Training guide
Your thoracic spine, the upper back between the neck and the bottom of the ribs, is where most of your trunk's turning happens. In one trial, rotation drills, extension over a foam roller and upper back strength work improved rotation within 6 weeks, even though the curve of the back didn't change. Posture and stiffness on their own are poor predictors of pain.
This guide covers what the upper back does, how to test its turn, what works and how much, thoracic mobility for posture, golf and overhead work, what the evidence says about shoulder and neck pain, the moves with doses and a step-by-step session, and the warning signs that mean upper back pain needs a doctor rather than a stretch.
In a scanning study of 13 volunteers, the spine from the base of the neck to the bottom of the ribs turned about 25 degrees each way at full trunk rotation, most of it in the middle and lower part, while the lower back turns very little, as our spine page explains.
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Sitting with a broomstick across your chest, young adults turned about 55 degrees each way, and a change of 4 to 6 degrees is needed to be sure it's real. Values differ a lot between methods, so compare yourself with yourself.
In 42 professional footballers, six upper back exercises 3 times a week for 6 weeks added about 8 to 9 degrees of rotation against about 1 in the comparison group, while the curve of the back didn't change. It's one trial, registered after it ran, and a 4-week programme in volleyball players made no difference.
The upper back's curve didn't differ between people with and without shoulder pain, slumped sitting at 17 didn't predict neck pain at 22, and stretching didn't change posture across 23 studies. There's no single correct posture; vary how you sit and move.
Sitting tall gave about 15 to 24 degrees more arm raise than slumping, in the moment. Our shoulder mobility guide covers the rest of overhead reach.
For neck and shoulder pain, the evidence is mostly about a therapist's manipulation, and it wasn't better than a placebo in pooled trials. With osteoporosis, avoid deep or loaded rounding, twist smoothly and ask before rolling. Upper back pain with chest pain needs a doctor, not a stretch: see the warning signs.
Twelve vertebrae from the base of the neck to the bottom of the ribs, each with a pair of ribs. It curves outwards (kyphosis) from birth, and it does most of the trunk's turning: about 25 degrees each way from top to bottom, most in the middle and lower segments, while each lower-back segment turns only 1 to 2 degrees, as our spine page explains. The ribs and the angle of the joints limit bending.
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Thoracic mobility usually means two things: turning (rotation), for golf, throwing, racket sports, swimming and looking behind you, and straightening (extension), for overhead reach and standing tall. Bending sideways matters too, for reaching.
It depends on the test. Seated with a bar across the chest, young adults turned about 55 degrees each way; kneeling back on the heels to lock the lower back, about 41 in one study and 65 to 75 in another; competitive male golfers measured about 37 to 39. Values differ widely between methods, and we found no norms by age, so compare yourself with yourself.
The curve increases with age and upper back extension falls: in 96 adults over 10 years, the curve rose from about 39 to 41 degrees. Trunk flexibility falls more with age than most joints'. Our kyphosis guide covers the curve, and when a new hunch needs a GP.
The ribs and the joints themselves, the muscles of the chest, lats and back, how much stretch your nervous system accepts, and habitual positions: sitting a lot and moving little goes with less rotation. Arthritis of the spine and ankylosing spondylitis stiffen it; see who should change the plan.
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Some people are naturally more curved, some less, and a curve within the normal range isn't a problem in itself, as our kyphosis guide says. Very flexible people need control more than stretch.
Our suggestion, from the studies' methods. These guide your practice; they don't diagnose anything.
Sit on a chair, feet flat and knees together, with a broomstick held across your chest. Turn each way as far as you can without your hips moving. Note how far the stick turns, or take a photo from above, and compare sides. Phone apps and inclinometers measured this well in a study of 23 adults.
Kneel and sit back on your heels with one hand behind your head, and turn that elbow towards the ceiling. Sitting back locks the lower back, so the turn comes from the upper back.
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Stand with your back against a wall and slide your arms up it. If your lower back lifts off before your arms reach the wall overhead, a stiff upper back may be part of it; our shoulder mobility guide has the rest.
The trials are small and short; the pain trials mostly test a therapist's manipulation, not exercises.
At full trunk rotation, the thoracic spine turned about 25 degrees each way in 13 volunteers, most between the middle and the bottom of the ribs. One small imaging study.
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In 46 young adults, seated rotation with a bar averaged 55 degrees, half-kneeling 61 and the heel-sit position 41, and results were consistent from day to day, with a change of 4 to 6 degrees needed to be sure it's real. Across 48 studies, values differ a lot between measuring systems.
In 42 professional footballers, six thoracic exercises (foam roller extension, rotations on all fours and in a plank, a side-plank open book and the bird dog) 3 times a week for 6 weeks raised rotation from about 74 to 83 degrees on one side and 78 to 86 on the other, against about 1 degree in the comparison group. The back's curve, the trial's main measure, didn't change, and the trial was registered after it ran. An all-fours drill improved rotation as much as a standing one over 2 weeks in 39 adults, with no untreated group, while 4 weeks of thoracic mobility work added to volleyball training made no difference in 36 teenage players.
Young adults who sat over 7 hours a day with under 150 minutes of activity a week turned about 65 degrees, against 75 in active adults who sat under 4 hours, in one snapshot study of 92 people. Exercise time went with more rotation. It shows a link, not a cause.
