May 14, 2014

Thoracic Extension Doesn't = Thoracic Extension

Howdy Folks! Today I wanted to take a quick moment to comment on some discrepancies that I have noticed when hearing people discuss thoracic mobility and the need for thoracic extension. Anyone that is familiar with the Functional Movement System is probably well aware of the lack of thoracic mobility that many people seem to suffer from. This is something that you often see targeted by FMS corrective exercises or may be a common finding during an Selective Functional Movement Assessment (SFMA) for some.

On the other hand, there is the kind folks associated with the Postural Restoration Institute (PRI) that are trying to promote thoracic flexion and minimize hyperextension of the thoracic spine. Then I have heard stories from colleagues at PRI courses mention how they are lacking thoracic extension only to be told they have too much. So what is the answer? Do we need thoracic extension? Who is right here?

Well I believe that both of these systems or schools of thought are trying to achieve the same thing, and are essentially saying the same thing despite it sounding different. I am arguing that people are not differentiating between the different hinge points of the spine and the exact levels of the thoracic spine that they are referencing. Look at this first squat picture below. Nobody from either school is going to like this squat form and PRI'ists will notice the excessive thoracic extension from T8 and down while FMS'ers will notice the lack of thoracic extension from T1-T4.


Now if I hit my first sticking point and decide to take another breathing cycle to help draw my ribcage down and promote lower thoracic flexion I am able to come down even further in my overhead deep squat as you can see below in the next picture. However, it is still less than ideal squat form. I still struggle with getting adequate upper thoracic spine extension


Now what happens if we lessen the burden of the upper thoracic spine and by switching this experiment over to a front squat? I am still hyper-lordotic in the lumbar spine and still extend the very last few segments of the thoracic spine.


If I perform another big exhale into the balloon I am able to decrease the lordotic curve, increase thoracic flexion from T8-T12 and my femurs actually break parallel! However, if you look closely you will still see a little bit of hyper-kyphosis in the first few segments of the upper thoracic spine.


In conclusion, I think there is a lot of confusion by some people when they learn about or speak about the thoracic spine between these two different schools of thought. In reality, I think that both schools are really trying to achieve similar things but sometimes there is definitely a lack of differentiation. I also think that these pictures can also help signify the importance of proper breathing, and the power of the diaphragm, obliques and transversus abdominus over form, function and movement. Just some food for thought! Thoughts?

7 comments:

  1. Adam,

    I'm not sure that using a balloon for diaphragmatic control, and ultimately thoracic extension/flexion about the differing segments, is best used to facilitate improvements in the overhead squat position from the FMS.

    If you were to say, notice an excessive thoracic extension during your OHS, then apply whatever techniques that have a positive correlation with decreasing your given thoracic extension at that specific time you tested, then retested your OHS with positive changes with regards to thoracic flexion (or reduction in extension), then I believe that the "treatment" or techniques were positive in helping improve your FMS scores.

    By involving the balloon breathing mid-test, it is, as you said, merely showing the importance of diaphragmatic breathing and rib positioning during the test. However, keeping in mind that you were the individual being presented here, given someone else who is uninitiated with the philosophies of either school of thought, the balloon breathing could very well provide a negative stimulus to cause the person to engage their breathing reflex in a "high threshold" manner.

    With that being said, I fully understand where you are coming from with regards to the question of "More thoracic extension?" or "More thoracic flexion?" While it is easy to postulate and stand by either school of thought and shout it to the world, another thought that has yet to gain traction is the idea of being able to both *extend and flex* about the thoracic flexion. If you are stuck too far down either continuum of flexion or extension, it is easy to understand how people can view things in such a black and white matter, mainly because you need both in order to function at a high level.

    Too far down extension and there may not be control of the diaphragm, upregulation of accessory breathing muscles, along with other cascading degradations.

    Too far down flexion and it may recruit a whole different stabilization strategy for function and breathing (pec minor/subclav/pec major "dominance" if I can use that word).

    In any case, this should provide some healthy discussion amongst those who are familiar with both schools of thought, and I'm looking forward to your thoughts.

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    1. ... about the thoracic *segments*

      :)

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    2. Miguel, I think I agree with everything that you are saying. I do not personally think that the balloon is the tool needed to correct my ODS pattern. I have heard some people postulate that one of the biggest problems for the ODS pattern is elevated rib cage, extended lower T-spine, hyperinflation, etc. I am trying to argue that yes..It does help, but no it doesn't make it perfect if they don't have enough extension at the upper segments.

