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PHYSIOTHERAPY EXERCISE FOR MID-BACK PAIN
Mid-back pain is discomfort or pain felt in the thoracic region of the spine, which is located between the base of the neck and the bottom of the rib cage. It occurs due to various reasons which include
- General postural changes like scoliosis, kyphosis
- Unable to maintain position due to muscle imbalance.
- Repetitive overuse or sudden injury when you lift something beyond your capacity.
Pain in the mid back is relatively common early in life, with a prevalence of 13% in children and 35% in adolescents as mentioned in the study done by Wedderkopp et al., in 2001 and Kjaer et al., in 2011.
The exercises below help you improve your load tolerance, strength, and mobility.
1. THORACIC SPINE ROTATION MOBILITY
Purpose:
Thoracic rotation exercises target the thoracic spine, shoulders, and upper back to improve thoracic spine mobility and relieve tension in the upper back and shoulders.
1.1 T-Spine Rotation in Sitting Position:
Step 1: Sit upright on a chair or flat surface with your feet flat on the ground, hip-width apart.
Step 2: Keep your back straight and shoulders relaxed.
Step 3: Cross your arms in front of your chest, placing each hand on the opposite shoulder. (Alternatively, you can place one hand behind your head and the other on your opposite knee for support).
Step 4: Slowly rotate your upper trunk to one side (e.g., rotate to the right), keeping your hips stable and facing forward.
Step 5: Focus on moving through your thoracic spine.
Step 6: Hold the end position for 1–2 seconds, feeling a gentle stretch in your thoracic spine and surrounding muscles.
Step 7: Slowly return to the starting position.
Step 8: Rotate to the opposite side and repeat.
Step 9: Perform 8-12 repetitions on each side for 2 -3 sets.
1.2 Quadruped position thoracic rotation:
Step 1: Start with a quadruped (all-fours) position on the floor. (as shown in the picture)
Step 2: Align your shoulders over your wrists and hips over your knees.
Step 3: Place one hand behind your head with your elbow pointing outward (the other hand remains on the floor for support).
Step 4: Inhale as you rotate your trunk upward, guiding your elbow toward the ceiling, twisting through the thoracic spine
Step 5: Inhale as you rotate your trunk, bringing your elbow down toward the supporting hand.
Step 6: Return to the starting position and repeat.
Step 7: Perform 8–10 repetitions on one side, then switch to the other side.
Step 8: Repeat for 2–3 sets.
1.3 The Quadruped Thread and Needle
Step 1: Start on quadruped (all fours – hands and knees).
Step 2: Slide one arm under the other, palm up, while lowering your shoulder and head towards the ground.
Step 3: Feel the stretch in your upper back and hold for 2 seconds.
Step 4: Return to the starting position.
Step 5: Repeat on the other side.
1.4 Thoracic spine rotation in a side-lying position:
Step 1: Start in the side-lying position. Bend your knees and hips to a 90º angle, and stack your legs on top of each other.
Step 2: Rest your bottom arm straight in front of you or under your head for support.
Step 3: Extend your top arm straight out, so that both arms are in front of you, palms together.
Step 4: Inhale deeply and as you exhale, slowly rotate your top arm up and over your body, aiming to open the chest toward the ceiling.
Step 5: Hold this open position for 2 seconds.
Step 6: Inhale and slowly return to the starting position.
Step 7: Perform 8–12 repetitions on one side, then switch to the other side.
1.5 Thoracic Rotation in Half-Kneeling Position Instructions:
Step 1: Begin in a half-kneeling position with one knee down on the floor and the opposite foot flat in front, creating a 90-degree angle at both knees.
Step 2: Ensure that your hips are square and your back is straight.
Step 3: Engage your core muscles to maintain stability and prevent excessive lower back movement.
Step 4: Extend your arms straight out in front of the chest.
Step 5: Slowly rotate your upper body (thoracic spine) and take one arm out, towards your back.
Step 6: Feel the stretch in your upper back and hold for 2 seconds.
Step 7: Repeat on the other side and return to the starting position.
Step 8: Switch legs and repeat the exercise on the other side.
Step 9: Perform 8–12 repetitions on each side.
2.Thoracic extension
Purpose: Thoracic extension exercises target the thoracic spine, shoulders, and upper back to improve thoracic spine mobility and relieve tension in the upper back and shoulders, especially for those who sit for long periods
2.1 Thoracic Extension in Baby Sitting Position:
Step 1: Start in Child’s Pose (Kneel on the floor with your knees spread apart and your big toes touching).
