Alleviating Back Pain Using the BOSU®

By: Justin Price, MA

In today's world, people spend increasing amounts of time sitting. Whether driving, working on the computer, or watching television, these seated postures are often characterized by a rounded upper back and shoulders. Over time, this stooped position in the thoracic spine can cause alignment problems and pain in both the upper and lower back.

How a Sagittal Plane Deviation (Forward Bend) of the Thoracic Spine Affects the Lower Back

The thoracic spine is comprised of the twelve vertebrae of the spine located in the area where the ribcage attaches to the spine. The thoracic spine is naturally curved forward forming what is called a kyphotic curve, however, when this curvature is excessive it can become problematic.

When the thoracic spine rounds forward, the head also moves forward. This forward shift in the torso and head means that a lot of extra weight falls forward of the body. Consequently, the pelvis has to adjust to accommodate this change in the body's center of gravity. The pelvis, therefore, will tilt down at the front (which is referred to as an anterior pelvic tilt) to prevent the entire body from toppling forward. The anterior tilt of the pelvis, however, causes the lower back to arch into excessive lumbar extension. Over time, this excessive arching places stress on the structures of the lower back and can lead to pain, dysfunction and/or injury.

Furthermore, when the thoracic spine rounds forward the ribcage drops at the front of the torso. This compression of the ribcage restricts blood supply to the internal organs and affects the functioning of the diaphragm and the ability to breathe correctly.

How a Lateral Deviation of the Thoracic Spine Affects the Hips

When people sit down at a computer they spend a lot of their time using the mouse to search the internet and check emails. A right-handed person will reach to the right side to use the mouse. As such, their spine bends to the right and their ribcage drops towards that side. Sometimes they even lean on their right elbow as they read emails or at other times in the car while driving. Ultimately, the soft tissue structures on the right side of the spine get used to this chronic side bending and the spine begins to develop a lateral side bending to the right (or to the left if they are left-handed).

Now when this same person stands up or begins to walk, their sideways posture has implications. Their spine is so used to being bent to the right that they develop a chronic lateral deviation in their thoracic (and possibly lumbar) spine to the right. Upon weight bearing, (when they stand or begin to walk) the hips must adjust to accommodate the lateral shift in their center of gravity. For example, a lateral bend in the spine to the right would move the weight of the torso more to the right. To help the body balance, the hips must then shift in the opposite direction to the left. Therefore, the most typical compensation pattern for a spine curved to the right is for the left hip to shift to the left. Eventually, the chronic compensation pattern described in this situation can lead to pain in the left hip and lower back.

How a Rotational Deviation of the Thoracic Spine Affects the Hips and Lower Back

When the thoracic spine bends to one side, the spine will rotate out of alignment in the direction of the curve to reduce the resultant pressure placed on the spinal cord. For example, if the thoracic spine bends to the right then the discs of the spine will rotate forward on the right side. If you were to look down the spine from a bird's eye view in this instance, the thoracic spine would be rotated anti-clockwise [counterclockwise].

Sooner or later, this malrotation of the spine in the anti-clockwise [counterclockwise] direction will make it increasingly difficult for the thoracic spine to rotate clockwise. If the curvature is reversed to the left, then the clockwise/anti-clockwise [counterclockwise] implications are obviously reversed as well.

A rotational imbalance in the thoracic spine that prevents effective rotation to one side effects many daily activities. For example, when you walk your arms swing opposite to your legs (i.e., when the right leg swings forward the left arm swings forward and visa versa). When the arms swing the thoracic spine should rotate as well. This opposite rotation of the upper and lower body helps pre-stretch the soft tissue structures that attach to the pelvis, ribs and spine, making walking an easy and efficient motion. However, if the thoracic spine does not rotate effectively in one direction then the pelvis and lower back may compensate to try to make up for the lack of rotation further up the spine. Over time, this can lead to overuse injuries in the hips and lower back.

Putting the Pieces Together

Now you can see how the most common deviations in the thoracic spine occur in all three planes of motion. Excessive thoracic kyphosis is a deviation in the sagittal plane, a dominant side bend in thoracic spine is a deviation in the frontal plane, and a malrotation of the thoracic spine is a transverse plane imbalance.

