Thoracic Spine

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Osteology

The thoracic spine consists of 12 vertebrae (T1-12) that sit between the vertebrae of the cervical spine and lumbar spine.

The thoracic vertebrae are larger than cervical but smaller than lumbar vertebrae. As you descend the vertebral column, the thoracic vertebrae increase in size in order to support more and more BW%¹.

Ribs 2-9 insert between 2 vertebrae at the superior costal facet and inferior costal facet. Ribs 1, 10, 11, and 12 insert on a single vertebrae at the complete costal facet¹.

Vertebrae T1-T10 have transverse costal facets which is an articulation between the transverse process and the tubercle of the adjacent rib. T11 and T12 lack a transverse costal facet since ribs 11 and 12 do not have tubercles¹.

Ribs 11-12 are floating ribs and lack cartilaginous attachment to the sternum and tubercles¹.

At the thoracic spine, the spinous processes are angled sharply inferiorly.

Thus the SPs vary in how far the SP is compared to the vertebral body:

• T1-T3 = at the level
• T4-T6 = Half segment below
• T7-T9 = Full segment below
• T10 = Full segment below
• T11 = Half segment below
• T12 = At the level

Kyphosis

Thoracic kyphosis can reduce the space available to the lungs, resulting in limitations in deep breathing².

Osteokinematics

T-spine can move in flexion/extension, lateral flexion, and rotation. Assessments of each movement can be found here.

Flexion

• Total: 20-45°³
  • Upper T/S: 4-5°³
  • Middle T/S: 6-8°³
  • Lower T/S: 9-15°³

Extension

• Total: 15-20°³
• Segment: 1-2°³
• *Compression @ center³

Extension Limitations

SB (Lateral flexion)³

• Segment: 3-4° per
• Total: 25-45°
  • Lower segment: 7-9°

SB Limitations

SB limited throughout d/t rib stacking³

Rotation

• Total: 35-50°³
• Segments:
  • Upper: 7°³
  • Middle: 5°³
  • Last 2 segments: 2-3°³

Arthrokinematics

T/S Pain

Referred pain

• Z-joints of the C/S can refer to the thoracic spine

Acute T/S Pain

• Fracture:
  • Old (>50) = Minor trauma (hx of osteoporosis or steroid use)
  • Young = Major trauma in younger pop
• Infection: Fever, night sweats, risk factors of inf (wound, etc)
• Tumor: Hx of malignant dx, age > 50 , no improvement w txt, unexplained weight loss, pain at multiple sites, rest, night pain

T/S Pathologies

• TOS
• Spinal nerve root syndrome— radiculopathy
• Osteoporosis: (10% of ppl 50 +)
• Chest wall variations
• Kyphotic variations
• Osteoarthritis
• Spinal stenosis

Rule of 3s

Note

Oakley CK, Janssen SAK, Pankratz JP, McCumber TL, Treffer KD, Olinger AB. Validity of the Rule of Threes and Anatomical Relationships in the Thoracic Spine. J Am Osteopath Assoc. 2018;118(10):645-653. doi:10.7556/jaoa.2018.143

Examination

ROM

• T/S spine ROM
  • Measure from T12 to acromion and compare to opposite side
  • Go into quadraped with max L/S flexion to bias T/S rotation

Thoracic ROM can be measured using the FMS quadriped T-spine rotation

TPI ROM

Greg Rose in his TPI course recommends measuring thoracic spine mobility by sitting with ankles crossed and knees together.

AROM

Rotation

• Open books
• Resisted open books
• Chops

Extension

• Thoracic extension over FR

Pain

• Clinical Considerations of Upper Back Shoulder and Arm Pain⁴

References

1.

Jones B. B Project Foundations. b Project; 2025.

2.

Neumann DA, Kelly ER, Kiefer CL, Martens K, Grosz CM. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed. Elsevier; 2017.

3.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.

4.

Donnelly JM, Simons DG, eds. Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Third edition. Wolters Kluwer Health; 2019.