5 questions, 5 answers with Adam Wolf, PT, LMT
This month we are excited to feature Adam Wolf in our blog to get some ideas on how we can help our patient take care of their Thoracic Spine.
This week we are excited to feature Adam Wolf a clinician, author, and educator. His professional credentials include Licensure in Physical Therapy (IL) and Massage Therapy (IL), Fellow of Applied Functional Science (Gray Institute), Level III Neurokinetic Therapy (NKT) practitioner, Enhance Running Technician, & Functional Range Conditioning (FRC) practitioner. Adam presents internationally to fitness and rehabilitation professionals and is co-owner of REAL pt, located in Chicago, and is the author of the recently released book, REAL Movement: Perspective on Integrated Motion & Motor Control.
WebExercises: Why is it so important to take care of our thoracic spine?
Adam Wolf: Because it’s the crossroad of the body! I subscribe to the thought process that the site of the injury isn’t the cause of the injury. Most often people have pain in the neck, shoulder, low back, hip or knee. The t-spine directly touches three of those areas, specifically the cervical spine, shoulder complex and low back, while directly and indirectly influencing the pelvic complex and knees. For example, I know many endurance runners that are positioned into a thoracically flexed position, and after running longer distances become more flexed, or in a position I like to call a “human cashew”. When this happens, there is more stress on the posterior line of tissue, and from a joint perspective the hips, low back and specifically knees have more stress placed upon them.
For me, mobility and stability are opposite ends of the same spectrum. Gary Gray, PT teaches that each joint (defined as space between bones) needs the right amount of mobility & stability, or what he calls most ability, for whatever the specific task is.
I also think that mobility is different than flexibility, which to me is just hanging out in a ‘stretch’ passively at an end range; versus mobility, which is lengthening under load and working to control end range joint motion. Most of the time, I’m more interested in mobility instead of flexibility.
WebExercises: How can we increase thoracic motion?
Adam Wolf: There’s no simple answer, and reasons include positioning (someone staring at a computer screen for long stretches of time), or if breathing mechanics are off. Or maybe the reason the mid back is tight is because of a tight pelvis, as the thoracic spine and pelvis are, in my opinion, intimately related.
I find that often times people need to improve their ability to be extended, and also go through extension in this region. If they’re in a flexed position, and have a lengthened posterior line (and shortened anterior line), realizing that this area of the body responds quite well to tri-plane stretching, particularly in the frontal and transverse planes. I’ve found that improving the ability of the thoracic spine to side bend and rotate in the same direction, or what’s called Type 2 motion in traditional osteopathic literature, works quite well to improve extension moments as well as the ability to maintain extension.
I’ve also found that working on diaphragmatic breathing exercises can be quite helpful in improving overall thoracic mobility. One of the things that I’ve extrapolated is that it’s quite important to be able to take a deep diaphragmatic breath (ideally through the nose) without moving from the spine on the inhale/exhale. I believe that often times those demonstrating this inability are the one’s labeled as having a ‘weak core’. I teach people to take deep, diaphragmatic breaths, ideally through the nose, especially with long slow exhales though the nostrils, which vibrates the cilia (nose hairs) which works to stimulate parasympathetic responses and improve the ability to learn new behaviors, which is important for those in pain (who are running sympathetic in nature already).
All these are potential reasons for lack of thoracic motion, but it just as easily could be emotionally driven, as introverts and those in distress tend to stand in this thoracically flexed “kyphotic” position. Remember, mind/body/spirit (or if you prefer bio/psycho/social, or physical/behavioral/biological) influences must be recognized with those requiring improved thoracic extension, which most often is those in pain.
WebExercises: What are your go-to exercises to increase thoracic mobility?
Adam Wolf: It depends! I like to improve thoracic extension through type two exercises, which is positioning the thoracic spine into side bending and rotation towards the same direction via the hands as drivers (a driver is a way to create a reaction). From there, I like to drive the pelvis in three planes of motion to CREATE reactions into the thoracic spine above (and hips/legs below).
If breathing is also something I work on, I like to modify a childs pose by positioning into a type two position and adding specific nasal breaths.
WebExercises: What are your go-to exercises to increase thoracic stability?
Adam Wolf: As I’m sure you can guess already, it depends on why their limited to begin with. I like lunges/steps with reaches to various positions in space, or a more dynamic/active stretch described above. I also like some traditional ‘yoga’ type positions, especially transitioning from a ‘plank’ position to a down dog position, and vice versa. When performed properly, this movement creates thoracic extension at both ends, while also being stabilized.
WebExercises: Do you prescribe exercises patients can do at home? How important is that to achieve your desired outcomes?
Adam Wolf: It depends! If people hate exercising with me, they never get a home exercise program, they get a home movement program, because I recognize that exercise is optional, but movement is essential, and when we stop moving we die. For me, words matter. Typically, I like to have people do no more than 1-2 movements as homework, because if I assign too many they won’t do any of it. However, if I can assign THE 1 or 2 that are necessary, which I typically prescribe often throughout the day at a low intensity, I find that they’re more likely to do it. I feel that home movements, or specific movements for the individual performed specifically, is quite important. I feel that most times what I do is create neurological opportunities or “windows” for someone to connect more or less with a specific region (most of the time it’s both, connecting less to one part and more to another). For the window to stay open longer, and the person to learn the new neurological task or behavior, this requires low intensity repetition.
The WebExercises Story:
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