What exercise program is recommended for a patient with thoracic radiculopathy to improve thoracic mobility and core strength?

Exercise Program for Thoracic Radiculopathy: Improving Thoracic Mobility and Core Strength

A comprehensive exercise program for thoracic radiculopathy should combine core stabilization exercises with thoracic mobility work, performed at moderate intensity for 20-30 minutes, at least 3 times weekly to effectively improve function and reduce pain. 1

Core Stabilization Exercises

Initial Phase (1-2 weeks)

• Isometric Core Exercises:
  • Abdominal bracing: Contract abdominal muscles without movement, hold 5-10 seconds, 10-12 repetitions
  • Bird dog: On hands and knees, extend opposite arm and leg while maintaining neutral spine, 8-10 repetitions each side
  • Modified plank: Hold position for 10-30 seconds, 3-5 repetitions with proper form

Progression Phase (2-4 weeks)

• Dynamic Core Stabilization:
  • Dead bug exercise: Lying on back, extend opposite arm and leg while maintaining core engagement, 10-12 repetitions
  • Bridge exercise: Lift hips while maintaining neutral spine, hold 5-10 seconds, 10-12 repetitions
  • Side plank: Modified versions progressing to full side plank, 10-30 seconds each side

Thoracic Mobility Exercises

Initial Phase

• Gentle Thoracic Mobilization:
  • Seated thoracic rotation: Sitting on chair, rotate upper body with hands across chest, 10 repetitions each side
  • Cat-cow: On hands and knees, alternate between spinal flexion and extension, 10-15 repetitions
  • Thoracic extension over foam roller: Gentle extension over foam roller at mid-back, 30-60 seconds at each segment

Progression Phase

• Advanced Thoracic Mobility:
  • Thread the needle: From quadruped position, reach one arm under body then toward ceiling, 8-10 repetitions each side
  • Standing thoracic rotation with stick: Hold stick across shoulders, rotate trunk while keeping hips stable, 10 repetitions each side
  • Thoracic extension with arms overhead: Seated or standing, extend thoracic spine with arms reaching overhead, 10 repetitions

Exercise Parameters and Progression

• Frequency: 3-5 times per week 2
• Intensity: Moderate - aim for Borg scale rating of 4-6 for dyspnea or fatigue 2
• Duration: Begin with 10-15 minutes, progress to 20-30 minutes per session 2
• Progression: Increase repetitions before increasing resistance or difficulty

Combining with Upper and Lower Body Training

• Include upper extremity exercises using light resistance (elastic bands, light weights) to improve function for daily activities 2
• Add lower extremity exercises to improve overall strength and function
• Progress from 2-3 sets of 6-12 repetitions at 50-85% of one-repetition maximum 2

Important Considerations

• Avoid high-impact activities and spinal manipulation which could worsen disc prolapse and radicular symptoms 1
• Monitor for increasing neurological symptoms which may indicate need for medical reassessment 1
• Back extension exercises in prone position have shown particular benefit for sub-acute radiculopathy by improving nerve root decompression 3
• Combining lumbar stabilization with thoracic mobilization exercises has demonstrated superior outcomes for reducing pain and improving function in patients with radiculopathy 4

Exercise Progression Algorithm

1. Assessment Phase: Begin with exercises that don't provoke symptoms
2. Initial Phase: Focus on isometric core exercises and gentle thoracic mobility (1-2 weeks)
3. Intermediate Phase: Progress to dynamic stabilization exercises and more challenging mobility work (2-4 weeks)
4. Advanced Phase: Incorporate functional movements that mimic daily activities (4+ weeks)

The evidence strongly suggests that a combined approach of thoracic mobility exercises with core stabilization training provides the most effective outcomes for patients with thoracic radiculopathy, with studies showing significant improvements in pain intensity and functional disability 4.