The Almighty Thoracic Spine – Part 1: Assessment

By March 18, 2018Blog

Unlock Your T-Spine, Unlock Millions of Possibilities

“What the hell is a thoracic spine and why should I give a shit about it?”

Well, get ready for an anatomy review before you learn why exactly you should give a shit. Then, stick around because next week we’ll go into some ways you can actually improve upon this week’s assessments.

Welcome to Thoracic Spine Anatomy 101

The thoracic spine is kind of like the middle sibling of the spinal column.

Sandwiched in between the thick and powerful lumbar spine and the delicate cervical spine, the thoracic spine gets no love.

When people’s shoulders begin to bother them or their lower back starts to hurt, no one seems to look there.

As stated above, the thoracic spine is a portion of the spinal column that sits above the lumbar vertebrae (L1-L5, known as the lower back) and below the cervical vertebrae (C1-C7, known as the neck).

Composed of 12 vertebrae, it’s main job is to work with the ribcage to protect the vital organs. In a movement capacity, the t-spine and ribs form a “floating joint” with the scapula called the scapulothoracic joint.

Simply based on its placement within the body, you can start to see how this section of the spine can interact closely with both shoulder and upper body function as well as lower back and lower body movement.

So What’s The Problem?

The problem that we are talking about here is that the thoracic spine gets “stuck” in one position. Your t-spine is actually supposed to be slightly flexed (about 40 degrees in most adults) but should be able to flex (round forward), extend (straighten up) and rotate (as in twisting).

I’ve noticed that thoracic stiffness most often occurs because of a few popular reasons. This is not an exhaustive list and there could be many other causes:

1.    Extended sitting and/or poor standing posture.

2.    Taller folks not wanting to stand out (like myself).

3.    Women who are taught by society to “downplay their assets” and slouch their shoulders to do so.

4.    Weakness in the posterior postural muscles (upper back) and tightness in the anterior shoulder girdle (pecs), often exacerbated or even caused by the above issues.

Now, you’re probably wondering if you have a nasty t-spine since you probably fall in one of the above categories.

Here’s a step-by-step breakdown of how to see if you have these issues (if a mirror doesn’t do the trick). In part 2 of this article, I’ll go through some ways to fix them and improve movement quality of the shoulder.

1.  Overhead Extension

Most people will tell me they are just fine getting their arms overhead and, to the untrained eye, it may look that way. However, there are several cues that must be followed to ensure we are actually testing your overhead extension at the shoulders and thoracic spine and not some compensation mechanism (and there are tons).

Back-to-Wall Overhead Extension Test

Key points: When setting up, ensure the heels are touching or very close to the wall (mine have to be about 4 inches so I can get all points of contact).

For the first trial, I often just tell people to reach overhead and watch what happens. This gives me a good sense of their compensation patterns before I educate them on what I’m looking for. You could do the same, but will most likely want to get right to it.

So, make sure the tailbone, lower back, upper back and back of the head are all touching the wall. Keeping those points of contact, try to reach overhead and stop if (a) any points come off the wall or (b) you feel tightness or pain.

This is where things can get confusing as your lack of range could be due to any number of factors including:

a)    lack of mobility between vertebral segments (structural)

b)    lat/lumbar extensor stiffness (muscular)

c)     anterior core weakness or laxity compared to lats/lumbar extensors (muscular)

d)    a myriad of other issues beyond the scope of today’s article

Don’t worry as much about “why” (we can talk about that later), but focus more on what you’re feeling and how you scored (below).


Level 1: Pain, lower back or head left the wall before thumbs touched

Level 2: Lower back or head left the wall as thumbs touched, or one side was tighter than the other

Level 3: Both thumbs touched the wall with no compensation whatsoever

2.  T-Spine Rotation

Rotation is often not tested, but the effects of lack of t-spine rotation can be profound.

In testing the rotation of people who have been diagnosed with major shoulder issues like frozen shoulder, they all (a) lack rotation on both sides and (b) severely lack rotation on their affected side (whether or not there are symptoms).

Not only can rotation affect the shoulders, it can affect the pelvis as well. A lack of thoracic rotation often leads to overcompensation in the pelvis and rotation/ issues with the sacroiliac joint, often leading to lower back pain.

See, told ya the thoracic spine was important.

Thoracic Spine Rotation Test

Key points: The knee must stay on the floor to ensure the rotation is not coming from the lumbar spine (a very common compensation pattern). Follow your testing hand with your eyes and stop if there is any pain, tightness or you have to hold your breath/make a ridiculous face/pass out.

Once again, a lack of range is not necessarily due to one single factor. Factors relating to this test include:

a)    Lack of rotation between the vertebral joints (structural)

b)    Impingement within the shoulder capsule (structural)

c)     Pec/anterior shoulder tightness (muscular)

d)    Oblique/anterior core and/or hip tightness (muscular)

Here is the scoring scale for the T-Spine Rotation Test:

Level 1: Wrist >15” off the floor

Level 2: Wrist 3-15” off the floor

Level 3: Wrist <3” off the floor

So, your homework for the week is to test each of these movement patterns and take note of how you score and how you feel.

Do you feel pain anywhere?

If so, where and what type of pain?

How does your body compensate if there is a lack of mobility?

Does your upper back closely resemble Gollum’s?

If you really want successful, pain-free training on your own, you’ll have to start thinking this way and really become a student of your own body, constantly learning and tweaking things to fit.

This will allow you to ask the right questions and understand your body better than 90% of the people out there.

Good luck and stay tuned for the corrective exercises that will help you if any issues pop up with these assessments. As always, drop any questions in the comments or email me at

To your spine (and hoepfully your face) not looking like Gollum’s,


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Gavin McHale

Author Gavin McHale

Online training and nutrition coach, retired semi-pro hockey goalie, and ex-skinny kid. Currently a beer league superstar, and lover of lifting heavy things, Gavin will help you reclaim that athletic, dead sexy body, and shrink your clothing budget. Because tarps are always optional.

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