A lack of thoracic mobility, particularly extension, is one of the chronic structural/functional issues of our time. In this episode of The ABMP Podcast, Kristin and Darren speak with Lynn and Ann Teachworth about why they decided to develop a class on the thoracic spine, how the dynamics of the thoracic relate to common pain syndromes and injuries in other parts of the body, and some strategies therapists should consider when understanding the importance of the spine in overall body function.
Self-care to Enhance Thoracic Spine Mobility: https://www.youtube.com/watch?v=0V6tRYKYJZY
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0:00:00.1 Speaker 1: Are you a massage therapist who loves to problem solve? Do you see clients with challenging musculoskeletal issues? If so, then studying Precision Neuromuscular Therapy will help to sharpen your decision-making skills and achieve better client outcomes. Our emphasis is on the problem-solving process rather than the teaching of a singular technique or approach. Led by founder Douglas Nelson, each PNMT instructor is a busy clinician with decades of practical experience. Visit pnmt.org to explore our offerings of live seminars, online courses, or the video resource library the PNMT portal. That's pnmt.org.
0:00:58.7 Darren Buford: I'm Darren Buford.
0:00:58.9 Kristin Coverly: And I'm Kristin Coverly.
0:01:00.4 DB: And welcome to the ABMP Podcast. A podcast where we speak with the massage and body work profession. Our guests today are Lynn and Ann Teachworth. The team behind Trunamics. Lynn has certifications in Structural Integration, Myofascial release, SourcePoint therapy, trigger point therapy, Craniosacral Therapy, Visceral Manipulation, and BodyTalk. His clients include over 2000 professional athletes in the PGA, LPGA, NBA, NFL, and MLB. In addition to recovery, rehab, and maintenance work, Lynn also helps improve athletic performance. As a Franklin method Educator, Certified life coach, and integrative healthcare practitioner, Ann's work focuses on helping people understand and embody their design and function so they can operate more fully and freely in their bodies, minds, and lives. For more information about them, visit trunamics.com. Hello, Lynn. Hello, Ann. And hello, Kristin.
0:02:00.8 Lynn: Hello.
0:02:01.4 Ann: Hi.
0:02:01.5 KC: Hello. We're so excited to have you back and I don't know, should we talk about this or not? You are joining us mid-hurricane from Orlando. So thank you so much for making that happen during this really challenging time. We're very grateful that you're here with us today.
0:02:17.5 Ann: Of course, we're happy to have a break from sitting around watching the weather. [chuckle]
0:02:22.6 KC: Okay, guys. Today we are doing a deep dive into the thoracic spine. So let's start at the very beginning so all of our listeners are on the same page. We're all starting this conversation together. Let's start by defining it. Which vertebra make up the thoracic spine? What are its common movements? What role does it play in the body? Let's start there and then we'll go deeper.
0:02:44.4 Ann: So thoracic spine is the middle portion of the spine. You have the cervical spine that is the neck, and that typically has seven cervical vertebrae. I say typically 'cause we always have anatomical variations but that'll be C1 through 7. And then you have the thoracic spine, T1 through 12, and then you have the lumbar spine, L1 through 5. And so the things that are gonna affect the movement of the thoracic spine are going to be the rib attachments. So that's where the rib basket is suspended from, also the organs very much relate to the thoracic spine. You have your whole thoracic cavity set of organs, the heart, the lungs and their various expansions and attachments, and then even in the abdominal cavity, you're gonna have impacts from the organs to the thoracic spine, like stomach and liver, the kidneys, pancreas, things like that.
0:03:38.2 Ann: The diaphragm is the division between the thoracic spine or the thoracic cavity rather, and the abdominal cavity. But the diaphragm is also very much related to the motion of the thoracic spine. And of course the movements available are all the spinal movements we expect, flexion and extension, rotation, lateral flexion, but the design of the vertebrae of the thoracic spine really allow a lot of movement. So some people and historically, if someone had a thoracic spine injury, they would say, "Ah, no big deal. It doesn't move that much. Just fuse it or don't worry about it," but thoracic spine movement turns out is very, very important for what's happening in the limbs and the rest of the body, which is what we'll kinda get into a bit more. So it's this part of the spine that people haven't paid a lot of attention to.
