Why We Treat the Upper Thoracic Spine for Shoulder Pain and ROM Restrictions

by Son’s Rehabilitation Medicine & Chiropractic Clinic in Seoul

Hello, this is Dr. Son’s Rehabilitation Medicine& Chiropractic Clinic.

When patients present with shoulder pain or limited Range of Motion (ROM), the focus is often mistakenly placed solely on the glenohumeral (G-H) joint. However, as a specialist in Rehabilitation Medicine and a licensed Chiropractor, I approach shoulder dysfunction through the lens of the "Kinetic Chain." To truly fix a shoulder, you must look at the Upper Thoracic Spine. Here is the clinical evidence why.

1. The Biomechanical Foundation: Scapulohumeral Rhythm

Efficient shoulder movement requires a coordinated movement between the humerus and the scapula (shoulder blade).

  • The Evidence: Research shows that for every 2 degrees of humeral elevation, the scapula must rotate 1 degree.

  • The Thoracic Role: During the final stages of shoulder flexion (above 150°), the upper thoracic spine must extend. If the thoracic spine is hyper-kyphotic (slumped) or rigid, it physically blocks the scapula from tilting backward, leading to Subacromial Impingement Syndrome.

2. Restoring the "Scapular Engine"

The scapula sits on the rib cage, which is supported by the thoracic spine. If the thoracic alignment is off, the muscles governing the scapula cannot function optimally.

  • Pectoralis Minor: A stiff thoracic spine often leads to a shortened pectoralis minor, which pulls the scapula into a "protracted" and "downwardly rotated" position—the worst position for shoulder health.

  • Serratus Anterior: This is the key muscle for scapular stability. Thoracic mobilization improves the length-tension relationship of the serratus anterior, allowing it to "glue" the scapula to the ribs during overhead movements.

3. Neurological Connection and the Brachial Plexus

The nerves that control shoulder strength and sensation originate from the lower cervical (C5-C7) and upper thoracic segments.

  • The Evidence: Structural dysfunction in the upper thoracic spine can increase sympathetic tone and myofascial tension in the upper trapezius and levator scapulae.

  • The Chiropractic Advantage: By utilizing chiropractic adjustments on the upper thoracic segments, we reduce neural interference and reset the resting tone of the shoulder musculature, often resulting in an immediate increase in ROM.

🎯 Our Integrated Treatment Approach

At Son Cheol-ho Rehabilitation Medicine, we don't just "mask" the pain; we restore function through a 3-step protocol:

  1. Thoracic & Cervical Mobilization: Using Chiropractic and Manual Therapy to unlock rigid vertebral segments.

  2. Myofascial Release: Targeting the Pectoralis Minor, Latissimus Dorsi, and Triceps Long Head to remove physical obstructions to movement.

  3. Neuromuscular Re-education: Specialized exercises to activate the Serratus Anterior and lower Trapezius, ensuring long-term stability.

"A shoulder is only as mobile as the spine it is attached to."

If you are struggling with persistent shoulder stiffness or "Frozen Shoulder" symptoms, it may be time to look at your spine. We provide evidence-based, non-surgical solutions to get you moving again.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

chson@daum.net

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