When confronted by a patient recently as to "what their diagnosis was", I answered quickly, "Does it really matter?"  A second later, I silently thought to myself, "Whoa, what was that?"  However, after a short delay, I explained to the individual that it really doesn't matter.  What is diagnosis going to do anyway - other than give an existing dysfunction a name.  

You may be sitting there asking yourself where am I going with this.  Take the common shoulder diagnosis of impingement syndrome.  All too often, doctors will diagnosis a patient with impingement syndrome, and prescribe some antiinflammatory or NSAIDS.  What is missing in this diagnosis is an explanation as to what is causing the impingement.  Yeah, what's the reason doc?  There can be multiple causes for an impingement to be occurring at the shoulder.  Does the patient lack thoracic extension?  Is the deltoid overactive while the rotator cuff is inhibited?  Is there a cervical issue that is causing compromise at the glenohumeral joint.  Has the subscapularis become dormant from an overactive pec or lat or both?   Perhaps the opposite hip is the cause!These are just some of the factors that need to be assessed and identified as causative factors - and treated accordingly.

Move to the lower extremity.  Let's use Iliotibial Band Syndrome (ITB) as our example.  Runners and cyclists who come to me sometimes present with this condition in which there is a burning type of pain running down the lateral side of the thigh and commonly manifests itself as knee pain.  What's the big question that needs to be found out?  You got it - what is causing the ITB to be stressed?  Is it a overactive tensor fascia latae?  A glute medius/minimus that is shut down?  An inhibited psoas?  A tight psoas?  A tight vastus lateralis?  An inhibited VMO?  How about a weakened and inhibited external oblique?  Or does the ankle lack dorsiflexion range of motion?  The list goes on....Most likely it is a combination of two or more of the above.  One thing I can assure you of is that "stretching" the IT-Band is not going to fix it.  The IT-Band is not stretchable!  It is a tendon sheath and has the tensile properties of steel, but that is a discussion for another day and newsletter.

The point I am trying to make is that the goal is find the cause of the pain.  It is by finding the cause and properly addressing it that can resolve these and other painful syndromes people deal with.  It is by restoring optimal function to the body that will allow the body will heal and to heal quickly.  The body knows what to do.  It is a matter of creating the right environment for it to do its thing. 

An optimally functioning body (yes, the body works as a whole) ensures that movement is efficient and strain-free.  When the body is imbalanced and movement is not efficient the body is forced to compensate.  The body can only compensate for so long before it reaches the threshold and tells us something is wrong.  We all know how the body tells us this important message....pain!  Making sure the muscular system is balanced ensures minimization of tissue stress, optimal joint positioning, less joint wear and tear, and for those of you involved in sports, minimization of fatigue and faster recovery.    

Prevention goes a long way to assuring optimal functional relationships between and within muscles and groups of muscles.  Thoracic spine mobility is one of the most common deficiencies I see in my office.  It is critical to attain mobility in this part of the spine because of its impact on the nearby glenohumeral joint, A-C joint, cervical spine, and lumbar-pelvis complex. 

The following foam roller exercises give us a simple way to work towards developing thoracic spine mobility.  The nice thing about t-spine mobility is that almost no one has enough of it, and it is hard to get too much.  In fact, I believe thoracic spine mobility should be worked on every single day.  Here's how to do it in a couple of minutes a day. 

Exercise 1:  T-Spine Segmental Extension (top picture on left).  To perform, lay a foam roll on the ground perpendicular to your spine about 2-3 inches below the bottom of your shoulder blades.  Lie on the foam roll with your knees bent, butt and feet on the floor, and your abdominals tightened.  Place your hands behind or on the sides of your head and pull your elbows together in front of you (don't pull on the neck though).  While keeping your butt on the floor, extend backward as if you were trying to touch your head to the floor.  Inhale and exhale fully and return to the start position.  Do two reps in the first position, then slide the roll up an inch or two toward the neck and repeat the process.  You should be able to cover the entire thoracic spine in four segments of two repetitions each.  Make sure that the motion comes from your thoracic spine and not your lumbar spine.  Keep the foam roll out of the cervical and lumbar areas since these are NOT areas that need mobility work.

Exercise 2: T-Spine Extension and Rotation (middle picture on left).  To perform, assume a left side lying position with the right hip and knee flexed to 90 degrees and the left leg straight.  Rest the right knee on a foam roll to keep the pelvis level (the hips should be stacked on top of each other).  Rotate your trunk and head to the right pushing the left arm and palm toward the ceiling (this will activate the obliques).  Simultaneously, reach out a a 45 degree angle with your right arm with the palm facing your face.  Actively brace the abdominals and stabilize the pelvis and lumbar spine.  With the right arm reach outward and upward (lengthening the shoulder internal rotators) to rotate the thoracic spine for a count of two followed by a brief relaxation.  Repeat the sequence for 5-10 reps or until you achieve the mobility you desire for both sides.   

S.N.  I just had to add this side note....I couldn't let it slide by.  I am recommending the foam roll used as a prop for the knee for this mobilization for the following reason.  The overall angle of lumbar spine rotation is about 13 degrees (Sahrmann, 2002).  The rotation between each segment from T10 - L5 (thoracic 10th vertebrae - lumbar 5th vertebrae) is 2 degrees.  The greatest rotational range is between L5 and S1, which is 5 degrees (probably why the majority of issues lie at L5/S1).  This means the thoracic spine - NOT the lumbar spine - should be the site of greatest amount of rotation of the trunk.  I cringe every time I am in a gym and invariably see a trainer kneeling over their client holding the knee to the ground and cranking their arm up and over behind them.  The trainer is trying to force the body into a range that is not only not good for them, but theoretically not even supposed to exist.  When an individual practices rotational exercises, he or she should be instructed to "think about the motion occurring in the area of the chest."  To force the lumbar spine (low back) beyond the 13-15 degrees is not desirable.  In fact, beyond this you are probably compromising structural integrity and causing harm.