0:04:27.5 Ann: They say, "Ah, it doesn't move that much," and yes, because of the rib basket and the organs, it doesn't move as much as the cervical spine. The Lumbars are more about stability and foundation, so they don't have a ton of movement, but the thoracic spine has this potential for incredible movement in all directions and Tri-planar movement. So throughout the course of the conversation, we'll talk about those dynamics. How the thoracic spine needs to be able to not just do one plane of movement at a time, but often our motions require it to do all three at the same time. Every time you take a step or reach your arm, your thoracic spine is adapting to that movement and transferring force three-dimensionally. So those different vertebrae might be doing some side bending, some rotation, and some flexion and/or extension at the same time. And that's what allowing us to do this three-dimensional movement every time we walk or run or reach for something or raise our arms in the air. So really, really important that we have healthy movement through the thoracic spine to transfer force and motion from the upper limb to the lower limb. From the head all the way down to the tail and the feet.
0:05:44.7 DB: So Lynn and Ann, we haven't seen many classes on the thoracic spine. So why did you decide to develop one?
0:05:50.5 Lynn: Well, that's just it. I don't think unless you've really studied the functional biomechanics, you have no idea how the thoracic spine works and how it affects the rest of the body. In fact, I first kinda got turned on to it, I don't know, 15 years or so. One of my really good friends when I was over in England teaching. I went to work with him for a few days and he was noticing. He was like, "Ah, your lower back is kind of messed up," and I said, "Yeah, I've got this weird tension in my L4. I can't seem to figure it out." And he goes, "Go for a walk." He goes, "Oh, it's your thoracic spine," and so he put me in this contraption ball that I use every day at work now. It's called a TRUE Stretch and it had me get in a position and drive my pelvis and drive my neck in certain planes of motion then go to walk, and my lumbar spine immediately was perfectly fine.
0:06:38.9 Lynn: And I was like, "Wow, what's going on here?" And he just kind of explained to me. He's like, "Look, if you can't get Thoracic extension and movement, then your lumbar spine and your cervical spine just get beat up," and so as I progressed and then of course, I learned that I had to go to the Grand Institute and get my fellowship and a lot of money and time later. But now you can't unsee it. Because if the thoracic spine doesn't move properly, you will have head forward problems with your head and neck. A lot of people talk about, "Oh, head forward posture. Let's go after that." And so they have all these fancy great techniques to do with the head and the SCMs and all of that but that's completely irrelevant if you don't take care of the thoracic spine. And so as I started playing with that and looking it's like, "Wow, well, most rotator cuff injuries are gonna have an issue if the person can't get into thoracic extension."
0:07:33.5 Lynn: And all of those things, so as we started, we put Trunamics together and started teaching, we were like, "Oh my gosh, so we have to have a thoracic spine class," because as you notice in education, we're the only ones that are teaching a thoracic class and once you kinda take it like we have all those students like, "Oh my god, I finally figured out this guy's ankle problem or their sport performance." And if you can't get into thoracic extension and drive very well, you can't run very fast either 'cause your legs actually start at your diaphragm and that whole area. So to us, it was like, Holy cow. And when a lot of people take the class or get the treatments, they're like, "Oh my gosh, well, this has been missing, it's such an important thing."
0:08:10.7 Ann: And it's pretty easy to feel, so maybe everyone out there listening could kind of... We'll do a little experiment, if you create just a little bit of flexion in your thoracic spine, meaning you kind of round a little bit, it doesn't have to be extreme, but just make it kind of solid so the thoracic spine isn't gonna extend and then you try to lift both arms out in front of you, and as you do that, you will feel that your range of motion is limited, but you'll also feel a strain in the back of the shoulder, and so that's why Lynn mentioned rotator cuff issues. So if I'm not able to get movement, especially extension and rotation through my thoracic spine, then any time I lift the arm, I'm straining those muscles around the rotator cuff and the deltoid and even onto the back.
