(Editor’s Note: this is a guest blog from our friend Dr. Chris Feil of Team Chiropractic and Rehabilitation of Ames.)
If the internet has done one thing for the world, it has made average people into “experts” on almost any topic with just a few clicks. My personal area of internet pseudo expertise is in the field of auto mechanics (just ask my wife how many times I’ve tried to save money fixing the car myself). It seems so easy on Youtube, and message boards always have creditable information, right? The same can be said for fitness and sport injuries information on the web. I believe the majority of content on the web is generally reliable (you are most likely reading this online), the problem starts when fundamentals are glossed over or basic concepts are assumed. In the world of functional exercise a great deal of attention is placed on athlete’s injuries, but not enough time and emphasis is spent on correct posture to prevent injuries.
As CrossFit coaches and organizations push to continually challenge and vary workouts, one of the undervalued fundamentals of shoulder and spinal health, is the posture of the thoracic cage. I believe if coaches and athletes spent more time focusing on the posture and movement of the thoracic cage during exercise, several shoulder and spinal injuries could be prevented. Believe it or not, by simply observing the positioning (posture) of the thoracic cage prior to an individual preforming an exercise, you can estimate how successful they will be at performing the exercise.
My novice ability to fix a car is the perfect analogy as to why the position of the thoracic cage is so important during exercise. A few years back I needed new brake pads for my car, so I pulled up a trusty YouTube video, ordered my parts online, and took on the automotive challenge in the driveway of my new house. As I jacked up the car, I failed to notice that the driveway at our new house had a slight slope compared to our old driveway. Just as I removed the second front tire, the car began to slowly lean backwards. I jumped away as the car slipped off the car jack and crashed to the ground. In this analogy, the sloped driveway represents the thoracic cage, the jack represents the scapula (shoulder blade), and the car is the shoulder. In the rehab world, a great deal of emphasis is placed on “scapular stability” to help injured shoulders. I am here to tell you that scapular stability is functionally impossible to obtain if the thoracic cage is out of position. The bigger the slope in the driveway, the more unstable the car jack is!
The thoracic cage consists of the spinal bones of the mid back (thoracic spine), the attaching ribs, and all of the muscles that attach to the bones and cartilage. The accepted term for faulty positioning of the thoracic cage is a “rib flare”.
Picture taking a deep breath into your lungs and holding it; the resulting rib position would be an example of a rib flare.The entire rib cage is elevated and the base of the front of the rib cage is protruded forward and out. Functionally this causes a lot of compromise in the body:
- The elongated posture of the rib flare causes a functionally long/weak core muscle.
- Hyperextended lumbar posture due to elevated thoracic cage and disengaged core muscles
- Rounded shoulders because the scapulae will try to maintain a vertical position to ground level at all times, this causes the scapulae to elevate and lose full contact with the thoracic cage wall
Why does a rib flare commonly occur in functional exercises like pull-ups, squats, pushups and overhead pressing? I think the number one reason people continue to exercise with a rib flare is that it provides “passive” stability when preforming explosive movements. “Active” stability is achieved by correct activation of stabilizing muscle groups in the region. For example: the abdominals and the muscles of the mid back. If the stabilizing muscle groups are inactive or weak, athletes will start to use the end range positions of their joints to provide a base of support for their body as they exercise. Meaning, the lower back joints lock into hyperextension and a rib flare causes the thoracic cage to become rigid and compressed, all to make up for a lack of active muscular stability. There are a few problems with this postural fault:
- A great deal of stress is placed on the joints of the lower back
- The middle back loses its ability to rotate due to the stiffening of the thoracic cage
- The scapulae are moved out of a position of stability, increasing strain on the actual shoulders.
When I went back and re-watched the automotive YouTube videos after dropping my car, of course I saw there were blocks behind the tires when they jacked up their car. A slight detail that I originally overlooked. Now, anytime that I jack up the car I place blocks under the tires to prevent the car from rolling down the driveway again. Going back to the shoulder analogy, the “tire blocks” represent our rotator cuff muscles. The number one job of the cuff muscles is to keep the shoulder stable in its socket. Athletes always ask me why their cuff muscles are tight and sore. I tell them it’s because of their posture; they usually give me a funny look. After a few visits they start to understand positioning the thoracic cage correctly during activity, enables the scapulae to stabilize in the thoracic wall, greatly reducing the stress in the lumbar spine and rotator cuffs.
Correcting a rib flare may be as simple as tightening the core muscles to pull the rib cage back down prior to and during an exercise. But, in an athlete that has had a rib flare for several years, it may take longer to correct the problem. First they have to regain the mobility of the thoracic spine and rib cage. The best way to combat a long-term postural problem is a ton of foam rolling (don’t forget to roll out the ribs) and dynamic mobility exercises. The mobility exercises must be followed up with a retraining program targeting core, glute, and scapular muscle activation and strength. Video analysis can be used to help the athlete visualize correct posture during exercise too.
In summary: Strengthen your core and do more mobility work on your thoracic cage. Do not constantly hyperextend your lower back and flare your ribs when exercising. Be sure to pay attention to details, and most importantly, never let me fix your car!
-Dr. Chris Feil
Team Chiropractic and Rehabilitation of Ames