Avoiding Injury in Middle Eastern Dance – Thoracic Region
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This article, second in my series of articles pertaining to applied anatomy for the oriental dancer, focuses on the basic anatomy, principles of movement, common problems with and exercises for the Thoracic Region (trunk). This region includes the 12 thoracic vertebrae (from the lowest rib to the base of the neck), their 24 corresponding ribs; and the sternum (the collar bone and shoulder blades will be discussed in a future article). The thoracic spine has a slight natural curvature, known as the kyphotic curve, which is slightly hollow to the front and rounded to the back. This hollow portion of the spine, together with the ribs, form the thoracic cage which contains the lungs, the heart, the esophagus, the trachea and major blood vessels. In a healthy, supple body, this curve increases and the ribs bend open during inhalation. Conversely, the curve decreases and the ribs close during exhalation.
If this natural expansion and contraction is restricted due to postural dysfunction or prior injury to the spine or ribs, our breathing capacity is decreased. If the natural curves of the spine are decreased, the spine loses its shock absorbing “S” contour. This most commonly occurs as a result of injury to the spine such as whiplash or a fall on the tailbone, or as a result of extensive classical ballet training at an early age.
The flattened spine then distributes the upper body weight onto the back of the thoracic vertebrae and their adjoining facet joints, the same as in an excessively curved lumbar spine. In both cases, this increases the pressure on these joints and on the spinal nerves which exit from the spinal cord through small openings beside these joints. However, in the thoracic spine, any irritation of these joints and/or the spinal nerves can result in irritation of the sympathetic nerves, which run parallel to the thoracic spine. The sympathetic nerves control the “fight or flight” response, which is designed to enable us to protect ourselves in times of danger. It is not designed to withstand constant irritation from such prolonged pressure. The results are many and varied including irregular or rapid heart rate, rapid shallow breathing, and digestive problems.
On the other hand, an increase in the natural kyphotic curve, known as hyperkyphosis, can result in even more problems. The upper back and shoulder muscles, such as the erector spinae, trapezius and rhomboids, are forced to support the extra weight of the shoulders, arms and head as these are displaced in a forward position. These muscles then become over stretched, overworked and weak. Their corresponding fascia (connective tissue) becomes dense and rigid in an attempt to compensate for the resulting lack of strength. This results in the all too common nagging upper back, neck and shoulder pain. Left uncorrected, this curve will eventually increase into an unsightly and dangerous “dowagers hump”.
Hyperkyphotic posture also decreases our breathing capacity by decreasing the available space for lung expansion. The anterior neck and shoulder muscles then overwork in order to lift the upper ribs to fill the upper portions of the lungs. Any decrease in breathing capacity decreases our supply of oxygen and vitality and increases fatigue. There are many factors which can contribute to a hyperkyphotic posture. These include chronic overwork and fatigue, sedentary lifestyle, occupations such as computer and desk work, emotional trauma and chronic pain.
Considering all of these factors, it becomes apparent how important it is to maintain a mobile, balanced and supple thoracic spine if we wish to maintain optimal health. In the following section, I will present several exercises to correct and maintain the health of this “thoracic segment” of the body.
If the natural curvatures and mobility of the thoracic region have already been compromised, the first step in a corrective exercise program is to reestablish healthy breathing patterns.
Exercise #1: The breath should slowly fill the lower abdomen, then the center of the chest and finally the upper chest, while the ribs soften and widen. Exhalation follows the reverse pattern.
Exercise #2: This simple exercise can be done in a seated position: drop the chin onto the chest and roll forward while exhaling, then roll up, stretch the arms above the head and arch backwards while inhaling.
The next step is to mobilize the spine.
Exercise #3: The cat stretch: on all 4’s, arch the back up to the ceiling, letting the head drop between the arms. Hold for 10 seconds. Lift the head and look at the ceiling while arching in the opposite direction, letting the abdomen protrude towards the floor. Hold 10 seconds and repeat 4-5 times.
Exercise #4: As above, but add side stretch of the ribcage. Stretch the ribcage to the right, bringing right shoulder to right hip, then stretch the mid back to ceiling, then stretch left ribcage to left, bringing left shoulder to left hip and then arch back and lift chin, inscribing a circle with your ribs. Repeat several times and then reverse direction.
Rib circles, undulations, figure 8s and chest lifts/drops as practiced in oriental dance are all fabulous exercises to restore and maintain mobility in the thoracic region.
To correct a decreased or excessive curve of the spine, or a lateral deviation called “scoliosis”, it is essential to see a qualified physical/massage therapist or osteopath, for assessment, treatment and assistance in designing a remedial exercise program specific to the individual. This is also especially important after any injury or surgery of the spine, ribs shoulders or abdomen.
Exercise #5: In the case of “flat back” posture, lay on the back for 5 minutes with a large rolled towel under the small of the back and a small rolled towel under the neck. Then roll onto the stomach with a semi- inflated ball under the chest for 5 minutes. This will restore the spine’s decreased lordotic and kyphotic curves. I also recommend craniosacral therapy to release dural tube (which covers the spinal cord) restrictions which may be the cause of or contribute this situation.
Exercise #6: In the case of “hyperkyphosis”, the anterior chest pectoralis major and minor muscles must first be stretched. Lay on the back with a rolled towel placed horizontally under the mid back (at breast level), with the arms stretched up at 45 degrees from the shoulders, for at least 5 minutes. This position is even more effective if one lays over a theraball.
Exercise #7: The “cobra” yoga posture will increase extension of the thoracic spine. Lay on the floor face down, with hands at shoulder height and slowly straighten the elbows. You are lifting your upper body while allowing the weight of the torso sink down to the floor.
Only after the anterior torso muscles have been restored to it’s natural length through Exercises # 6 &7, the muscles which stabilize the shoulder blades (trapezius and rhomboids) must be strengthened.
Exercise #8: Slowly squeeze the shoulders together, hold for 30 seconds, release and repeat 3 times. Stretch and strength of the shoulder region will be covered more specifically in a later article.
Because scoliosis (lateral deviation) must be managed by a therapist, I will not include exercises in this column.
The key to restoring and maintaining a mobility and balance to the thoracic region is consistent and careful exercise. Postural ” bad habits” have taken time to form and will take time to reform into good habits. Be patient and try to incorporate the above exercises into your daily routine. The rewards will be many.