0:08:56.4 Ann: And then if I try to add a motion like swinging a tennis racket for example, all of that twerk, rather than being transferred through the body is gonna be right at the shoulder or even right at the elbow, so even elbow issues can stem from this lack of thoracic movement, and then same down with the lower back, if my thoracic spine isn't able to extend, then my lumbars are gonna be required to move more than they might like to be moving. So any part of the body that isn't moving requires some other part to move more than its design would allow, which means that part is the one that's gonna start hollering, and so often people focus in on the lower back or the neck, but you've got this rigid part right in the middle, and so our focus says, "Hey, let's go get that rigid part in the middle moving, so that those other things are able to do their job and not more than their job."
0:09:50.1 Lynn: And also to just add on what Ann was saying too, is like if you keep your thoracic spine in flexion and try and look up and turn your head, you can't, it just jams all those cervical facet joints together. So it affects every single part of the body.
0:10:06.6 KC: Let's talk a little bit more about what causes the movement restrictions in the thoracic spine? What are the common causes of those restrictions?
0:10:14.7 Lynn: Well a lot of it is just our lifestyle. We're sitting in flexion all the time, we're sitting at desks, we're driving, we're looking at our phones, or we're going to a gym, and we're doing crunches, and we're doing v-ups with our legs, which is not what our abdominals actually do. In real life, if we're standing up, gravity gives us that motion for free, so our abdominal muscles don't really kick in until we lean backwards and load that up, so when people are doing a ton of planks and all of that, they just create all this rigidity because that's not true function.
0:10:46.5 Lynn: So it's just a lack of extension, people have such tight quads and adductors and no extension, and unless you're taught to do exercises like that, which most trainers aren't even aware of, PTs, it's just gonna... It's like, use it or lose it thing, because if your body is not used to decelerating extension your hip or your abdominals or your spine, then we start to lose the ability to do that, because if your body says, "Hey, I'm gonna lean backward into thoracic extension," your proprioceptors are gonna be screaming to the brain, it's like, "Oh my gosh, we can't decelerate this motion, we're gonna hurt an organ or the spine, so lock it down," so it really is use it or lose it.
0:11:28.1 Lynn: So we're really big... I'm huge on giving people homework after they leave because if they're gonna go... We can do all the great wonderful body work that we want and get it opened up, but if they just go back and drive home in their car and sit at a desk every day, it's not gonna last. So in reality, we do need to teach people how to get their body to break the patterns and learn how to use their muscles properly, and that's one of the things that are huge on our education, is teaching our clients and our students like, "Look, you've gotta get your clients moving," and clients love it, they're like, "Oh, you actually understand why my neck or back or shoulder hurts and you gave me something to do about it, thank you." Which just really empowers them a lot more when they have stuff like that to do on their own.
0:12:12.1 Ann: We tend to see people get more cathodic over life, meaning their thoracic spine gets more rounded, and I think there's just an assumption that that has to happen, it's just gonna be that way, but it really doesn't. It's just that your body forms itself to help you do what you do most of the time efficiently, so it will make it very efficient and easy for you to slouch and sit and stare at your computer or phone, if that's what you're doing most of the time. And so this thoracic movement, we have to be practicing extension, but not just extension, also with rotation and with lateral flexion, that's kind of where people get stuck, sometimes, Lynn will tell people like, "Oh, you have tight abs," and people will look at their little beer gut and be like, "Ha-ha-ha, tight abs, not me."
