IS YOUR THORACIC SPINE LIMITING YOUR OVERHEAD PRESS?

INTRODUCTION

If there are three areas’ that demand mobility and are problematic for many athletes, it’s the ankle, hip and thoracic spine. Now, this is a massive over simplification and is entirely specific to the demands of the activity the athlete is attempting to perform. However, if the athlete wants to get strong in the weight room, the mobility of at least one of these three joint segments will be a prerequisite for performing the movements in an efficient and safe manner.

Although the thoracic spine plays an important role during lower body exercises such as the deadlift or squat, it is a huge determinant on the performance of upper extremity exercises – particularly if they involve overhead reaching (i.e. Overhead Pressing and Pull Ups). Here are just a few issues (with hyperlinks to the relevant studies) poor thoracic spine alignment can cause as they relate to shoulder movements:

• Thoracic spine hypomobility can limit shoulder ROM during overhead reaching tasks by more than 20˚.
• The inability to extend the thoracic spine can also limit shoulder strength during overhead tasks.
• Limited thoracic extension during overhead tasks (such as Overhead Pressing and Pull Ups) can negatively disrupt scapulohumeral rhythm which is the dynamic movement relationship between the glenohumeral and scapulothoracic joint and pretty important for shoulder health.
• Upward rotation of the scapula, which is vitally important to support overhead movements, is phase locked with thoracic spine extension and therefore, dependant on thoracic movement.
• The thoracic spine also supports posterior rotation of the scapula during shoulder elevation, which is required to alleviate impingement of the subacromial tissue.

As we can see, thoracic extension is important. If you’re trying to improve your overhead strength, the evidence here would suggest that thoracic spine movement is a major player in supporting performance. This article will therefore suggest a strategy to identify limited thoracic spine mobility, as well as to improve it for Overhead Pressing.

 ASSESSING THORACIC MOBILITY

During overhead lifting tasks, if the thoracic spine is unable to extend to a sufficient degree, then the shoulder complex will likely be impacted in its performance (as discussed above). Barbell Overhead Pressing can require up to 150˚ of shoulder flexion, with dumbbell variations likely demanding more due to the hands being positioned closer together at the end of the ascent phase. Although research has indicated approximately 10˚ of thoracic extension is required during bilateral shoulder elevation, this amount will change depending on the athletes start position. If an athlete begins their Overhead Press in a position of thoracic hyperkyphosis, then they’ll need more extension to get their shoulder complex into a good place. Likewise, if their thoracic spine is already extended, then little to no thoracic spine extension will be needed.

Figure 1. Bilateral shoulder elevation test (BSET).

In order to test thoracic extension, ask the athlete to perform the bilateral shoulder elevation test (Figure 1). You can measure thoracic extension with this test in two different ways:

1. You can use hand held inclinometers (Figure 2)
2. You can eye-ball thoracic spine alignment and decide if it gets to where it needs to at the end of the shoulder elevation.

Figure 2. BSET using two inclinometers to measure thoracic extension.

If the athlete fails to achieve 180˚ of shoulder elevation and you establish that the thoracic spine doesn’t extend enough to support the motion, you can test the mobility of the thoracic spine using the Occiput-to-Wall test (Figure 3).

Figure 3. Occiput-to-wall test.

During the Occiput-to-Wall test, ask the athlete to roll their pelvis posteriorly so their lumbar spine is flat against the wall (moving the feet a foot or two forward helps with this as it takes the slack of the hip flexor musculature). From here, the athlete attempts to touch their head against the wall with their chin tucked in (corner of the eye in line with the superior junction of the auricle). If they can achieve this position, they have pretty good thoracic extension and just don’t know how to use this extension during shoulder elevation. If not, they need to chase mobility with a corrective programme.

This process for screening and improving overhead performance is illustrated in Figure 4.

Figure 4. Screening process for the BSET.

