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Chapter 19 · Back & Spine

Mid-Back And Rib Cage Pain protocol

Indexed — full page in progressSource: Rehab Science · Ch 19 · PDF pp. 658–685📖 Rehab ScienceBuild my programme →
AMBER — get assessed before starting rehab
Screen for red flags before starting any protocol (safety check). Progress by symptoms and function, not by the calendar: > 3/10 pain → start phase 1; < 3/10 → phase 2 (PDF p. 205).
Follow this programme to treat
  • Pain and stiffness in the upper or mid-back
  • Thoracic disc bulge
  • Rib pain and injuries—sprain, fracture, or subluxation (dislocation)
Conditions in this protocol
1

Phase 1

Source: Rehab Science · PDF p. 664
Good for
  • Alleviating upper back pain
  • Reducing muscle stiffness
  • Improving range of motion
  • Warm-up for phase 2 and 3 exercises
Guidelines
  • Perform every day
  • Tools: small massage ball, foam roller, peanut tool
  • Add phase 2 when you have no pain at rest and no more than mild pain (3/10) with the exercises

Soft Tissue Mobilizations

▶ Spend 1‒2 minutes on each area · Perform in any order on both sides · Stop on tender points for 10‒20 seconds

STARTArm reaches over the ball
Rhomboid mobilisation
Relieve tension between the shoulder blade and spine.
PDF p. 665
STARTReach overhead
Pectoral mobilisation
Release tension at the front of the shoulder and chest.
PDF p. 665

Thoracic extension (choose one)

choose one

▶ Spend 1‒2 minutes on each area · Perform in any order on both sides · Stop on tender points for 10‒20 seconds

diagram pending
With foam roller (thoracic extension)
PDF p. 666 · instructions pending
diagram pending
With peanut tool (thoracic extension)
PDF p. 667 · instructions pending

Mobility Exercises

▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds

diagram pending
Thoracic flexion and extension
PDF p. 667 · instructions pending
STARTSweep arms overhead
Angel (foam roller)
Dynamically stretch the chest and encourage a more upright posture.
PDF p. 668
diagram pending
Shoulder protraction and retraction
PDF p. 669 · instructions pending
2

Phase 2

Source: Rehab Science · PDF p. 671
Good for
  • Improving thoracic and rib mobility
  • Early back and pec strengthening
  • Warm-up for phase 3 exercises
Guidelines
  • Perform every day
  • Tools: dowel, resistance tube band
  • Add phase 3 when you can do the exercises with no more than mild pain (3/10)

Stretching Exercises

▶ Do 3 reps with 30- to 60-second holds · Perform in any order on both sides · Don’t stretch into pain

diagram pending
Thoracic rotation stretch
PDF p. 671 · instructions pending
diagram pending
Pectoral stretch
PDF p. 672 · instructions pending
diagram pending
Lat/thoracic extension stretch with dowel
PDF p. 673 · instructions pending

Resistance Exercises

▶ Do 3 sets of 10–15 reps · Push sets to fatigue · Add load or reps to make the exercises more challenging

STARTPull handle to the armpit
Banded row (kneeling)
Strengthen the scapular retractors with a band.
PDF p. 674

Press with protraction (choose one)

choose one

▶ Do 3 sets of 10–15 reps · Push sets to fatigue · Add load or reps to make the exercises more challenging

STARTLower then push the floor away
Push-up plus
Strengthen pressing plus the serratus anterior, an upward rotator of the shoulder blade.
PDF p. 675
STARTPress and reach forward
Banded press with protraction
Press and finish with shoulder-blade protraction.
PDF p. 676
3

Phase 3

Source: Rehab Science · PDF p. 678
Good for
  • Strengthening the upper back and abdominal muscles
  • Preventing upper back and rib injuries
Guidelines
  • Perform 3 or 4 days a week
  • Do 3 sets of 10–15 reps
  • Push sets to fatigue
  • Add load or reps to increase difficulty
  • Tools: bench, resistance tube band

Exercises

0
STARTLift arms into a T
Prone T
First strengthening exercise for the shoulder-blade retractors.
PDF p. 678
diagram pending
Pallof press
PDF p. 679 · instructions pending
diagram pending
Prone reach
PDF p. 680 · instructions pending
diagram pending
Skydiver
PDF p. 681 · instructions pending
diagram pending
Plank crawl
PDF p. 681 · instructions pending
Source: Rehab Science · Ch 19 · PDF pp. 658–669· 4 original research citationsshow sources ▾
Also cited by the book on these pages:
  1. [Ch 19·27] Wood KB, Blair JM, Aepple DM, et al. The natural history of asymptomatic thoracic disc herniations. Spine (Phila Pa 1976). 1997;22(5):525-530. find original ↗
  2. [Ch 19·28] Gundersen A, Borgstrom H, McInnis KC. Trunk injuries in athletes. Curr Sports Med Rep. 2021;20(3):150-156. find original ↗
  3. [Ch 19·29] Foley CM, Sugimoto D, Mooney DP, Meehan WP 3rd, Stracciolini A. Diagnosis and treatment of slipping rib syndrome. Clin J Sport Med. 2019;29(1):18-23. find original ↗
  4. [Ch 19·30] Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617-620. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.