0:13:04.6 Ann: No worries, but it doesn't mean tight as in strong and dense, it means that they don't have the ability to lengthen, so we put a lot of focus on muscles being strong and able to shorten, but like Lynn said, that's not really what we need at the front of the body, we need these muscles to have the ability to lengthen and load, especially if I'm gonna reach up behind me, I want that whole line from my shoulder to my opposite hip to be able to lengthen, so that includes chest, anterior shoulder muscles, serratus anterior, the oblique muscles on both sides, that line needs to be able to lengthen and load, and if it's not trained in that motion, it's not practiced in that motion, then it will lock it down, it won't do it, it won't have that flowing glide.
0:13:51.5 Lynn: Yeah, and unfortunately, there's still a lot of misinformation about corrective exercises and things out there, it's still taught in a lot of schools, universities like, "Oh, if your shoulders are forward, then you need to go do corrective exercises and make your rhomboids and your erectors stronger to hold your shoulders back," it's like, "Okay, so you're implying that I need to contract my muscles to have good posture and function," that's so outdated and just 10% effective, but like Ann was saying, if we teach people to eccentrically load in the front and balance all that, their shoulders go back, 'cause clients and people will be amazed when you can get them in a position, like Ann was talking about the line. I can have from the front of the hip joint to their shoulder on the opposite side, I can get them up in a lunge and have him grab an exercise band and stretch and fire the muscle at length and within 20 seconds, their shoulder is completely back where it's supposed to be a normal posture.
0:14:46.2 Ann: One thing we say is that if your postural strategy requires tension, that means it's probably gonna restrict breath and motion, so if you have a postural strategy like, "Draw your shoulders back, squeeze your belly in." If your postural strategy means you can't breathe and you can't move, it's not a good postural strategy, any postural strategies should be something that has the body freely ready for movement and freely breathing fully, and the thoracic spine is kind of at the center of those things happening, like that, the movement through the spine, anyone at home, you can try it, if you swing an arm forward or you swing a leg forward, like you do when you walk, that rotation translates through the thoracic spine, if it doesn't, if I'm using a strategy like, "Oh, hold my shoulders back or grip my core," then the rotation like skips the body and goes to just the shoulder or just the leg, that's where we start to see joints get that wear and tear.
0:15:43.7 KC: Let's take a short break to hear a word from our sponsors.
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0:16:58.0 KC: Let's get back to our conversation.
0:17:02.4 DB: Lynn and Ann, how did the dynamics of the thoracic spine relate to common syndromes and injuries in other parts of the body?
0:17:08.3 Lynn: Well, it's really related to that extension that we were talking about, and like as Ann put people before, if you're sitting there and trying to reach back behind you, like if you were gonna throw a ball and you can't get extension in the spine, then you're gonna have rotator cuff injuries. That's just a given. And most rotator cuff protocols or post surgically are in there just doing band exercises in and out, and it's just like, "Wow, you didn't get educated in function," it's really kind of sad 'cause that's what's out there for the most part. So shoulder injuries, like we were talking about the cervical injuries as well, if people got head forward posture, you can't have that without kyphosis in your thoracic spine, and also if the body is really tied in the front, as we know advanced body workers gonna tell you they spend 70% of their time on the front of the body, 'cause that's where all the problems are.
0:18:02.4 Lynn: So if everything's really pulled forward, then your hamstrings are gonna be chronically tight, your erectors are gonna be chronically tight, and that puts a tremendous amount of strain on your lumbar spine, so a lot of herniated discs down the lower spine and the lumbars are gonna come from lock short really, hip flexors and adductors and quads, not so much the so as that's not as important as that, as we think, but having all of that tension down there is gonna lead as well to that, so you're gonna get all kinds of pain and injuries and even ankle injuries when people can't get extension, the ankles have to do too much or they're never gonna load properly and gate. And so pretty much anything in the body is gonna be more susceptible injury of that thoracic spine is not working for sure.
