Thoracic Spine Mobility: How to Fix Upper Back Stiffness

Your thoracic spine—the twelve vertebrae of your mid and upper back—is one of the most neglected yet critically important areas for athletic performance and everyday comfort. When this region becomes stiff and immobile, the consequences ripple throughout your entire body: shoulder problems, neck pain, lower back compensation, and severely limited overhead movements.

For calisthenics athletes, thoracic spine mobility isn't optional—it's foundational. Without adequate t-spine mobility, handstands become impossible, muscle-ups become dangerous, and even basic movements like pull-ups suffer. The good news? Upper back stiffness is highly correctable with targeted mobility work.

This comprehensive guide covers everything you need to know about thoracic spine mobility: why it matters, what causes stiffness, how to assess your current mobility, and the most effective exercises to restore full function.

Why Thoracic Spine Mobility Matters

The Anatomy of the Thoracic Spine

The thoracic spine consists of 12 vertebrae (T1-T12) located between the cervical spine (neck) and lumbar spine (lower back). Unlike the highly mobile cervical spine or the stability-focused lumbar spine, the thoracic spine is designed for a balance of both.

Key characteristics:

• Rib attachments: Each thoracic vertebra connects to a pair of ribs, which inherently limits some movement but provides stability for vital organs
• Natural kyphosis: The thoracic spine curves slightly outward (kyphotic curve), typically 20-45 degrees
• Movement capabilities: The thoracic spine is designed for rotation, flexion, extension, and lateral flexion

What makes thoracic mobility unique:

The thoracic spine should be the primary contributor to spinal rotation and a significant contributor to extension. When it loses mobility, other regions—particularly the lower back and shoulders—must compensate, often leading to injury.

The Modern Thoracic Mobility Crisis

We're experiencing an epidemic of thoracic stiffness. Consider the average day:

• 8+ hours sitting at a desk or driving
• 3+ hours looking down at phones and tablets
• Minimal time in positions requiring thoracic extension or rotation

This sustained flexed posture causes adaptive shortening of anterior structures (chest, anterior shoulders) and lengthening/weakness of posterior structures (upper back muscles). The result? A stiff, immobile thoracic spine that struggles to extend or rotate.

Health Consequences of Poor Thoracic Mobility

1. Shoulder Impingement and Injuries

Limited thoracic extension forces the shoulder to compensate during overhead movements. When you can't extend through your t-spine, the shoulder must hyperextend, increasing impingement risk and rotator cuff strain.

2. Neck Pain and Headaches

A stiff thoracic spine often accompanies forward head posture. For every inch your head sits forward, neck muscles must work exponentially harder, leading to chronic tension, cervicogenic headaches, and upper trapezius pain.

3. Lower Back Pain

When the thoracic spine can't rotate, the lumbar spine compensates—but it's not designed for significant rotation. This leads to facet joint irritation, disc stress, and chronic lower back pain.

4. Breathing Dysfunction

The thoracic spine houses the rib cage. A stiff, flexed t-spine restricts rib expansion, limiting lung capacity by up to 30%. This affects athletic performance and recovery.

5. Reduced Athletic Performance

Nearly every athletic movement requires thoracic mobility: throwing, swinging, pressing overhead, and rotational power generation. Stiffness creates energy leaks and movement compensations that limit performance and increase injury risk.

Understanding spinal anatomy is crucial for movement quality. Our free Anatomy Course includes detailed lessons on the vertebral column and how different spinal regions work together.

Common Causes of Upper Back Stiffness

Understanding what causes thoracic stiffness helps you address root causes, not just symptoms.

1. Prolonged Sitting and Desk Work

The biggest culprit. Sitting promotes thoracic flexion (rounding), shortens the pectorals and anterior shoulder structures, and weakens the thoracic extensors over time. Eight hours of sitting undoes the benefits of one hour of exercise.

2. Smartphone and Device Use

"Tech neck" involves looking down at devices for extended periods. This position encourages thoracic flexion and forward head posture, creating adaptive stiffness over months and years of accumulated screen time.

3. Aging and Natural Degeneration

Intervertebral discs lose hydration with age, reducing space between vertebrae. Facet joints may develop arthritic changes. Without active mobility work, age-related stiffness accelerates significantly after 40.

4. Poor Training Programming

Many training programs overemphasize anterior muscles (chest, front deltoids) while neglecting the posterior chain. This muscle imbalance pulls the shoulders forward and encourages thoracic flexion.

