The thoracic spine is naturally the stiffest section of the spine, because of the rib attachments forming the costotransverse and costovertebral joints. The two main planes of movement are flexion/extension and rotation. I like to think of the thoracic spine in three sections: upper thoracic spine which has a very important relationship to the neck, the mid thoracic spine and the thoracolumbar junction, which has a very important relationship to the lower back.

Kyphosis can occur at any of these sections. So it is important to assess exactly where the stiffness is taking place. The assistance of a Physiotherapist may be required here.

In general the types of exercises can be broken up into two categories. Firstly, range of movement exercises aimed at increasing movement of the many joints that make-up the thoracic spine. Flexibility exercises into rotation, flexion and particularly extension are essential. I find the most useful exercise, is to use a high density foam roller, laying it cross the spine in the relevant area, knees bent up and then arching back over it as the most useful flexibility exercise.

This is a very good maintenance flexibility routine and very handy to do before stretching as a way to mobilise the joints. The other flexibility exercises that are important is stretches for the pecs and lats. Tightness through here can often pull peoples shoulders forward and increase the kyphosis.

If someone is stiff and rounded through the thoracic spine, upper trapezius, rhomboids and levator scapulae muscles are often very tight and overactive. Trigger pointing and stretching is then helpful.

The second group of exercises are to improve muscle tone and endurance and thus posture. The better the muscles are at holding the thoracic spine in correct posture, the less stiff the thoracic spine will become. Key muscle groups are the lower trapezius, serratus anterior and thoracic erector spinae.

Some of my favourite gym based exercises that improve are, back extension, bent over row and diagonal cable pulls. Another favourite exercise is what I call YTEW. You have your feet on the ground and up against the wall face down with the swiss ball positioned under your stomach and pelvis.

You have to hold your thoracic spine extended while feeling like your pushing your chest out and pulling shoulders away from your ears. Then make the letters with your arms and hold each position for 10 seconds.