0:18:51.5 Ann: Yeah, and the thoracic spine doesn't position itself. So we're talking about the muscular patterns that are gonna relate and it's kind of a chicken or the egg, which comes first. Like we sit in this slouch thing and then we get kind of short lines across the front or maybe the way we train means the muscles don't move as well. But if you... Some of the muscles we talk about that relate to this, the thoracic kyphosis would be the Serratus anterior to the oblique line, but in also to the adductors and all the way down the legs. So Lynn gives a great example of like if you are trying to catch a ball and year thoracic spine can extend and rotate, your knee is gonna go and you can feel that if you stand up and you just try to try to rotate and reach back, but don't do it from your thoracic spine, the knee literally has to do the motion to do that or the ankle or we could track it all the way down to Plantar fasciitis.
0:19:49.8 Ann: If I'm tight through the adductors and the front of the hip and drawn in through the thoracic spine. That tensioning of the back body line tensions of the plantar fascia, and so it's not like this is the only thing, but it is at the center of many things, and it's a place where people... We just skip over it in terms of thinking about range of motion and function, and we go sort of to the extremities as opposed to saying "What's happening right at the center," and if we can liberate that and mobilize that the limbs just flow from that.
0:20:22.4 KC: What can we do now that we're all on board with giving that thoracic spine some attention?
0:20:28.3 Lynn: Well, I think first, like with anything else, you need to do a proper assessment to see if you get that. I like to just have, I mean you guys can feel this on yourself too if you wanna, I mean step up into like a lunge, either leg forward and then lean back and try and go into extension, and then once you're, back stay in extension, then drive yourself through some frontal plane and and transverse plane motion and see how well you do. Because a lot of us think, "Oh man, I've got really good thoracic extension." You look at it, it's still either kyphotic or perfectly straight. So there's different ways to assess that, but that's a real basic one.
0:21:05.5 Ann: Yeah, I was just gonna say step one is to start noticing. I think it's an area people don't necessarily look at and as therapists we may tend to say where does it hurt? But we always wanna step back and say, how is the way they're using their body causing those patterns that are having something be strained? And so first just noticing this area of the body and then like Lynn said, that it's really simple to have them kind of go through movement in that body. But when you're focusing your attention there, then you will start to see and notice like, "Ah, yeah, it's restricted, it's not moving." And you don't even have to know the extent of what it should be moving or all of that. It's just noticing how it is not moving. And I bet if you started paying attention to that with your clients with just a simple, like Lynn said, lunge, have them then try to move through all three planes, you will start to see that lack of movement there.
0:22:03.8 Lynn: There's so many different causes for anything. That's why when we teach people like we don't want to teach you a bunch of protocols, we want to teach you how to think because anything can cause anything. When you see people saying, "Oh, well, you have Plantar fasciitis, it's this and this, it's like, no 'cause the thoracic spine usually causes a lot of that and hip flexors. But we do like to talk about the usual suspects, like, okay, if you have something, this is what we like to say. And first and foremost I think from a midsection is you're gonna look at the stomach, the actual organ itself because of where the ligaments are that hold the stomach in place and everything. When you've got, somebody that's got really, really just stiff, tight tension in their thoracic spine, they're usually means they're gonna need some visceral work.
0:22:46.4 Lynn: That's one of the reasons we teach a visceral classes because visceral problems are gonna cause so many biomechanic issues and referred pain issues in the body. But I would say the stomach first and then I'll go just kind of check of course the the abdominals, the transverse abdominus and the obliques for sure, the serratus anterior as it runs around, becomes the rhomboids for sure. And then the hip flexors, quads, and adductors, I would say were really, really big in that. And so anything that would decelerate extension or cause people to be in chronic flexion is gonna be that. Because the thoracic spine, always like to say bones are stupid, they're not stupid, but they don't do anything. So if you've got lack of mobility in your thoracic spine, it can be, it's all gonna be coming from the front, especially if Kyphotic, and then of course getting back in the [0:23:37.5] ____ and rotatory and everything in the spine there. Once you get that cleared up to establish movement in each individual vertebrae and in all three planes of motion is super important.