INCREASING THORACIC MOBILITY

When selecting mobility exercises, there is one primary principle that I think everyone should adhere to within reason. That is, you need to know if the mobility exercise and technique works. This sounds obvious, but there are so many S&C coaches who don’t follow this general guideline, failing to establish if what they are doing has any benefits for their individual athlete. The only way to do this is to test for mobility, try an intervention, and then re-test mobility. If you don’t see changes, what you did doesn’t work.

This doesn’t mean you need to do a different exercise. It might mean you need to change the dosage, the way they performed the actual movement, or apply a different technique (i.e. go from a static version to a Muscle Energy Technique). But whatever you do, check to see if the athlete’s performance on the test got better. Using this strategy will allow you to individualising the process.

In the context of this example, if I had an athlete with poor thoracic extension, I could have them perform the Occiput-to-Wall test, then perform a thoracic extension mobility exercise, then re-check their Occiput-to-Wall.

When it comes to establishing the prescription of acute variables, I recommend starting with as low a dosage as possible in order to establish what is the least amount the athlete can do but still get results. From here, if you find you can increase thoracic spine extension acutely with the mobility exercise in Figure 5 using 5 reps of 10 seconds hold (as an example), then prescribe that technique. If you find nothing changes after a few adaptations of the approach, switch the exercise or drastically change the technique (e.g. try long sustained holds).

Figure 5. Bench thoracic spine mobilisation.

The same strategy should be used when it comes to selecting the optimal frequency. Once you know the acute dosages, have the athlete start by doing their mobility exercises three times per day. After 3-5 days, re-test their Occiput-to-Wall. If there is no improvement, up the frequency – especially if you’ve established that the volume is sufficient for a single bout.

Another consideration is specificity. If you want to increase thoracic extension, do thoracic extension exercises. In my own experience, I’ve never seen thoracic rotation exercise increase thoracic extension to the same degree as an extension based exercise.

THE LAST PIECE OF THE PUZZLE

Once mobility has been improved, you need to teach the athlete how to use it. Through my own research, I found that if you just mobilise a joint, you’ll increase ROM but it won’t have any impact on movement quality in multi-joint dynamic tasks. This tells us that increasing thoracic extension won’t necessarily lead to immediate increases Overhead Pressing performance, at least acutely. We need to teach the athlete to use their new found ROM. The approach I suggest to accomplishing this is as follows:

1. Teach them to use their new found ROM in isolated tasks. This will likely start in unloading positions that look nothing like the Overhead Press. The performance of these movements will unlikely transfer to the Press, but the athlete needs to know what it feels like to extend their thoracic spine. To start with, this will involve an isolated approach where the thoracic spine is the only segment contributing to the movement. From here, bringing the neighbouring segments (i.e. the shoulder complex) into the movements will teach the thoracic spine to function within the chain of joint segments. This can take a few minutes or a few weeks based on the athlete.
2. Find their success threshold in the specific movement you want to improve. Now they know how to extend their thoracic spine, we need to incorporate this strategy into the Overhead Press. The prescription of acute variables will be dictated by the athlete’s ability to achieve an optimal position of thoracic extension. This means finding a load and rep-set scheme that allows the athlete to successfully incorporate their new movement strategy into their Overhead Press.
3. Challenge the threshold. This may mean you add load, volume, density or complexity to the movement. Anything that challenges them, whilst maintaining a level of success will lead to progression in the pattern.

SUMMARY

Exercises that include overhead movements demand thoracic extension. Therefore, thoracic spine issues can be a serious problem for athletes in the weight room. When ROM limitations are observed, coaches need to improve thoracic mobility using an evidence-based approach(does what you’re doing work?). From there, integrating the new found motion into the athlete’s overhead movement strategies is not an automatic process. Learning to use the mobilised thoracic spine as part of Overhead Pressing is paramount to being successful in optimising performance. This article has presented a number of tools that will help improve an athlete’s thoracic spine mobility, specifically as it relates to Overhead Pressing.

