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Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis
  1. Nicola R Heneghan1,
  2. Svein M Lokhaug1,2,
  3. Isaak Tyros3,
  4. Sigurd Longvastøl4,
  5. Alison Rushton1
  1. 1Centre of Precision Rehabiliation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK
  2. 2Helsefag, Norwegian Institute of Sport Medicine, Oslo, Norway
  3. 3Edgbaston Physiotherapy Clinic, Birmingham, UK
  4. 4Molde Performance Center AS, Molde, Norway
  1. Correspondence to Nicola R Heneghan; n.heneghan{at}


Background The thoracic spine is critical for athletic kinetic chain functioning yet widely overlooked in terms of specific evidenced-based exercise prescription. Thoracic mobility, motor control and strength are required to optimise performance in sport and minimise excessive load/stress on other components of the kinetic chain.

Objective To identify and evaluate mobility, motor control, work capacity and strength thoracic exercises for use in athletes.

Design Systematic review involving expert reviewers at key stages: searches and screening (n=1), eligibility, evaluation, data extraction and evaluation (n=3). Key databases and social media sources were searched to 16 August 2019. Eligible exercises were thoracic exercises to promote mobility, motor control, work capacity and strength. A narrative synthesis enabled an outcome-based classification of exercises, with level of evidence of individual sources informing overall level of evidence for each outcome (Oxford Centre for Evidence-based Medicine).

Results From 2348 sources (social media, database searches and other sources), 38 exercises were included. Sources included images, video clips and written descriptions of exercises. Exercises targeting all planes of motion were evaluated and classified according to outcome. Exercises comprised functional and non-functional exercises for mobility (n=9), work capacity (n=15), motor control (n=7) and strength (n=7). Overall level of evidence for each outcome was level 5.

Conclusion This synthesis and evaluation of exercises has captured the scope of thoracic exercises used in ‘practice’. Evaluation against an expert-derived outcome-based classification provides practitioners with a framework to facilitate exercise prescription. Evaluation of validity and effectiveness of exercises on outcomes is now required.

  • thoracic spine
  • exercise rehabilitation
  • sports & exercise medicine

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  • Contributors Conception and design: NRH, SML and AR. Data collection: NRH, SML and IT. Data analysis: NRH, SML, IT and SL. Data interpretation: NRH, SML, IT, SL and AR. Manuscript contribution: NRH, SML, IT, SL and AR. NRH is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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