As fitness coaches and organizations push to continually challenge and vary workouts, one of the undervalued fundamentals of shoulder and spinal health, is the posture of the thoracic cage. I believe if coaches and athletes spent more time focusing on the posture and movement of the thoracic cage during exercise, several shoulder and spinal injuries could be prevented. Believe it or not, by simply observing the positioning (posture) of the thoracic cage prior to an individual preforming an exercise, you can estimate how successful they will be at performing the exercise.

The thoracic cage consists of the spinal bones of the mid back (thoracic spine), the attaching ribs, and all of the muscles that attach to the bones and cartilage. The accepted term for faulty positioning of the thoracic cage is a “rib flare”.
- The elongated posture of the rib flare causes a functionally long/weak core muscle.
- Hyperextended lumbar posture due to elevated thoracic cage and disengaged core muscles
- Rounded shoulders because the scapulae will try to maintain a vertical position to ground level at all times, this causes the scapulae to elevate and loose full contact with the thoracic cage wall

- A great deal of stress is placed on the joints of the lower back
- The middle back loses its ability to rotate due to the stiffening of the thoracic cage
- The scapulae are moved out of a position of stability, increasing strain on the actual shoulders.
When I went back and re-watched the automotive Youtube videos after dropping my car, of course I saw there were blocks behind the tires when they jacked up their car. A slight detail that I originally overlooked. Now, anytime that I jack up the car, I place blocks under the tires to prevent the car from rolling down the driveway again. Going back to the shoulder analogy, the “tire blocks” represent our rotator cuff muscles. The number one job of the cuff muscles is to keep the shoulder stable in its socket. Athletes always ask me why their cuff muscles are tight and sore. I tell them it’s because of their posture; they usually give me a funny look. After a few visits they start to understand positioning the thoracic cage correctly during activity, enables the scapulae to stabilize in the thoracic wall, greatly reducing the stress in the lumbar spine and rotator cuffs.
Correcting a rib flare may be as simple as tightening the core muscles to pull the rib cage back down prior to and during an exercise. But, in an athlete that has had a rib flare for several years, it may take longer to correct the problem. First they have to regain the mobility of the thoracic spine and rib cage. The best way to combat a long-term postural problem is a ton of foam rolling (don’t forget to roll out the ribs) and dynamic mobility exercises. The mobility exercises must be followed up with a retraining program targeting core/glute/ and scapular muscle activation and strength. Video analysis can be used to help the athlete visualize correct posture during exercise too.
In summary- Strengthen your core and do more mobility work on your thoracic cage. Do not constantly hyperextend your lower back and flare your ribs when exercising Be sure to pay attention to details, and most importantly, never let me fix your car!
By Dr. Chris Feil