Common programming mistakes:

• Heavy bench pressing without equal rowing volume
• Neglecting thoracic extension exercises
• Skipping mobility work entirely
• Not including rotational movements

5. Breathing Pattern Dysfunction

Chest breathing (rather than diaphragmatic breathing) creates chronic tension in accessory breathing muscles around the neck and upper back. Over time, this contributes to thoracic stiffness.

6. Stress and Emotional Factors

Psychological stress manifests physically as hunched posture and elevated shoulders. Chronic stress keeps these muscles in a state of tension, contributing to stiffness and restricted mobility.

7. Previous Injuries

Past injuries to the ribs, spine, or shoulders can create protective guarding patterns that persist long after healing, leading to chronic stiffness in the thoracic region.

8. Sleeping Position

Sleeping in fetal position (curled up) for 6-8 hours nightly reinforces thoracic flexion. Combined with poor daytime posture, this accelerates stiffness development.

Thoracic Mobility Assessment: Test Yourself

Before starting a mobility program, assess your current status. These tests identify specific limitations and help track progress.

Test 1: Wall Test for Thoracic Extension

How to perform:

• Stand with your back against a wall, heels 4-6 inches from the wall
• Press your buttocks and upper back against the wall
• Try to touch the back of your head to the wall
• Keep your chin tucked (don't extend the neck to reach)

Results:

• ✅ Head touches wall easily with chin tucked: Good thoracic extension
• ⚠️ Head touches but chin must lift: Adequate but needs improvement
• ❌ Head cannot touch wall: Limited thoracic extension
• ❌ Lower back arches excessively to reach: Significant limitation with compensation

Test 2: Seated Thoracic Rotation

How to perform:

• Sit on a chair or bench with feet flat on floor
• Cross arms over chest, hands on opposite shoulders
• Keeping hips facing forward, rotate your torso to one side
• Measure how far you can rotate (use a wall or mirror for reference)

Results:

• ✅ Can rotate 45-50+ degrees each side: Excellent rotation
• ⚠️ 30-45 degrees: Adequate
• ❌ Under 30 degrees: Limited rotation
• Note any asymmetry between sides

Test 3: Quadruped Thoracic Rotation

How to perform:

• Start on hands and knees
• Place one hand behind your head
• Rotate your elbow toward the opposite arm, then rotate upward toward the ceiling
• Compare range of motion on each side

Results:

• ✅ Elbow points toward ceiling (90+ degrees from floor): Excellent
• ⚠️ Elbow reaches 60-90 degrees: Adequate
• ❌ Elbow below 60 degrees: Limited rotation
• Pay attention to where you feel restriction

Test 4: Foam Roller Extension Test

How to perform:

• Lie on your back with a foam roller perpendicular to your spine at mid-back level
• Support your head with your hands, elbows pointing forward
• Let your upper back extend over the roller
• Note your range of motion and any discomfort

Results:

• ✅ Can extend comfortably with head near floor: Good extension
• ⚠️ Some extension possible but feels very tight: Moderate limitation
• ❌ Cannot extend or significant discomfort: Severe limitation

Test 5: Overhead Reach Test

How to perform:

• Stand against a wall with lower back pressed flat
• Raise both arms overhead, trying to touch thumbs to the wall
• Keep lower back pressed against wall (no arching)
• Keep elbows straight

Results:

• ✅ Thumbs touch wall easily: Good overhead mobility
• ⚠️ 1-3 inches from wall: Moderate limitation
• ❌ 4+ inches from wall or back arches: Significant thoracic extension limitation
• ❌ Must arch lower back to reach: Compensation pattern

When to Seek Professional Help

Consult a physical therapist, chiropractor, or sports medicine physician if you experience:

• Sharp or radiating pain during assessment
• Numbness or tingling in arms or hands
• Pain that worsens with movement
• Significant asymmetry with pain on one side
• No improvement after 8-12 weeks of consistent mobility work
• History of spinal injury or surgery

The Best Thoracic Mobility Exercises

These exercises are organized from foundational to advanced. Start with the first section and progress as your mobility improves.

Foundational Exercises (Start Here)

1. Thoracic Foam Roller Extensions

The single most effective exercise for thoracic extension.

