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Part 2: “Posterior Rib”/ Limited Thoracic Extension

In Part 1 we discussed the problem of shoulder IR limitations with swimmers. The second common problem that I have seen in swimmers with shoulder pain is what we will call a “posterior rib”. To keep this simple, our ribs have to move anteriorly (forward) and posteriorly (backward) when we breath or move in the upper back region. Sometimes a rib can get “stuck” in the back position. This can be painful with shoulder or upper back movements, but it also changes the mechanics of the shoulder which can again lead to abnormal tissue irritation.

Swimmers tend to be very strong and can have adaptive tissue shortening at the anterior structures (front) of the shoulder and chest. This can lead to inhibition of the upper back muscles and scapular stabilizer muscles. With this muscle imbalance, the ribs are more susceptible to being pushed posteriorly… ouch!

I have seen this to be most common recently in teenage swimmers. And here is why… poor postural control! These teens are sitting a lot at school, looking down at their books/homework for prolonged periods and spending a lot of time looking down at their smartphones! This again contributes to adaptive shortening of anterior structures and limited strength/stability in the upper back (thoracic spine).

There is a solution! And no, I’m not suggesting every teenager should ditch their smartphone (although that’s not a bad idea). But there are a few activities the swimmer can do each day to limit this adaptive shortening and improve their ability to extend through the thoracic spine! See the link to videos below.

I typically recommend the athlete perform the above exercises at least 4x per week, but preferably every day! Give these a try and feel free to reach out to me with any questions.

Stay tuned for part 3 of this series!

-Andy Johnson PT, DPT, OCS

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