ANKLE MOBILITY OR SPINE EXTENSOR STRENGTH – WHAT’S MESSING UP YOUR SQUAT?

INTRODUCTION

Strength and Conditioning coaches seem to love looking at things in isolation (obviously generalising here!), as do physio’s (again, a massive generalisation and definitely not always the case). In fact, in my experience, the more a rehab orientated position you come from, the more this is the case when viewing technical faults in lifts like the squat and identifying the cause. It’s understandable, as this is quite an easy approach.

Here are a few examples of what I mean as they relate to the squat exercise:

• Knee’s cave in (valgus) = weak glutes
• Pronate at the feet = weak supinators (i.e. TA, TP, FHL, FDL, etc.)
• Go on to your toes during the descent = lack of ankle mobility
• Round your back during the descent = weak spinal extensors or lack of thoracic mobility

While each of these can be the case, they definitely aren’t the only driver. In fact, in my opinion they are rarely the cause. The reason I say this is as we view an athlete’s squat from a technical standpoint, we need to appreciate each joint complex relative to the other. From this perspective, we need to understand that what any joint does during the movement will impact the other joints in the system.

This is due to the demand of the task. Using the squat as an example here, the demands of the movement (and nearly all other movements) require us to keep our centre of mass (COM) over our base of support (BOS). If this doesn’t happen, we fall over. During the descent of the squat, if the ankles don’t dorsiflex and the knee and hip joints continue to flex, we fall over (Figure 1B).

Figure 1. The effects of ankle dorsiflexion ROM on the position of the COM relative to the BOS.

This information makes it lots more challenging to identify who is the primary driver (this is a concept that Diane Lee made me aware of – I heavily recommend some of her online material). Therefore, if we see the spine flexing excessively during the squat, it might not be spinal extensor weakness. It also might not be a tight posterior chain.

In the example here, I’ll use this concept to identify how restrictions in ankle dorsiflexion can impact spinal position during the squat, along with how we can identify this cause as a primary driver.

WHERE TO START

Whenever we view a movement, the first thing we need is to understand what the movement should look like. If we don’t know what the movement should look like, how can we know if the movement the athlete shows us is good or not? And by good or not, I mean is it a movement that will allow the athlete to develop physical qualities or expose them to unnecessary risk.

So we need a technical model. There are a ton of places you can get this information from – my starting point is always SCJ or PSCJ as this siv’s through a lot of the misinformation that is available online. An example of misinformation is when coaches tell us people should squat with their feet facing forward. This strategy is not only problematic; it can be dangerous as we fail to consider the individuals anatomical variations.

As it relates to the bottom position of the squat, we know that we should be able to dorsiflex the ankle to approximately 30-40°, flex the knee to approximately 120-130° and flex the hip to about 130-140°. The reason I say approximately is because this is pretty heavily determined by an athlete’s anthropometric profile. Some people may need more ankle motion relative to their hips to break parallel; others may need more hip mobility relative to their ankles.

Importantly, these are the only joints that contribute to us lowering our COM during the descent. This means one thing: if your squat is technically poor, one or more of these joints are the problem. This is always the case unless another segment is moving which shouldn’t be.

IDENTIFYING ISSUES

Once we know what movements should look like, now we can compare our athlete to our “model”. If major discrepancies exist, all we need to do is identify what joint is not doing as it should. So, say for example an athlete leans forward excessively with their trunk in the bottom position, and we look at the hip and they hit >130° of flexion, we look at the knee and they are <120° and the ankle is nowhere near 30°, we can comfortably say the hip is good (in terms of mobility) but the ankle and knee ROM is limited. The next thing for us to do is see whether it’s the ankle, the knee or both that is impacting the squat.

An easy way to do this is to manipulate the task to take the demands away from one of those joints. For example, if you do a pole squat where the athlete doesn’t need a use as much ankle dorsiflexion ROM (due to being able to lean back on the pole), and their knee flexion improves beyond 120°, the knee has the available ROM and the ankle is implicated as the cause for the forward trunk lean. If not, knee flexion ROM is an issue.