How to perform:

• Lie on your back with a foam roller perpendicular to your spine at mid-back (around T6-T8)
• Bend your knees, feet flat on floor
• Support your head with your hands, elbows pointing up
• Slowly extend backward over the roller, letting your upper back arch
• Hold the extended position for 2-3 breaths
• Roll the foam roller up slightly and repeat at the next segment
• Work from mid-back to upper back (never onto the neck)

Key points:

• Keep your hips on the ground—don't let them lift
• Move slowly and breathe into the stretch
• Spend extra time on stiff segments
• Perform 2-3 minutes daily

Progression: Use a firmer roller or double lacrosse balls taped together for more targeted pressure.

2. Cat-Cow with Thoracic Focus

Teaches segmental spinal movement and improves flexion/extension.

How to perform:

• Start on hands and knees, wrists under shoulders, knees under hips
• Cow (Extension): Inhale, drop your belly toward the floor, lift your chest and tailbone, look slightly up. Focus on extending through the thoracic spine, not just the lower back
• Cat (Flexion): Exhale, round your spine toward the ceiling, tuck your chin and tailbone
• Move slowly, spending 3-5 seconds in each position
• Consciously try to move each vertebra sequentially

Key points:

• Avoid rushing—slow, controlled movements are more effective
• Focus on the mid-back region, which tends to be stiffest
• Perform 15-20 repetitions daily

3. Thread the Needle

Excellent for thoracic rotation.

How to perform:

• Start on hands and knees
• Reach your right arm under your body, threading it through the space between your left arm and left knee
• Let your right shoulder and temple rest on the ground
• Feel the stretch through your upper back and between your shoulder blades
• Hold for 20-30 seconds
• Return to start, then reach your right arm up toward the ceiling, rotating your torso and following your hand with your eyes
• Hold for 5-10 seconds
• Repeat sequence 5-8 times per side

Key points:

• Keep your hips stacked over your knees throughout
• Reach as far as comfortable—don't force the stretch
• Exhale as you reach through, inhale as you open up

4. Open Book Stretch

Targets thoracic rotation while stabilizing the lower back.

How to perform:

• Lie on your side with knees bent at 90 degrees, stacked on top of each other
• Extend both arms in front of you at shoulder level, palms together
• Keeping your knees stacked (bottom arm can hold them in place), rotate your top arm up and over, opening your chest toward the ceiling
• Follow your hand with your eyes
• Let your upper back rotate while your hips stay still
• Hold for 5 breaths, then return to start
• Perform 8-10 repetitions per side

Key points:

• The key is keeping hips and lower body still while the thoracic spine rotates
• Go to your comfortable end range—don't force
• Breathe deeply in the open position to increase the stretch

Intermediate Exercises

5. Quadruped Thoracic Rotation

Active rotation with control.

How to perform:

• Start on hands and knees
• Place your right hand behind your head (or on your right shoulder)
• Rotate your right elbow down toward your left arm
• Then rotate upward, leading with your elbow, trying to point it toward the ceiling
• Move slowly through the full range
• Perform 10-15 repetitions per side

Key points:

• Keep your hips level—don't shift your weight
• Exhale as you rotate up, inhale as you rotate down
• Focus on moving through the thoracic spine, not the shoulders

6. Child's Pose with Rotation

Combines thoracic flexion, extension, and rotation.

How to perform:

• Start in child's pose (sitting back on heels, arms extended forward)
• Walk your hands to the right, feeling a stretch through your left side
• Hold for 30 seconds
• Return to center, then walk hands to the left
• For added extension, prop your hands on a foam roller or yoga block and let your chest sink toward the floor

Key points:

• Keep your hips back toward your heels throughout
• Breathe deeply into the stretch
• Hold each position 30-45 seconds

7. Bench Thoracic Extension (Prayer Stretch)

Excellent for combined thoracic extension and lat stretch.

How to perform:

• Kneel facing a bench, chair, or couch
• Place your elbows on the bench, hands together in prayer position
• Sit your hips back toward your heels
• Let your chest drop toward the floor, head between your arms
• Feel the stretch through your upper back and lats
• Hold for 45-60 seconds

Key points:

• The further back your hips go, the more intense the stretch
• Keep elbows on the bench—don't let them slide off
• Breathe deeply and relax into the position

8. Wall Slides (Wall Angels)

Builds active thoracic extension and scapular control.

