Thoracic Spine Mobility Exercises for Back Pain
In both daily life and sport, the region of the spine between the neck and the low back, your thoracic spine often gets overlooked. Yet it plays a crucial role in how you move, breathe and even how effectively your shoulders and neck function (Ristovski et al., 2025). When this mid-back segments is stiff, other parts of the body, particularly the lower back and neck, try to compensate. This can contribute to pain, fatigue and reduced functional performance across everyday activities and athletic pursuits alike (Ergin, Vatansever Kayali, & Kara, 2025).
From an osteopathic or physiotherapy perspective, thoracic mobility isn’t simply about range of motion for its own sake. Limited thoracic rotation and extension can influence posture, breathing dynamics and the efficiency of movement patterns (Ristovski et al., 2025; Suzuki et al., 2019). These factors are integral to both rehabilitation and performance enhancement. One recent randomised controlled trial emphasised the importance of targeted physiotherapy to improve thoracic rotation in people with spinal pathologies; although mobility increased after intervention, deficits remained compared with healthy individuals, underscoring the need for focused exercises that address this region of the spine (Ergin et al., 2025).
A systematic review from 2026 also highlights that thoracic-focused interventions — including thoracic mobilisation and breathing techniques — have small but meaningful effects on pain and a larger effect on disability in patients with chronic low back pain, suggesting that improving thoracic motion may support recovery beyond the mid-back region itself (Seyedhoseinpoor et al., 2026).
Recent evidence shows that regular thoracic mobilisation exercises led to significant improvements in chest expansion, hip flexibility and thoracic range of motion in young adults when performed consistently over a four-week period (Vemulavada Shiva, Banu, Rafi, & Maruboyina, 2026). These findings align with broader trends. Thoracic mobility work is increasingly recognised not only as a remedy for stiffness but also as a proactive tool to enhance functional movement and reduce compensatory strain.
Incorporating thoracic mobility into rehabilitation or conditioning programmes helps individuals access the spinal motion required for efficient movement without overloading other regions of the body. This reflects the concept of regional interdependence, where mobility or dysfunction in one area of the musculoskeletal system can influence adjacent or even distant structures (Engell et al., 2019). Improving thoracic motion may therefore support smoother, more coordinated movement and reduce compensatory stress on nearby regions such as the lumbar spine, shoulders and cervical spine (Vicente & Wooley, 2025).
Bretzel Exercise for Thoracic Spine Flexibility
One particularly effective drill is the Bretzel exercise. Although not yet widely studied in controlled trials, the Bretzel has a strong functional rationale and is frequently recommended in both Osteopathic, Physiotherapy, Chiropractic and strength-conditioning sectors as a compound mobility stretch that targets rotation through the thoracic spine while also addressing hip and shoulder flexibility (FunctionalMovement.com, n.d.).
To perform a Bretzel:
Start lying on your side with your knees bent so that your hips are stacked and comfortable.
If helpful, support your head with a small pillow and place a foam pad under your top knee to ensure hips stay level.
Reach the arm closest to the floor forward and use your top arm to gently guide your upper body into rotation — exhaling as you twist and allowing your shoulder to move towards the mat.
Take 3–5 controlled breaths in the end-range position, feeling the mid-back open and the rib cage expand.
Return slowly and repeat on the opposite side.
This movement combines rotational stretch with deep breathing, which has been linked in research to improved thoracic mobility and chest expansion when paired with other exercises (Bhambure et al., 2024).
As you explore the Bretzel and similar drills, it’s important to do them comfortably and with control. Gentle progressions are always better than forcing a large range. Many may also notice not just improvements in rotation but also changes in how they stand, sit and access overhead positions without shoulder or neck strain.
Bringing It Together: Consistency Counts
Current research, though varied in design and sample populations, consistently supports the notion that thoracic-specific exercises and mobilisation techniques have measurable benefits for range of motion, pain and functional outcomes (Ergin et al., 2025; Seyedhoseinpoor et al., 2026; Vemulavada Shiva, Banu, Rafi, & Maruboyina, 2026).
Whether your goals are rehabilitation or performance-oriented, integrating mobility drills such as the Bretzel, into your regular routine may help unlock the mid-back and create more resilient, coordinated movement patterns. Pair these with mindful breathing and postural awareness, and you’re giving yourself a solid foundation for long-term spinal health and improved everyday movement. If you are having issue, book in and lets go through some strategies to see what we can do to help.
References
Bhambure, M. V., & Yadav, T. S. (2024). Effect of thoracic mobility with breath stacking exercise on chest expansion in postsurgery breast cancer patients: A pilot study. Indian Journal of Physical Therapy and Research, 6(1), 65–70. https://doi.org/10.4103/ijptr.ijptr_88_23
Engell, S., Triano, J. J., & Howarth, S. J. (2019). Force transmission between thoracic and cervical segments of the spine during prone-lying high-velocity low-amplitude spinal manipulation: A proof of principle for the concept of regional interdependence. Clinical Biomechanics, 69, 58–63. https://doi.org/10.1016/j.clinbiomech.2019.07.006
Ergin, G., Vatansever Kayali, A., & Kara, B. (2025). Effect of physiotherapy on thoracic rotation in individuals with spinal pathology. Turkish Journal of Sports Medicine, 60(4), 134–142.
FunctionalMovement.com. (n.d.). Brettzel. https://www.functionalmovement.com/exercises/222/brettzel
Suzuki, Y., Muraki, T., Sekiguchi, Y., Ishikawa, H., Yaguchi, H., Suzuki, Y., Morise, S., Honda, K., & Izumi, S. (2019). Influence of thoracic posture on scapulothoracic and glenohumeral motions during eccentric shoulder external rotation. Gait & Posture, 67, 207–212. https://doi.org/10.1016/j.gaitpost.2018.10.022
Ristovski, A., Kapeleti, M., Zlatović, I., & Mrdaković, V. (2025). Acute effects of diaphragmatic breathing on trunk and shoulder mobility and pulmonary function in healthy young adults. Journal of Functional Morphology and Kinesiology, 10(3), 325. https://doi.org/10.3390/jfmk10030325
Seyedhoseinpoor, T., Jafari, R., Shafizadegan, Z., & Abbaszadeh‑Amirdehi, M. (2026). Effects of breathing exercise and thoracic techniques on pain and disability in low back pain: A systematic review and meta‑analysis. PLOS ONE, 21(1), e0339263. https://doi.org/10.1371/journal.pone.0339263
Suzuki, Y., Muraki, T., Sekiguchi, Y., Ishikawa, H., Yaguchi, H., Suzuki, Y., Morise, S., Honda, K., & Izumi, S. (2019). Influence of thoracic posture on scapulothoracic and glenohumeral motions during eccentric shoulder external rotation. Gait & Posture, 67, 207–212. https://doi.org/10.1016/j.gaitpost.2018.10.022
Vemulavada Shiva, M., Banu, N., Rafi, M., & Maruboyina, S. (2026). Effect of thoracic mobilization exercises on gluteus maximus flexibility: A pre‑ and post‑experimental study. Indian Journal of Physiotherapy and Occupational Therapy, 20(1), 145–153. https://doi.org/10.37506/j4r07758
Vicente, J., & Wooley, R. (2025). The addition of thoracic spine manipulation or mobilization to exercise in adults with subacromial impingement syndrome: A critically appraised topic. Journal of Sport Rehabilitation, 34(6), 677–681. https://doi.org/10.1123/jsr.2024‑0135