Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis

Key points

1. 0138 exercises were identified and classified into four domains: mobility (9), work capacity (15), motor control (7), and strength (7).
2. 02Sources came from both databases and social media platforms such as YouTube, reflecting common practice rather than proven effectiveness.
3. 03Overall evidence level for every outcome domain was rated D (level 5), meaning expert opinion with no critical appraisal backing.
4. 04No randomised controlled trials have specifically investigated thoracic spine exercise effectiveness in athletic populations.
5. 05The classification framework maps exercises by static vs. dynamic displacement and functional vs. non-functional movement to guide personalised prescription.

How it was conducted

Design

Systematic review and narrative synthesis

Sources searched

Medline, Google Scholar, PEDro, SportDiscus, PubMed, Index to Chiropractic Literature, key journals, and social media (YouTube, Facebook, Twitter, Vimeo, Instagram) to 16 August 2019

Total sources screened

2348

Included exercises

38 exercises (18 from database articles, 20 from social media)

Population target

Athletic population aged 18-40 participating in competitive sport or physical exercise aimed at improving athletic ability

Evidence grading

Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence

What they found

• From 2348 sources, 38 exercises with variants were included after removal of duplicates and eligibility screening.
• 18 exercises were sourced from database articles and 20 from social media, primarily YouTube.
• Exercises were distributed across: mobility (n=9), work capacity (n=15), motor control (n=7), and strength (n=7).
• The overall body of evidence for each of the four outcome domains was rated Grade D (level 5 evidence).
• Four included database sources were randomised controlled trials, but thoracic exercise was only one component of each intervention (sample sizes ranged 22-52).
• One large cohort study included thoracic exercises as part of rehabilitation in athletes with groin pain (n=205).
• Inter-reviewer agreement on exercise classification was 100%.
• Altered trunk rotation was related to increased shoulder external rotation of more than 7 degrees (p<0.016) in baseball pitchers.

Limitations

• All outcome domains were rated level D (level 5) evidence, meaning no effectiveness data exist for any included exercise in athletic populations.
• Social media sources could not be fully reviewed due to volume (a single YouTube search for thoracic spine exercises yielded 1,490,000 results), so some exercises may have been omitted.
• Only one reviewer completed searches and screening, increasing the risk that exercises described with inconsistent terminology (torso, trunk, upper body) were missed.
• The review protocol was not prospectively registered, reducing protection against reporting bias.

Why it matters

For patients

Athletes cannot yet rely on evidence-proven thoracic exercises, but this framework provides a structured starting point for clinicians to tailor programs to individual needs and sport demands.

For clinicians

The classification framework maps 38 exercises by outcome domain and movement type, giving physiotherapists and strength-and-conditioning coaches a practical tool for thoracic spine prescription while highlighting the absence of dose-response or effectiveness data.

For readers

This review is primarily a practice resource and research roadmap rather than a source of efficacy conclusions; results from all domains carry the lowest evidence grade.