How to perform:

• Stand with your back against a wall, feet 4-6 inches from the wall
• Press your lower back, upper back, and head against the wall
• Raise your arms to shoulder height, elbows bent 90 degrees (goalpost position)
• Press the backs of your hands, wrists, and elbows against the wall
• Slowly slide your arms up overhead, maintaining all contact points
• Slide back down to starting position
• Perform 3 sets of 10-15 repetitions

Key points:

• Maintaining contact with the wall is more important than height
• If you can't maintain contact, work at the height where you can
• This exercise reveals limitations—embrace the feedback

9. Thoracic Rotation with Reach

Dynamic rotation with full range of motion.

How to perform:

• Start on hands and knees
• Reach your right arm under your body (thread the needle)
• Then sweep that arm along the ground in a wide arc, rotating your torso until the arm reaches overhead
• Return along the same path
• Perform 8-10 repetitions per side

Key points:

• Move slowly and fluidly
• Follow your hand with your eyes
• Feel the entire arc of movement

Advanced Exercises

10. Thoracic Bridge

Full thoracic extension with shoulder integration.

How to perform:

• Sit on the floor with knees bent, feet flat, hands behind you with fingers pointing toward your feet
• Lift your hips up toward the ceiling
• Push your chest forward and up, looking toward the ceiling
• Try to create a straight line from knees to shoulders
• Hold for 15-30 seconds, then lower with control

Key points:

• Start with brief holds and build duration
• If wrists are uncomfortable, use dumbbells or parallettes
• Focus on pushing the chest up, not just the hips

11. Jefferson Curls (Light Weight)

Segmental spinal flexion for mobility.

How to perform:

• Stand on a raised surface (box, step) holding a very light weight (5-15 lbs maximum)
• Tuck your chin and slowly roll down one vertebra at a time
• Let the weight pull you into a deeper stretch
• Go as low as comfortable, then slowly roll back up vertebra by vertebra
• Perform 8-10 slow repetitions

Caution: This exercise is controversial and should be performed only with very light weight and perfect control. Skip this if you have disc issues or lower back problems.

12. Loaded Thoracic Rotations (Cable/Band)

Builds strength through rotation.

How to perform:

• Stand perpendicular to a cable machine or anchored band at chest height
• Hold the handle with both hands, arms extended
• Rotate away from the anchor point, keeping hips facing forward
• Control the return to starting position
• Perform 12-15 repetitions per side

Key points:

• Start with light resistance and focus on quality movement
• Keep core engaged throughout
• The rotation should come from the thoracic spine, not the hips

How Thoracic Mobility Affects Calisthenics Performance

For calisthenics athletes, thoracic mobility isn't just about avoiding pain—it's about unlocking advanced skills and moving more efficiently.

Handstands

Why thoracic mobility matters:

A handstand requires a straight line from wrists through shoulders, spine, hips, and feet. Limited thoracic extension creates a "banana" shape, making balance significantly harder.

What happens with poor t-spine mobility:

• The upper back rounds, shifting the center of gravity
• Shoulders must hyperextend to compensate, increasing injury risk
• Balance becomes unstable and requires excessive muscle tension
• Wrists take more load due to poor alignment

Mobility requirements:

• Full overhead shoulder flexion (180 degrees)
• Adequate thoracic extension to create a neutral spine in the inverted position
• Ability to maintain extension under load

Key exercises for handstand mobility:

• Wall slides (builds active extension)
• Thoracic foam roller extensions
• Bench thoracic extension stretch
• Overhead wall reaches

Muscle-Ups

Why thoracic mobility matters:

The muscle-up transition requires significant thoracic extension and rotation. A stiff thoracic spine makes the transition slow, inefficient, and shoulder-stressful.

What happens with poor t-spine mobility:

• Difficulty getting chest over the bar during transition
• Shoulders must do excessive work to compensate
• The movement feels "stuck" at the transition point
• Increased risk of shoulder impingement

Mobility requirements:

• Thoracic extension to lean forward over the bar
• Thoracic rotation to allow the shoulder transition
• Lat flexibility to reach full depth

Key exercises for muscle-up mobility:

• Thread the needle and open book (rotation)
• Foam roller extensions
• Dead hangs with scapular movement

Pull-Ups and Rows

Why thoracic mobility matters:

While pull-ups seem shoulder-dominant, thoracic extension allows proper scapular positioning. A rounded thoracic spine prevents full scapular retraction, limiting pulling power and shoulder health.