Step 2: Sit back on your heels.
Step 3: Flex your hips and extend your arms forward, allowing your forehead to rest on the floor or a mat.
Step 4: Keep your hands shoulder-width apart and fingers spread.
Step 5: While in this position, focus on lifting your chest slightly off the ground as if creating an arch in your mid-back (thoracic spine).
Step 6: Inhale while extending the chest and exhale while going down.
2.2 Thoracic Spine Extension stretch using a wall:
Step 1: Stand facing a wall, 2 feet away from the wall.
Step 2: Place your hands on the wall at shoulder level and shoulder-width apart.
Step 3: Lean your upper body forward slightly so your arms are straight and your chest is closer to the wall.
Step 4: Hinge at your hips and gently lower your chest downwards, aiming to create an arch in your upper back.
Step 5: Inhale deeply as you prepare, and exhale as you sink into the stretch.
Step 6: Hold the stretch for 2 seconds.
Step 7: Return to the starting position and repeat for 10 to 12 rounds.
2.3 Thoracic Spine Extension using a foam roller:
Step 1: Sit on the floor with your knees bent and feet flat on the ground.
Step 2: Lie back on the horizontally placed foam roller, so that it supports your thoracic spine.
Step 3: Keep your elbows flexed and place your hands behind your head to support your neck.
Step 4: Slowly extend your upper back over the foam roller with inhalation, allowing your head and shoulders to move toward the floor.
Step 5: Pause when you feel a gentle stretch in the upper back and hold it for 2 seconds.
Step 6: Use your core to bring your upper body back to the starting position with exhalation.
Step 7: Perform 10 to 12 repetitions.
2.4 Thoracic Spine Extension using a chair:
Step 1: Sit upright on a sturdy chair
Step 2: Position yourself so the backrest aligns with your mid-back (just below your shoulder blades).
Step 3: Place your hands behind your head to support your neck or keep your elbow on the front desk.
Step 4: Keep your elbows slightly tucked in to engage your upper back.
Step 5: Focus on extending through the thoracic spine (mid-back), allowing your chest to lift upward.
Step 6: Pause at the point of a gentle stretch and hold the position for 2 seconds.
Step 7: Exhale as you relax into the stretch and inhale deeply as you return to the starting position.
Step 8: Perform 10- 12 repetitions.
3. Scapular Strengthening
Purpose: The Prone exercise is excellent for targeting the muscles of the mid-back, particularly the trapezius and the rhomboids.
3.1 Prone ‘T’ Exercise
Step 1: Lie face down on a mat with your arms extended out to the sides, forming a “T” shape.
Step 2: Keep your legs straight and together.
Step 3: Engage your core muscles by pulling your belly button towards your spine.
Step 4: Lift your arms off the floor, squeezing your shoulder blades together.
Step 5: Hold the position for a few seconds, then slowly lower back down.
Step 6: Perform 10-15 repetitions for 2-3 sets.
3.2 Prone “V” Exercise
Step 1: Lie face down on a mat with your arms extended overhead in a “V” shape.
Step 2: Keep your legs straight and together.
Step 3: Engage your core muscles by pulling your belly button towards your spine.
Step 4: Lift your arms, squeezing your shoulder blades together.
Step 5: Hold the position for a few seconds, then slowly lower back down.
Step 6: Perform 15 repetitions for 2-3 sets.
3.3 Prone A
Step 1: Lie face down (prone) on the floor with your arms extended and parallel to the body. (forming an upper-case A)
Step 2: Lift the extended arms from the floor slightly
Step 3: Squeeze your shoulder blades together as you lift your arms.
Step 4: Hold this for 10 seconds. Perform 10 repetitions for 2 to 3 sets.
3.4 Prone W
Step 1: Lie face down (prone) on the floor with your arms extended and elbow flexed. (forming an upper-case W)
Step 2: Lift the arms from the floor slightly and squeeze your shoulder blades together
Step 3: Hold this for 10 seconds. Perform 10 repetitions for 2 to 3 sets.
3.5 Prone Angels
Step 1: Start in a prone lying position (Lying face down) on the floor with arms extended overhead and palms facing down.
Step 2: Lift your both arms slightly off the ground.
Step 3: Slowly move your arms out to the sides, then down toward your hips, and take them behind the trunk up to the lower back while the palms face upwards.
