Recently I had the pleasure of working with a client at the gym I consult and train out of. He had an upcoming Brazilian Ju Jitsu match in a few weeks. His upper thoracic spine had been bothering him for a couple weeks, especially during martial arts practice and his strength training. Here is a brief overview of his findings during a movement screen and breakout.
Cervical/Shoulder: ROM looked excellent.
Multisegmental flexion: Mid-thoracic pain past mid-range of movement, which looked good otherwise.
Multisegmental extension: No problem here
Multisegmental rotation: End-range mid-thoracic pain to the right and left
Hip mobility/Single Leg Stance: ROM and stability excellent here
Observations: This was a bit surprising to me, but he maintained a very flat upper thoracic spine before and during movement. Almost all fighters tend to hang out in quite a bit of flexion, so this jumped out at me. Otherwise, it was clear that overhead pressing/squatting/heavy lifts were contributing to his pain. This does not mean they were bad exercise choices. He just needed to make a few adjustments in position and was much better with movement. So what did I do/add?
We discussed how creating more thoracic flexion would likely help get him into a better position to work from during his big lifts. I immediately went to closed chain work that progressed from breathing to heavier strength training. We added all fours belly breathing, progressed into bear crawl variations, created more thoracic flexion with heavy farmers carries, and finished with sled pulls using the same cue.
Otherwise I did not touch his current strength and conditioning program. Avoiding a ton of extension through his thoracic spine while loaded made sense, and he incorporated this for a couple of weeks.
I saw him a few days ago, and he was feeling much better not only during training but fighting as well. A proper assessment drives positive training choices. Unload new patterns to help learn the motor plan. Reintroduce heavy loads during training to make the changes stick.
Check back in a few days for another case study, and please share any thoughts that contribute to a good conversation!