What happens with poor t-spine mobility:

• Shoulders internally rotate, increasing impingement risk
• Scapulae cannot fully retract, reducing lat engagement
• The upper back remains rounded at the top of the pull
• Grip and biceps compensate for poor back engagement

Key exercises for pulling mobility:

• Cat-cow with thoracic focus
• Quadruped thoracic rotations
• Foam roller extensions before pulling sessions

Dips and Push-Ups

Why thoracic mobility matters:

These pressing movements require thoracic extension to maintain proper shoulder position. A rounded upper back puts shoulders in a compromised position during pressing.

What happens with poor t-spine mobility:

• Shoulders round forward at the bottom of dips
• Increased anterior shoulder strain
• Limited depth due to positional restriction
• Chest cannot fully engage

Key exercises for pressing mobility:

• Wall slides
• Doorway pec stretch combined with thoracic extension
• Cat-cow before pressing sessions

Front and Back Levers

Why thoracic mobility matters:

Lever positions require the ability to maintain a straight body line against gravity. Thoracic stiffness creates compensatory arching or rounding.

What happens with poor t-spine mobility:

• Difficulty maintaining straight body position
• Lower back compensates with excessive extension
• Increased core demand due to poor positioning
• Limited progression due to positional faults

Key exercises for lever mobility:

• Full thoracic mobility routine before lever training
• Active extension drills
• Jefferson curls (with appropriate caution)

Sample Thoracic Mobility Routines

Daily Maintenance Routine (10 minutes)

Perform this routine daily, ideally in the morning or before training.

1. Thoracic Foam Roller Extensions: 2 minutes
2. Cat-Cow with Thoracic Focus: 15 reps
3. Thread the Needle: 5 reps each side
4. Open Book Stretch: 5 reps each side
5. Wall Slides: 10 reps

Pre-Workout Mobility Routine (15 minutes)

Perform before any upper body or full-body training session.

1. Cat-Cow: 10 reps
2. Thoracic Foam Roller Extensions: 2-3 minutes
3. Thread the Needle: 8 reps each side
4. Quadruped Thoracic Rotation: 10 reps each side
5. Open Book Stretch: 8 reps each side
6. Wall Slides: 15 reps
7. Bench Thoracic Extension Stretch: 45 seconds

Intensive Mobility Session (25-30 minutes)

Perform 2-3 times per week for rapid improvement.

Part 1: Self-Myofascial Release (5 minutes)

• Thoracic foam roller work: 3 minutes
• Lacrosse ball on upper back trigger points: 2 minutes

Part 2: Extension Focus (8 minutes)

• Thoracic foam roller extensions: 2 minutes
• Bench thoracic extension stretch: 60 seconds
• Cat-cow with thoracic focus: 15 reps
• Wall slides: 3 sets of 12

Part 3: Rotation Focus (8 minutes)

• Thread the needle: 8 reps each side
• Open book stretch: 8 reps each side with 10-second holds
• Quadruped thoracic rotation: 12 reps each side
• Thoracic rotation with reach: 10 reps each side

Part 4: Integration (5 minutes)

• Child's pose with rotation: 30 seconds each side
• Thoracic bridge holds: 3 x 15 seconds
• Cat-cow cool-down: 10 reps

Programming Thoracic Mobility Work

Frequency Guidelines

When to Do Mobility Work

Morning: Light mobility work helps counteract overnight stiffness and sets the tone for the day. Focus on gentle movements like cat-cow and light foam rolling.

Pre-workout: More dynamic mobility work prepares the thoracic spine for training demands. Include all movements that mirror your workout's requirements.

Post-workout: Gentle stretching and foam rolling helps recovery. Avoid aggressive stretching on fatigued tissues.

Evening: Restorative mobility work promotes relaxation and can improve sleep quality. Focus on held stretches and breathing.

Progression Strategies

Week 1-2: Focus on foundational exercises only. Build consistency and body awareness.

Week 3-4: Add intermediate exercises. Increase hold times on stretches.

Week 5-8: Include advanced exercises as appropriate. Begin loaded mobility work.

Ongoing: Maintain with daily practice. Periodically test mobility to track progress.