      I agree with what you are saying about the differing segments may have differing demands or requirements! I definitely can see how some people are making it a "black and white matter" when in reality it is truly a gray matter and both answers are correct when placed in the appropriate light!

      Finally, I definitely have to agree for the potential for somebody to have an issue with the balloon and causing a negative stimulus. Especially if it is first introduced in standing posture (both systems seem to use a sort of neurodevelopmental hierarchy of posture progression). I don't think of the balloon as an intervention for this issue nor do I intend it to be portrayed as one for this post. I just wanted to highlight what happened when I myself activated IO's and TA's and brought my ribcage down into a better position. There was still more left to be desired after doing so.

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    3. Oh and I also wanted to thank you for commenting, Miguel.

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  2. This may be just me, but I'm seeing 1 of 3 things: Decreased DF and talocrural ER resulting in increased tibial IR, decreased knee flexion due to an over IR tibia, compensatory coxafemoral IR, stretching the piriformii resulting in sacral nutation, which is causing lumbar lordosis and then thoracic kyphosis. OR: inhibited TrA & multifidus resulting kypholordosis and an inhibited pelvic floor allowing CF IR, resulting in increased tibial IR. OR: something somewhere in the middle of those. No matter which of those 3 it is, or a combination of them, thoracic kyphosis is more likely a symptom than a problem.

    To that end, what I've seen from both FMS/SFMA and PRI would both tend to agree on this. The major thing is then how do we treat it? Do we treat TrA inhibition to ultimately cause the DF and talocrural ER to come along for the ride? Do we treat DF and ER to ultimately place the TrA in a sufficient position to allow it to activate? I would say "find the middle ground." In this day and age, both are probably to blame so treat them both.

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    1. Hi Timothy, thanks for commenting! Let me just begin by stating that the point of this blog post is not to discuss, dissect or diagnose my inability to squat. It was merely a commentary on PRI versus FMS goals to increase thoracic flexion or extension, respectively.

      Secondly, I am a little confused because the tibia needs to internally rotate for knee flexion so if knee flexion was limited it would be to a lack of tibial IR not an excess. Additionally, I am not sure what you are referring to by talocrural ER because the motion of the talocrural joint is dorsiflexion or plantar flexion.

      Nevertheless, you are correct about my decreased DF and I will be the first to tell you that I have a mobility issue there. Maybe I am totally wrong on these things and I'm not seeing what you are saying. I would agree that my poor ankle DF, decreased thorax mobility, and poor stability/motor control in certain areas are all definitely to blame. Not just one segment. However, once again that is beyond the scope of this discussion for this post.

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  3. Let me expand on my point a little bit more because I think I glossed over it a bit leading to your misunderstanding. My point is majorly in agreement with you that PRI and FMS are not at odds at what the problem is, but rather on how to approach the problem. (Though to be fair, I haven't gotten through all of the PRI coursework yet, so I may be off on that.) What I have gotten so far from the PRI is more of a core/breathing->out view, and FMS then also looks heavily at DF in addition to the core. Even if I am off on what is the main focus of each, they both take a holistic approach to function. My view is that they both have their value and both would probably be beneficial for a patient with a squat like yours. Therefore, it shouldn't be FMS vs. PRI, but rather FMS and PRI both will result in the desired effect (more function) and can be used together.

    The purpose of mentioning the chain reaction between the ankle and TrA was to show how one could cause the other. However, leaving your present example and thinking about our patients, who are most likely more sedentary than they should be, they probably have BOTH limited DF AND inhibited TrA/multifidus/diaphragm/etc. If they have both, treat both, or focus on one and give them a HEP focusing on the other. What I think your pictures do a good job in showing is that the core (as you mention) can force the LQ in to proper alignment (PRI does work). If you do this AND work on DF, maybe you get even better results than doing 1 or the other.

    Finally, and I will keep this brief since this is not the point of the article, as I know that you know, all joint motions are composed of roll, glide, and spin. At the ankle this can be thought of as IR and ER of the tib/fib on the dome of the talus. Some of the work by Gary Gray is a good resource for this, which you can find in the references of my thesis that I sent you.

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