Step 4: Return to the starting position.
Step 5: Keep movements controlled and repeat for 10 to 12 reps.
3.6 The serratus push with dumbbells (dumbbell serratus anterior punch)
Purpose:
- It is an excellent exercise for strengthening the serratus anterior muscle. This muscle is crucial for scapular stability and shoulder health.
- Improves scapular stability, crucial for shoulder health.
- Enhances performance in pressing movements (e.g., bench press, overhead press).
- Helps reduce the risk of shoulder injuries, especially for athletes or those with scapular winging.
How to perform:
Step 1: Lie on a flat bench with your back supported and feet planted firmly on the ground.
Step 2: Hold a dumbbell according to your capacity (3kg to 6kg) in your hands.
Step 3: With your arms lifted straight above your chest, without bending your elbow, push the dumbbell upward by protracting your shoulder (pushing forward). Imagine trying to reach the ceiling with the weights.
Step 4: Feel the engagement in your serratus anterior as your shoulder blades protract (move away from each other).
Step 5: Slowly lower the dumbbell back to the starting position as your shoulder blades retract.
Step 6: Perform the movement in a controlled manner for 10–15 repetitions per set.Then switch the side.
3.7 Rowing – shoulder
Know more about Shoulder pain exercise
4. Possible stretch you can perform:
Purpose:
- Improve flexibility and posture
- It reduces tension and provides pain relief.
4.1 Rhomboid stretch:
Step 1: In the sitting position, place both elbows on your knees.
Step 2: Now move your knees outwards (wide apart) as if you are abducting your hips.
Step 3: Feel the stretch in rhomboids. Hold it for 15 seconds and do possible reps (average recommended 3 sets).
4.2 Trapezius stretch:
Step 1: Start in a sitting or standing position, keep your shoulders relaxed and your back in a neutral position.
Step 2: Gently tilt your head to one side, bringing your ear toward your shoulder.
Step 3: Place the hand over your head and gently apply pressure to deepen the stretch.
Step 4: Maintain the position for 15-30 seconds. You should feel a stretch along the side of your neck and shoulder
Step 5: Switch sides and repeat the stretch.
4.3 Levator scapulae stretch
Step 1: Sit straight in the chair. You can hold onto the seat edge of a chair with the hand on the same side as the shoulder you’re stretching for stability.
Step 2: Turn your head about 45 degrees toward the opposite side of the shoulder you’re stretching. For example, if you’re stretching your right levator scapulae, turn your head to the left.
Step 3: While keeping your head turned, gently bring your chin down toward your chest. You should feel a stretch along the back and side of your neck.
Step 4: Use the hand on the side your head is turned toward (e.g., left hand if your head is turned left) to gently pull your head downward for a deeper stretch. Apply light pressure.
Step 5: Maintain this position for 20–30 seconds, breathing deeply.
Step 6: Slowly release and return to a neutral position. Repeat on the other side.
Step 7: Perform the stretch for 2–3 sets.
4.4 Latissimus dorsi stretch:
Child’s Pose Stretch
Step 1: Start on your hands and knees in a tabletop position.
Step 2: Sit your hips back toward your heels while extending your arms forward on the floor.
Step 3: Keep your palms flat and feel a stretch along your back and sides.
Step 4: Hold for 20–30 seconds, breathing deeply.
Wall Lat Stretch
Step 1: Stand facing a wall, about an arm’s length away.
Step 2: Place both hands on the wall at shoulder height.
Step 3: Hinge at your hips, letting your chest drop toward the floor while keeping your arms straight.
Step 4: Feel the stretch in your lats and hold for 20–30 seconds.
NOTES:
But the Majority of the time, Midback pain occurs just because of weakness in the shoulder and scapular muscles, loading the joint and muscle beyond your tolerance. So, it is necessary to strengthen your upper limb muscles with much concentration on the shoulder and scapular musculature. To see the strengthening exercises for shoulder and scapular muscles click here to watch.
DISCLAIMER:
The exercises mentioned above are to be performed with a specific progression and regression. To know more about it, click here to watch this video.
Always keep in mind that this exercise plan helps to improve general thoracic spine health, flexibility, ROM, and strength. Considering that every individual has differences in anatomical structure, pain perception, lifestyle, needs, and goals.
So, it is better to consult with a physician or a physiotherapist. Click here to book an appointment for a consultation to get a better understanding of your problem, and to obtain a tailor-made rehab plan, specific to your needs and goals.