0:23:48.4 DB: Alright, Lynn and Ann let's close with just some self-care tips for our listeners or that they could pass along to their clients, you mentioned you love giving your client's homework and they love homework. How can we keep our own thoracic spine healthy?
0:24:01.4 Ann: So well, I'll start simple. You might have noticed I called the rib cage the rib basket because cage is very solid sounding [chuckle] and it's not solid. It's more like a wicker basket. That's very movable. So for self care, first step is always awareness. So you could just palpate and explore the rib basket and that's where the thoracic spine is in the back and then mobilize that area yourself through all three planes. So lateral flexion, side, side, back and forth and rotation, appreciating just how mobile the whole, the ribs are. And then that increases the mobility at the thoracic spine, like when you use rib imagery. And then where it gets really nice is when you combine those motions. So if you go into rotation and then you do flexion and extension there and lateral rotation there, we offer, and Lynn may talk about the homework that we give people is probably a little hard to describe.
0:25:01.0 Lynn: What I think is best for people. And one thing that I give my clients to do if they're sitting at desks and things like that and getting pulled forward is just to sit up and I'm gonna demonstrate even though you can't see and just reach back with your arms into extension and then as you're in extension, drive the arms side to side through frontal plane motion and then come down and just keep looking up into extension with your neck and your thoracic spine and drive into a transverse plane motion because that's something you can just do at the desk every day. So go into as much extension as you can get and drive the other two motions. As far as homework goes, with that, what I like to do is just kind of modify that, but have people get up into lunges and reach both arms and lean back and drive through the same thing, standing up on both sides. And then another thing, to do the same thing, but to lean to the side as you're doing that and then go into flexion and extension as you're leaning to the side and go into rotation that really gets it going. So that's a great way to just kinda lubricate the joints and get things moving and get those proprioceptors stimulated. So at least it gives the body a little bit of feeling of movement in extension and that goes a little bit to help people get through that.
0:26:17.8 Ann: Yeah, and don't underestimate the role of hip extension and the things that might prevent that. So hip flexors and adductors, which is why a couple of those things are done in lunges because then you're opening up the anterior and the medial hip as well, which really plays into what's happening with the spine. So if you're sitting all the time, unless your relationship to gravity is perfect, that sitting is gonna eventually draw you down and into that kind of slouched position. So getting the hip into extension with some movement in all three planes and then really just mobilizing, like appreciating my thoracic spine is very flexible and mobile in all directions. Even when you go for a walk, pay attention. Like let your arms swing a little bit more, let the shoulders and the thoracic rotate a little bit more and appreciate how that, that's this like torque conversion that's happening between the lower body and the upper body that takes rotational movement and drives us forward. So for us to go in a straight line forward, that's happening through rotation and counter rotation and if we can appreciate that and kind of activate that in our running or our walking, that's ensuring that all those joints are getting lubricated and moved.
0:27:36.1 Lynn: Yeah, you wanna be a more efficient, faster runner, more powerful, a lot of that drive comes into thoracic Spine. So getting that opened up and moving is huge for just about everything in the body. We also made a video to help with the podcast today so that people can see some of these self-care videos if they want to go ahead and try 'em on theirselves 'cause we know it's hard to kind of explain it auditorial, but we made a video to help everyone be clear on what they can do for that.
0:28:03.5 DB: I wanna thank our guests today, Lynn and Ann Teachworth. For more information about the good work they're doing, visit trunamics.com. Thanks Lynn, Anne, and Kristin.
0:28:13.6 Ann: Thank You.
0:28:14.6 Lynn: Thanks guys, have a great rest of your week.
0:28:15.7 KC: Thank you so much for that incredible conversation, so much information, and for shining a spotlight on the importance of the thoracic spine, we appreciate you.
0:28:25.9 Lynn: Thanks.
0:28:26.8 Ann: Thank you. Thanks for the work you're doing.
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