By Patricia Staszak, PT

The rib cage is probably one of the most overlooked pieces in the posture/rehab puzzle.  Dysfunction in this area can greatly contribute to pain in the neck, shoulders, thoracic spine, and even the lumbar spine, for the following reasons:

  • The rib cage and the thoracic spine combine to make the most stable portion of your spine.
  • The placement of the rib cage also determines the position and function of neck, scapula, shoulders and lumbar spine.
  • The way shape of the rib cage and thoracic spine can contribute to movement dysfunction in the upper body.

Stability in the rib cage and thoracic spine is necessary to protect the vital organs in the chest cavity, but if any part of the spine gets too stiff, it can play havoc with adjacent joints.  For instance, when we rotate our trunk to one side, much of this rotation is designed to occur in the thoracic spine.  If this area is stiff, the rotation will occur below the thoracic spine in the joints of our lumbar spine.  This can lead to wear and tear at the low back and potentially, arthritis.

In neutral, the rib cage should be centered over the pelvis in both an anterior and posterior, and the side-to-side plane.  If the whole rib cage is displaced forward, backward, or to either side, it changes the way the force of gravity is absorbed through our joints.  Some areas of our bodies will experience more stress and compression.

There are two general patterns that we see with rib cage shape that can lead to wear and tear on the nearby joints: excessive curvature and thoracic flattening. (The pictures below are staged.  Thankfully our therapists know to stay in neutral and this is NOT their normal posture!)

Excessive Curvature (kyphosis):
Normally, our spine has three natural curves. The lumbar Spinal Curvatureand cervical spine have a lordosis, which is a slight anterior curve, and the thoracic spine has a slight outward curve, called a kyphosis.  These curves are normal, but if they are too extreme, it can affect our alignment and again, cause joint wear and tear at the shoulders, neck, and sometimes low back.

If the thoracic curve is too large, the head and neck tend to get pulled forward and close down the front of the chest.  If the head and neck are pulled forward, the neck becomes overextended causing compression in the cervical spine, the jaw, and the anterior chest.  This also tends to pull the shoulder blades forward and potentially lead to shoulder problems and tight, achy upper trapezius muscles.

Thoracic Flattening:
This is essentially when there is not enough kyphosis at some part of the thoracic spine.  A sign of thoracic flattening is a flared lower rib cage, which indicates that the abdominals are not holding the ribs down in the front.  This position can lead to increased use of the spinal extensor muscles in your back and compression through the joints in the thoracic and lumbar spine.  It also sets up a faulty foundation for the shoulders.  To correct this pattern, we have to make sure the ribs are lined up directly over the pelvis and learn to use the abdominals correctly, to connect the rib cage to the pelvis.

As you can see, the rib cage and thoracic spine play an integral role in keeping our upper body healthy.  And it makes sense- it is in the center of our head, neck, and shoulders.  We stabilize from the center of our body ,so if there is restricted motion, poor positioning, or postural abnormalities in this area, it will affect the surrounding joints.

The following exercise, which can be performed in supine and sitting illustrates how to keep the ribs and thoracic spine in neutral as we move our arms.

Arm circles:


Inhale:  Reach arms toward ceiling and overhead as far back as you can, while maintaining abdominal connection, scapular stabilization and good rib cage alignment. The lower posterior rib cage should keep contact with the mat.

Exhale:   Circle arms out to sides, then around to hips, and return to the start position.

©Cueing provided by STOTT PILATES
Spinal, Pelvic & Scapular Stabilization: Matwork & Reformer. Toronto: STOTT PILATES, 2010. Print.