spine.  This corresponds to the 10:00 and 2:00 positions on a clock.  Exercises such as the wall slide, prone trapezius raise, and shoulder external rotation in 90 degrees of abduction position the scapula for optimal lower trapezius activation.

Prone 1-Arm Lower Trapezius Raise

This exercise is performed lying face down with one arm over the side of the table or bench.  Be sure to keep the neck in a relaxed neutral position resting on your other forearm.  With the thumb up, arm straight, elbow slightly bent, lift toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This position is aligned with the muscle fibers of the lower trapezius.  Be careful to avoid shrugging the entire shoulder as you raise the arm.  Instead, think about tilting the shoulder blade backward as you raise the arm.  Pause at the top of the movement before returning to the start position in a controlled manner.

Prone External Rotation in 90 Degrees of Abduction      

Lie face down with one arm over the side of the table or bench supported on a small towel roll.  Be sure to keep the neck in a relaxed neutral position resting on your other forearm.  Rotate the hand up towards the sky in a slow and controlled manner.  Be careful to avoid shrugging the entire shoulder as you perform the exercise.  Pause at the top of the movement before returning to the start position.

Wall Slides at 135 Degrees with Lift Off

Stand to face a wall with one foot slightly ahead of the other.  Place both forearms against the wall starting just below shoulder level.   Initiate the movement by sliding the forearms toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This aligns with the muscle fibers of the lower trapezius.  Once the elbows are fully extended, slightly lift the hands and arms away from the wall.  Be sure to avoid arching the low back as you lift away.  Instead, think about tilting the shoulder blades backward as you lift away.   Pause at the top of the movement before returning to the start position in a controlled manner.

Closing Thoughts

The lower trapezius muscle is often ignored by athletes and exercise enthusiasts who regularly engage in strength training.  Poor timing or weakness of this muscle results in compensatory movement patterns during overhead activity.  Specific exercise targeting the lower trapezius should be included as part of a warm-up routine or regular strength and conditioning program for athletes looking to optimize shoulder health.

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Serratus Anterior: 3 Exercises to Improve Overhead Mobility

The serratus anterior is a key muscle involved with the performance of many overhead movements such as throwing a baseball, serving in tennis, and pressing a barbell overhead.   This muscle spans from the upper 8 ribs along the side of the trunk up to the inner border of the shoulder blade.  This muscle assists with rotating the shoulder blade (scapula) upwards and tilting it backward in order to position the arm for optimal overhead function.  Along with thoracic spine extension mobility, these scapular movements are often ignored as important components of overhead function.  The serratus anterior is also the primary muscle that protracts the scapula during upper extremity function.  This involves the scapula moving forward along the rib cage such as when punching in boxing.

The Serratus Anterior and Overhead Function in Athletes

Individuals with shoulder problems demonstrate decreased upward rotation of the scapula, decreased posterior tilt of the scapula, and increased activity of the upper trapezius muscle.  In particular, swimmers and baseball pitchers commonly present with a pattern of decreased serratus anterior activation and increased activation of the upper trapezius.  This alteration in muscle patterns leads to compensatory movements, decreased overhead range of motion, and increased stress to other structures such as the rotator cuff and elbow joint.

The serratus anterior functions to upwardly rotate and posteriorly tilt the scapula
Assessing strength of the serratus anterior

Exercises that combine scapular upward rotation, posterior tilt and protraction are ideal to activate the serratus anterior.  It is also helpful to include closed chain exercises where the hand is fixed to a surface through the floor or a wall.  Finally, exercises performed with the arm elevated above the shoulder or eye level elicit greater activation of the serratus compared to exercises performed at or below the shoulder level.  Wall slide and bear crawl variations fulfill these criteria which are optimal to train the serratus anterior in overhead function.

 Wall Slide with Foam Roll

Begin with your forearms resting on a foam roll against the wall placed at shoulder height.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior.  Next, “roll” the forearms up the wall in a controlled manner, making sure you don’t lose protraction.  Return back to the starting point in a controlled manner and repeat for the desired number of repetitions.

Serratus Anterior Wall Walks with Band

Begin by wrapping a resistance band around your wrists and pulling your wrists apart. Your forearms should remain parallel and take the form of the number “11” throughout the exercise.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior.  Then, “walk” the forearms up the wall in a controlled manner to approximately eye level or slightly higher, making sure you don’t lose protraction.  Return back to the starting point in a controlled manner and repeat for the desired number of repetitions.

Bear Crawl

Assume an all-4’s position with the hands in front, shoulder-width apart, feet behind the hips and up in the air.  The knees should remain elevated from the floor so you are stabilized by 4 points of contact.  Begin by pushing the back up towards the sky to protract the scapula and activate the serratus anterior.  Crawl forward starting with your right hand and your left foot following with the left hand and the right foot.  After each step, pause briefly to exhale. Take four steps or more depending on space, then turn around and bear crawl back.

Closing Thoughts on Serratus Anterior Exercise

Building a foundation of strength targeting the scapular muscles is crucial for overhead athletes.  This foundation should include movements that facilitate activation of the serratus anterior through scapular upward rotation, posterior tilt, and protraction.  These exercises can be included as part of a strength training session warm-up or part of a regular arm care program.   Overhead athletes, such as baseball players and swimmers, should particularly include exercises targeting the serratus anterior and lower trapezius as part of their year-round strength and conditioning program.

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5 of the Best Thoracic Spine Mobility Exercises

The position and mobility of your thoracic spine directly affects the amount of overhead shoulder movement you have.   A more erect and mobile thoracic spine and rib cage will give you greater overhead range of motion.  A slouched posture or stiffness in your thoracic spine and rib cage will result in a loss of range of motion reaching overhead. A slouched posture will alter the position of your shoulder blade and worsen your muscle activation.  Both of these problems will limit your overhead function and cause shoulder pain.

How Much Thoracic Spine Mobility Do You Need?

Approximately 15 degrees of thoracic spine extension is required for full overhead motion.  This is true 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 your power is transferred through your trunk.   A baseball pitcher who lacks thoracic spine rotation will compensate by increasing movement and stress through their shoulder and elbow.

Why You Need to Include Thoracic Spine Mobility Exercises

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 your 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 your 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 for 10 to 20 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 your low back and maximizes movement to your 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 10 to 20 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 their thoracic spine.

Begin in a lying position over a foam roll.  Place your hands behind your neck supporting, but not pulling on, your neck.  Raise yourbuttocks off the ground and roll your 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 your elbows up towards the ceiling.  Be careful not to overextend at your 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 your knee and hip bent to 90 degrees.  Your 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.  Your top knee and leg should remain in contact with the foam roll throughout the exercise.  Perform 10 reps 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 your knees.  This position will block unwanted hip and pelvic movement.

Next, rotate your 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 10 reps and then repeat on the opposite side.

Final Thoughts on Thoracic Spine Mobility

After performing these mobility drills it is important to work on strength and endurance of the thoracic muscles.  Also, manual therapy to your thoracic spine and rib cage will accelerate your recovery.  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.  Call us if you want help getting started.  The physical therapists at BSR have been helping people of Southern Ocean County move without pain since 2007.