To correct these imbalances we need exercises that can help unlock these dysfunctional movement patterns and/or structures. We need to incorporate strategies that get the thoracic spine to extend, to bend correctly to both sides, and to rotate effectively in both directions. However, often when we try to get the thoracic spine to move correctly, people have a tendency to cheat and create the desired motion from elsewhere in the body. For example, when we ask someone with excessive thoracic kyphosis to arch their back to help facilitate thoracic extension, they will most likely just arch their lower back even more to achieve the desired movement. Similarly, if we ask the person to bend to one side and their thoracic spine does not bend that way, then the lumbar spine or neck may compensate and overwork to achieve the movement goal. Moreover, in trying to get the thoracic spine to rotate in a direction in which it is restricted, then the hips or lumbar spine may cheat or overwork to take up the slack for a dysfunctional thoracic spine.

How Can the BOSU® Balance Trainer Help Alleviate These Problems?

The arch on the dome of the BOSU® Balance Trainer is perfectly suited to act as a fulcrum for the middle of the thoracic spine. By placing the center of the thoracic spine over the center of the dome, we can ensure that the movement is restricted to the thoracic spine and we can achieve the desired movements from the specific area we are trying to correct. This placement of the BOSU® Balance Trainer can be utilized to facilitate motion in all 3 planes and will ultimately help create balanced mobility in the thoracic spine and help alleviate compensations of the lower back and hips.

Using the BOSU® Balance Trainer to Train Muscles Effectively

The video clip and exercises that accompany this article demonstrate four exercises that are specifically designed to increase the range of motion for the thoracic spine in all 3 planes of movement. Facilitating these movements will not only help increase the range of motion at the thoracic spine, but can also reduce the amount of extra work the lower back has to do to compensate for thoracic spine dysfunction.

This mobilization exercise with self massage helps release restrictions in the abdominals while increasing extension in the thoracic spine and hips.

back pain 1 Instructions: Support the head. Align top of dome of BOSU® Balance Trainer with middle of thoracic spine. Self-massage the abdominal muscles and fascia to release the front side of the torso to help increase the ability of the thoracic spine to extend.


This next mobilization exercise helps increase frontal plane mobility in the thoracic spine and hips.

back pain 2 Instructions: Support the head. Align top of dome of BOSU® Balance Trainer with middle of thoracic spine. Reach the top arm over the head. Drop the knee on the same side as the arm that reaches over the head. Try to stretch open the ribcage on the top side of your body. Do both sides to assess which feels easier to bend. Do three times as many on the side that is difficult. This will help balance the spine.


This next mobilization exercise helps increase rotation and extension in the thoracic spine.

back pain 3 Instructions: Support the head and keep eyes looking at ceiling. Align top of dome of BOSU® Balance Trainer with middle of thoracic spine. Let the spine lie back into slight extension. Straighten the leg on the left side. Keep the hips level (i.e., do not rotate them) and reach your left arm to your right to rotate the thoracic spine. Repeat on the other side to assess which side is the most difficult. Do three times as many on the side that is difficult. This will help balance the spine.


This strengthening exercise helps increase the thoracic spine ability to extend, side flex and rotate under load.

back pain 4      back pain 5 Instructions: Support the head. Align top of dome of BOSU® Balance Trainer with middle of thoracic spine. Keep the pelvis posteriorly tilted to decrease the tendency for extension to happen in the lumbar spine. Extend over Balance Trainer to increase extension and then crunch up to neutral. Do not crunch up too far. Add side bending and rotation to this exercise to increase mobility in all three planes.

About the Author:

Justin Price is co-owner of The BioMechanics, a private training facility located in San Diego, CA, that specializes in providing exercise alternatives for sufferers of chronic pain. He is also the co-creator of The BioMechanics Method which is a method for pain reduction that combines structural assessment, movement analysis, corrective exercise and life coaching that teaches trainers how to help clients alleviate chronic pain and improve their function. He was named International Personal Trainer of the Year in 2006 by the worlds' leading organization of health and fitness professionals, IDEA Health and Fitness Association, and has helped thousands of people around the world overcome pain and injury through his methods. For more information about Justin or The BioMechanics Method go to


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