Fix Your Back, Free Your Shoulders: The Thoracic Connection

As a physical therapist, I regularly see the consequences of prolonged sitting and sedentary lifestyles—one of the most common being increased thoracic kyphosis. This rounded upper back posture not only limits shoulder mobility but also contributes to painful conditions like shoulder impingement. Add in the rotational demands of everyday life and recreational activities, and it’s easy to see how stiffness in the thoracic spine can lead to a cascade of compensatory movement patterns and overuse injuries.

For patients experiencing shoulder pain or limited overhead motion, restoring thoracic mobility—particularly extension and rotation—is often a critical part of the treatment plan. The good news? With consistent, targeted mobility work, we can make measurable improvements.

Below are several thoracic mobility exercises I often prescribe, whether as part of a warm-up, active recovery, or daily movement routine. Each helps restore movement through the mid-back and reduce strain on the shoulders and neck.

1. Foam Roller Thoracic Extensions

Why it helps: Encourages segmental thoracic extension, improving posture and shoulder range of motion.

How to perform:

• Lie on your back with knees bent and feet flat.

• Position a foam roller horizontally under your upper back, just below your shoulder blades.

• Support your head with your hands, elbows forward.

• Engage your core to stabilize the ribcage and slowly extend over the roller.

• Avoid excessive arching from the lower back—focus the movement in the thoracic spine.

• Repeat 1–5 times in one spot, then shift the roller slightly higher and continue up the back.

2. Thoracic Extension on a Bench

Why it helps: Opens up the thoracic spine and shoulders, especially before overhead pressing or pulling movements.

How to perform:

• Kneel beside a bench, holding a dowel or PVC pipe with palms facing up.

• Place your elbows on the bench, then hinge at the hips and lower your chest toward the floor.

• As your hips rock back, let your head drop between your arms.

• Keep your core braced and gently extend the upper back.

• Reset by returning forward, then repeat 5–10 times with control.

3. Thread-the-Needle (Quadruped Thoracic Rotation)

Why it helps: Improves thoracic rotation while keeping the lumbar spine stable.

How to perform:

• Start on hands and knees. Shift your hips slightly back to stabilize your lower spine.

• Reach one arm underneath the opposite arm, allowing your torso to rotate and follow your hand with your eyes.

• Pause at end range, then reverse the motion and open the chest, reaching the hand toward the ceiling.

• Focus on smooth, controlled movement. Repeat 5–10 times each side.

4. Side-Lying Open Book

Why it helps: Promotes thoracic rotation while isolating movement from the lumbar spine.

How to perform:

• Lie on your side with knees bent to 90° in front of you and hands together in front of your chest.

• Keep your knees and hips stacked and glued together—this protects the lower spine.

• Slowly open the top arm, rotating it behind you while keeping your gaze on your moving hand.

• Pause in the open position, then bring the arms back together.

• Repeat 5–10 times, then switch sides.

Integrating These Movements

I often recommend these exercises as part of a dynamic warm-up, between strength sets, or as movement breaks during long periods of sitting. They’re particularly useful before workouts involving overhead lifting or activities requiring rotation (like golf, tennis, or throwing sports).

Keep in mind: thoracic mobility gains are often temporary unless reinforced regularly. Consistent practice—several times per week—is the key to long-term change.

When we restore proper movement in the thoracic spine, we’re not just improving flexibility—we’re addressing the root cause of many shoulder and neck issues. A mobile, upright thoracic spine supports better posture, reduces compensatory stress on adjacent joints, and helps my patients move and feel better.