Another commonly used method to establish the primary driver is to elevate the heels. If this increases ROM at the knee (by giving the athlete artificial dorsiflexion ROM), ankle dorsiflexion is likely the issue.

The only problem with this thought-process is that it is most times not this simple. For example, an athlete may look like they can get the ankle to dorsiflex to 30° at the bottom of the squat, but they also go into a knee valgus to do this. In this case, the knee valgus is likely being combined with pronation at the foot complex (due to joint coupling). This pronation allows the midtarsal joint to unlock and the tibia to continue moving forward. If this is combined with the feet spinning out into external rotation (a very common strategy), then it may be that the subtalar joint is also helping out by using eversion to keep the tibia moving forward into what appears (but isn’t) to be ankle dorsiflexion. You can read more about this from some of the articles on my reasearchgate.

This is why we have to always consider movements that may be occurring outside of sagittal plane. The frontal and transverse plane compensations can hide the real issue if we don’t look carefully.

SO HOW CAN THE ANKLE DRIVE SPINAL FLEXION DURING THE SQUAT?

If the ankle can’t dorsiflex to the necessary angle during the descent of the squat, this will increase the demands higher up the chain. This is due to the relationship that I previously discussed between the position of the COM and the BOS. Figure 1B shows that during the squat, if an ankle doesn’t dorsiflex and the knee and hip flex as they should, the will move posteriorly relative to the BOS – the end result being the athlete falls over. The athlete’s survival system will obviously not allow this to happen (although with some athletes this does happen – I wish I had £1 for every athlete or student I’ve seen fall or stumble backwards on their first attempt of an overhead squat).

So the athlete will compensate. They’ll do this by using any strategy they have access to. This might be to extend at the shoulder complex if the movement is the overhead squat and the arms are free to “roam” (as in Figure 1C). However, when the arms are constrained during a movement such as the front squat, another segment is required to help out, and there’s no better segment than the thoracic spine for this job due to it’s location.

As the athlete squats down and the ankle’s stop dorsiflexing, the hips run out of ROM to compensate, then the thoracic spine will have to flex excessively which moves the barbell weight and upper torso mass forward. This strategy results in the the COM staying over the BOS.

Now the traditional view would be to look at this and say thoracic hypomobility or lack of thoracic strength issues exist – and it definitely could be the case. But it could also be nothing to do with lack of mobility or strength at the t-spine. Here are 3 ways to check this.

1. If they can get into a good position with the thoracic spine in the start position, it’s not a lack of mobility – you can pretty much cross that one off your list. If they were stuck in a position of hyperkyphosis, this wouldn’t change in regards to where they are in their squat movement. You can test thoracic mobility with an Occitput-to-Wall test (check out my t-spine paper of researchgate for this test).
2. Look at other lifts. If they don’t round at the thoracic spine in more hip dominant lifts such as the RDL or good morning, it’s not a lack of spine extension strength. These lifts don’t require ankle mobility but put high force demands on the spinal extensors.
3. Manipulate the ankle position. A simple one here is to elevate the heels and see if the thoracic spine still flexes during the descent, or flexes later in the movement. If this prevents spinal flexion from occurring, then it is likely an ankle mobility issue. Another little trick I like to test this hypothesis is to go the other way round – elevate the forefoot (1 inch block is all you need here). If this makes the thoracic flexion worse by either making it occur to a higher degree or earlier in the descent phase, then it’s an ankle joint limitation. Bet your house on it. Especially if you can check number 1 and 2 off the list.

SUMMARY

Hopefully I’ve highlighted or at least reinforced with this article an important concept regarding viewing movement as a whole and not in isolation. In later blogs I’ll talk about how we can screen ankle and thoracic mobility, as well as showing some of the things we can do to improve movement quality.