Thoracic Rotation-Flexion Syndrome

Thoracic Rotation-Flexion Syndrome


Pain in the thoracic region that may radiate laterally along the ribs to the anterior ribcage or abdomen.  Symptoms are worse lying down, while reaching or during trunk rotation, and with forceful exhalation.  These symptoms are usually due to participating in flexion and rotation activities such as racket sports or golf, but also with daily activities that use flexion and rotation (sitting at a desk with a monitor turned to 1 side or reaching for a phone or filing to one side frequently).

Diagnostic Tests:

  • Increased thoracic kyphosis.
  • Asymmetry in muscles of the thoracic spine (paraspinals, obliques, pecs).
  • Asymmetry in the ribcage.
  • Excessive motion into thoracic flexion during forward bend.
  • Rotation of the thoracic spine during forward bend.
  • Asymmetry in trunk sidebending or rotation.


  • Correct postural deviations into flexion and rotation.
  • Identify triggers in every day life and rearrange furniture or a seating position to improve posture and decrease incidence of flexion and rotation.
  • Improve thoracic paraspinal muscle recruitment and performance.
  • Eliminate trunk flexion exercises like sit ups.
  • Use upper extremity and lower extremity exercises to improve thoracic extension performance and to develop an abdominal strengthening exercise routine consisting of resisting motion rather than creating motion.

These are primarily sourced from work by the great Shirley Sahrmann PhD. I use these pages as a personal reference for this type of information.


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