Signs of Progress

• Improved scores on assessment tests
• Decreased stiffness upon waking
• Better overhead positions in training
• Reduced neck and shoulder tension
• Improved breathing depth
• Better posture with less conscious effort

Complementary Strategies for Thoracic Health

Ergonomic Modifications

Workstation setup:

• Monitor at eye level (use a stand or books)
• Keyboard and mouse at elbow height
• Chair with lumbar support
• Consider a standing desk option

Movement breaks:

• Set a timer for every 45-60 minutes
• Stand, stretch, and move for 2-3 minutes
• Perform 10 thoracic rotations or cat-cow stretches

Breathing Practice

Diaphragmatic breathing (5 minutes daily):

• Lie on your back with knees bent
• Place one hand on your chest, one on your belly
• Breathe into your belly, letting it rise before your chest
• Exhale slowly, letting belly fall
• Focus on expanding your ribcage laterally as well

This counteracts chest breathing patterns that contribute to thoracic stiffness.

Sleep Position

Best positions for thoracic health:

• Back sleeping with a thin pillow under your head
• Side sleeping with a supportive pillow that maintains neck neutrality

Avoid:

• Stomach sleeping (forces neck rotation)
• Sleeping in fetal position (reinforces thoracic flexion)

Posture Awareness

Rather than constantly "pulling shoulders back" (which creates tension), focus on:

• Gentle sternum lift (imagine a string pulling your chest up)
• Relaxed shoulders (not pulled back, just not rounded forward)
• Neutral head position (ears over shoulders)

The goal is effortless good posture, not muscular forcing.

Common Mistakes to Avoid

1. Forcing Range of Motion

Aggressive stretching triggers protective muscle guarding, making you tighter, not more mobile. Always work within a comfortable stretch—intensity 6-7 out of 10 maximum.

2. Neglecting Consistency

Sporadic intensive sessions are less effective than brief daily practice. Five minutes every day beats thirty minutes twice a week.

3. Only Stretching Without Strengthening

Flexibility without strength creates unstable joints. Include active exercises like wall slides, not just passive stretches.

4. Ignoring the Cervical and Lumbar Connection

The spine works as a unit. Thoracic stiffness often accompanies neck tension and lower back issues. Address all regions for lasting improvement.

5. Expecting Instant Results

Tissue changes take time. Expect 4-8 weeks of consistent work before significant, lasting improvements. Patience is essential.

6. Poor Breathing During Exercises

Holding your breath increases tension and limits mobility gains. Breathe deeply and continuously during all mobility work.

7. Training Through Pain

Discomfort during stretching is normal; pain is not. Sharp, radiating, or worsening pain requires stopping and professional evaluation.

Conclusion

Thoracic spine mobility is a fundamental component of athletic performance, daily comfort, and long-term spinal health. For calisthenics athletes, it's the difference between struggling with basic movements and progressing to advanced skills.

The thoracic spine's tendency toward stiffness in modern life makes consistent mobility work essential—not optional. The good news is that significant improvements are achievable with 10-15 minutes of daily practice.

Key takeaways:

1. Assess first: Use the tests in this guide to identify your specific limitations
2. Start with foundations: Master basic exercises before progressing to advanced work
3. Prioritize consistency: Daily practice beats occasional intensive sessions
4. Address root causes: Combine mobility work with ergonomic changes and postural awareness
5. Be patient: Lasting tissue changes take weeks to months

Your thoracic spine was designed to move. Years of sitting and poor posture may have restricted that movement, but with dedicated practice, you can restore full mobility and unlock your athletic potential.

Ready to deepen your understanding of movement and anatomy? Explore our free Anatomy Course to learn how the spine, shoulders, and ribcage work together to create efficient, pain-free movement.

References

1. Edmondston, S. J., and K. P. Singer. "Thoracic spine: anatomical and biomechanical considerations for manual therapy." Manual Therapy 2.3 (1997): 132-143.

2. Heneghan, N. R., et al. "Physical characteristics of the thoracic spine with pain: systematic review." Journal of Back and Musculoskeletal Rehabilitation 31.4 (2018): 677-703.

3. Tsang, S. M., G. P. Szeto, and R. Y. Lee. "Normal kinematics of the neck: the interplay between the cervical and thoracic spines." Manual Therapy 18.5 (2013): 431-437.

4. Johnson, K. D., and T. K. Grindstaff. "Thoracic spine and rib manipulation frequency on pressure pain sensitivity and cervical range of motion in patients with chronic neck pain: a randomized controlled trial." Journal of Manual & Manipulative Therapy 20.4 (2012): 186-192.

5. Kebaetse, M., P. McClure, and N. A. Pratt. "Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics." Archives of Physical Medicine and Rehabilitation 80.8 (1999): 945-950.

6. Cleland, J. A., et al. "Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial." Manual Therapy 10.2 (2005): 127-135.