Athletes Treating Athletes

This is part eleven in the Self Muscle Massage Series. In the introduction post to this series we introduced and demonstrated the three muscle release techniques that will be used in this post. If you would like to review them, click here. If you would like to see any other parts of the series, click here.

In this post we’ll be working on the mid back or thoracic region. It is home to the rib cage and as such is the most stable part of the spine. While this feature is required as a means of protecting vital organs and the spinal cord itself, it also means that the area can be difficult to work on when trying to loosen up muscles and other soft tissue structures. This area is also home to the shoulder blades or scapula. While technically part of the shoulder itself, the shoulder blade relies on both the muscles of the thoracic region and the shoulder joint to function properly. Imbalances or muscle restrictions here will affect shoulder function and can lead to more serious injuries.

Anatomy

Bony Landmarks

#1 The Thoracic Spine (aka T1-12). You may have heard of the spine being described by letters and numbers. Traditionally, the spinal column is broken down into four regions (the neck/cervical – C, thoracic/midback – T, lumbar/low back – L, and sacrum/tailbone- S) and then given a number based on it’s level. The number refers to each specific vertebrae (they are stacked up one on top of the other). The easiest way to visualize the the level is to count the little bumps down the middle of your back. These are the spinous processes ( the little circles in the middle of the picture above). There are twelve vertebrae in the thoracic spine, numbered one thru twelve. Of all the regions of the spine, the thoracic or mid back region is the easiest to visualize. For each vertebrae or level, there is a rib that connects to each side. Both ribs wrap around the outside of the body to connect in the front at the breast bone (or sternum). This forms the actual rib cage itself.

#2 Upper Border- T1/first rib. The thoracic/midback spine are the easiest to identify because each level in this region has a rib coming off it’s side. To find the first level (aka T1), place both hands around your neck (thumbs in the front and fingers wrapping around to the back). Where your fingertips meet in the back, you will feel a big bony bump. This is the first thoracic vertebrae and marks the start of the rib cage. For the sake of this post, it will also mark the upper border. If you find yourself working above this level, you’ve gone to far and are now working on the neck or cervical region.

#3 Lower Border- T12/last rib. To find the lower border you will need to find T12 where the last rib connects to it. Start with your hands on your rib cage and work your way down till you find the last one (note: not all of the lower ribs reach around to the front; the lower two in particular do not. For this reason, keep your thumbs on your back and your hands on your side to make sure you feel them). When you find the last one, follow it to the spine and find the little bump (spinous process). This is T12 (or vertebrae #12 of the thoracic spine). The key here is that when working on the muscles of the mid back you need to work all the way up the rib cage! Consider this the lower border for the area when trying to loosen up the muscles. If you find yourself working below it, you’re actually working on the low back.

Muscles

Like the low back, the muscles in this region are arranged in layers. To better identify where they begin and end, we’ve broken them down into these layers.

Layer One (the innermost layer closest to the bone)

#1 The Transversospinalis Group. This group is actually composed of several smaller muscles, including the rotatores, semispinalis and multifidus muscles. The key take away from identifying this group as a whole is that these are all very small muscles that connect one spinal segment to the next. They all start on the transverse processes (where the ribs attach) and differ only in how many levels they move  up the spine. The main part of the muscles sits between the spinous processes (bumps down the middle of your back) and where the ribs start (think 1-2 finger widths depending on your size).  Since these muscles are the closest to the bone, simply leaning backwards will contract the larger and more superficial muscles. To contract this group, slide your fingers just to the side of the spinous process, dig them in, and lean back. From here rotate your upper body to the opposite side (i.e. if feeling the right side, twist left while leaning back). You will feel the muscles push into your fingertips.

Layer Two

#1 The Erector Spinae Group. This group is also composed of multiple muscles and lays directly over the TS group. There are three muscles in this group. From closest to the spine to furthest away they are: spinalis, longissimus and iliocostalis. Due to the size of these muscles, they are very easy to locate. All three muscles run vertically along the spine from the bottom of the rib cage up to the top. Most of the fibers are between the spine and the shoulder blade. It is difficult to isolate each of the three muscles. Typically, these are the muscles you spasm/injure while performing lifts/carries or twisting motions.

Layer Three

#1 Rhomboids. The rhomboids lay just above the ES muscle group and attach the shoulder blade to the spinous processes. The easiest way to find them on yourself is to reach your hand behind to the small of your back. With your opposite hand (depending on your flexibility/mobility; if you can’t have a friend help you) you will feel the muscle push into your fingertips along the edge of the shoulder blade. If you are having difficulty looking for your shoulder blade, the easiest way is to lay your hand on top of your shoulder with your fingertips pointing towards the back. When you do so you will feel bone under your fingertips; this is the spine of your shoulder blade. From here, work your way in towards the spine till you find the inside edge. In the space between this edge and your spine are the rhomboids. The muscle itself angles up slightly so when working on this muscle, remember up + in.

Layer 4 (the most superficial)

#1 The trapezius muscles. On top of the previous three layers of muscles is the trapezius muscle. It is typically broken down into three parts- upper (which will be covered in the next post on the neck or cervical region), middle and lower. Together this muscle works to rotate and move the shoulder blade to better accommodate the shoulder joint as it moves. The middle fibers pull the shoulder blades together and the lower portion rotates the scapula up while pulling the shoulder blade down. The muscle forms a big diamond on your back with the upper fibers inserting near the base of your skull, running out to the ends of your shoulder blades and then down to T12 (the end of your rib cage).

Soft Tissue Release

What you’ll need: stick/foam roller and tennis ball

The techniques: click here for an introduction to the techniques and a video demonstration

1) Lengthening/elongation with the foam roller or stick.
2) Cross friction with your hand or tennis ball.
3) Sustained pressure or trigger point release with the tennis ball.

Key Areas

When working on the muscles of the thoracic region, try to visualize the muscles moving in two main directions.

#1 The muscles either move up and down parallel to the spine or between the shoulder blade and the spine. When using the foam roller, you will want to position it in two ways: perpendicular to the spine and parallel to the spine. This will allow you to hit all of the muscles described above.

a) When the foam roller is positioned horizontally you will be able to work on the TS and ES muscle groups.

b) When the foam roller is positioned vertically you will be able to work on the rhomboids and trapezius muscles.

#2 Always start with the foam roller as a way to loosen up the muscles and to increase blood flow to the area before moving to the deeper cross friction and trigger point techniques.

#3 Cross friction works best on the ES muscles, rhomboids and traps. Remember- let the tennis ball sink into the muscle and work PERPENDICULAR to the way the muscle fibers run. There should be minimal movement of the tennis ball (approx 1 inch) when performing this technique. Here are some pictures to help visualize the direction you will be working in:

#4 Here are some popular trigger points in the low back (trigger points = yellow x’s).

#5 Thoracic Mobilization. Due to the fact that the tiny little muscles interconnecting all of the vertebral levels are difficult to find and work on, you may find it easier to work on stretching them out by mobilizing the spine itself. For this you will need the foam roller. Technique is demonstrated in the video. The goal here is to stretch out all of the little connections that exist between each level. By doing so you will be effectively working on the smaller muscles. remember- this should never hurt. If you are working your way down the spine and get to a level that is uncomfortable, do NOT try to push through it. You can go safely to the point of discomfort, but moving past that will likely do more harm than good. This isn’t one of those no pain, no gains examples.

Video

Here is a video demonstration of the mid-back.

References

1) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

2) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Moore, Keith and Dalley, Arthur. (1999). Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, MD.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.