Thoracic extension

Thoracic extension means straightening, or gently arching, the upper back. Exercises that train it improve mobility in the part of the spine that rounds forward with long screen work and with age, and they are a core part of programmes for rounded shoulders and the neck hump. This page shows three versions, the dosage and the evidence.

Three ways to do it

Over a chair back (at your desk)

1. Sit tall with the top of the chair back just below your shoulder blades.
2. Put your hands behind your head, elbows forward.
3. Lean back over the chair, lifting your chest toward the ceiling. Keep your lower back still.
4. Hold for 2 seconds, return. Repeat 5 to 8 times.

Over a foam roller (on the floor)

1. Lie with a foam roller across your upper back, knees bent, hands supporting your head.
2. Let your upper back extend over the roller, then lift back up.
3. Move the roller a few centimetres up or down and repeat. Stay above the lower back.

Lying face down (strength version)

1. Lie on your front, forehead on a folded towel, arms by your sides.
2. Lift your head and chest a few centimetres, keeping your eyes on the floor.
3. Hold 3 to 5 seconds, lower. Repeat 8 to 10 times.

How often

Mobility versions: 5 to 10 repetitions once or twice a day, especially after long sitting. The strength version: 2 to 3 sets, three times a week, adding holds or light weight in the hands over the weeks.

What the evidence shows

In the SHEAF randomised trial, 99 adults aged 60 to 88 with an increased upper back curve did a physiotherapist led programme of spine strengthening and posture training, including extension work, three times a week for six months. Their curve improved by about 3° more than in the control group.¹ A 2024 meta-analysis of exercise for forward head, rounded shoulders and upper back rounding found improvements across all three, from programmes that combined strengthening and stretching.²

Common mistakes

• Arching the lower back instead of the upper back. Keep the ribs down and the movement above the waist.
• Pulling on the head with the hands. The hands only support it.
• Rolling over the lower back on a foam roller.

Who should take care

People with osteoporosis or a known vertebral fracture should get advice before loaded extension or foam roller work. Stop and get advice if an exercise causes sharp pain, pain spreading into an arm, numbness, tingling or dizziness. Mild muscle effort and a gentle stretch are normal.

Pair with scapular retraction and the chin tuck, as in how to improve your posture.

Footnotes

1. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults (SHEAF RCT). 2017. ↩

2. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. 2024. ↩