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Sitting slumped cut arm raising by 15 to 24 degrees against sitting tall, in 34 and 12 adults, and there is strong evidence from single-session studies that shoulder range is greater upright. Whether training the upper back raises arm range over weeks is tested only in 11 older women with no comparison group (about 6.5 degrees more after 8 weeks of daily roller work).
A therapist's upper back manual therapy added to usual care helped at 6 to 52 weeks in 3 trials, at low to very low quality, but a single session wasn't better than a placebo, and thrust manipulation matched a sham in shoulder impingement. One 2025 review reported a large short-term effect that other reviews don't match; a 2026 review found gentle mobilisation helped where thrust techniques didn't. Adding thoracic extension exercises to shoulder exercises improved pain sensitivity and strength but not pain or function in 75 adults, and in a pilot of 30 people, mobilisation plus extension exercise did best.
Upper back thrust manipulation eased neck pain more than mobilisation or usual care in the short term, but no more than a placebo thrust (14 trials, 885 people). Adding thoracic mobility exercises to neck rehab didn't ease pain more but improved posture, mobility and neck disability in 54 adults; thoracic mobility exercise matched manipulation in 26 office workers; in 24 people with neck pain and forward head posture, upper back flexibility exercise beat neck stabilisation exercise over 4 weeks; and self-mobilisation over taped tennis balls improved neck movement straight away but not pain.
Across 20 studies, flexibility wasn't associated with clubhead speed, while strength and power were. Better golfers had more trunk and hip rotation flexibility (25 golfers), and golfers with past back pain turned less (32 golfers), in snapshot studies.
In 686 young people, slumped sitting at 17 didn't predict neck pain at 22, and in young women it went with less. Forward head posture went with neck pain in adults but not teenagers across 15 snapshot studies, and the upper back's curve didn't differ with shoulder pain. Experts argue there's no single correct way to sit.
Across 23 studies, stretching didn't change posture, while strengthening improved it a little in the upper back and neck only. An expert panel agreed unanimously that stretching doesn't change posture.
Across 7 trials, exercise programmes reduced the upper back's curve, and the authors suggest strengthening matters more than stretching. In adults aged 45 and over with a rounded upper back, 8 of 13 studies found exercise improved at least one measure of posture, though the data were too thin to pool. Our kyphosis guide has the plan.
The UK consensus advises modifying or avoiding sustained, repeated or end-range forward bending of the spine, and says twisting should be safe if smooth and comfortable; an international panel advises care when twisting or bending with a load. In an old, non-randomised study of 59 women with spinal osteoporosis, those taught bending-forward exercises had more new spinal fractures than those taught back-extension exercises.
Stretching programmes didn't cut sports injuries across 25 trials, and the extra range from one session fades within about 30 minutes.
Thoracic rotations, open books and thread the needle, 6 to 10 slow reps or 30 to 60-second holds each side, turning from the ribs with the hips still. The doses come from the move pages and our upper back mobility routine.
Foam roller extension at 3 or 4 spots along the upper back, 5 to 8 slow breaths at each, then cat-cow and the sphinx. With osteoporosis, skip the roller unless a physiotherapist has cleared it.
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Prone Y-T-W raises, low cobras, band pull-aparts and rows. Strengthening, not stretching, improved upper back posture a little in trials.
The footballers' trial saw gains after 6 weeks of 3 sessions a week, and an all-fours drill improved rotation within 2 weeks in a smaller study. People vary. Once you're happy, 2 or 3 days a week kept range in a stretching trial, as our flexibility guide says.
Get up and move every hour or so, with a few seated rotations, as our fascia upper back guide suggests. People who sit a lot and move little turn less, and moving more is the sensible response.
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Turning the hips or lower back instead of the ribs (pin your knees together, or sit back on your heels); arching the lower back over the roller instead of the upper back; rolling the lower back or neck; holding your breath; twisting fast or with a weight if you have osteoporosis (our editorial list).
Our editorial session, the shape of our upper back mobility routine and the exercise types in the footballers' trial, with the moves' doses.
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The movement on the figure: Side-lying open book
Turn from the ribs with the hips still: for thoracic rotations, 6 rotations per side, moving with the breath (the move page's dose); for open books, 8 to 10 slow openings each side, pausing 2 seconds at the end (our editorial starting point, as on the move page); and thread the needle, the world's greatest stretch and the seated middle back stretch at the doses on their move pages.
Gentle and slow: foam roller extension at 5 to 8 slow breaths at each of 3 or 4 spots along the upper back (our editorial starting point, as on the move page); cat-cow at 8 waves, slower than feels natural (the move page's dose), keeping the rounding small with osteoporosis; the sphinx at 3 holds of 20 seconds (our spine mobility routine), skipped with spinal stenosis; extended puppy pose for 45 seconds (our fascia release for the back); and the breath reach at the dose on its move page. With osteoporosis, skip the roller unless a physiotherapist has cleared it.
The upper back muscles that turn and arch the spine, 2 or 3 times a week: prone Y-T-W raises at 5 of each letter, wall angels at 8 and band pull-aparts at 15 with a light band (our upper back mobility routine); low cobras at 5 lifts held 3 to 5 seconds (our kyphosis exercises for seniors); and bird dogs at 5 each side, holding each for 3 breaths (our spine mobility routine).
Upper back mobility work won't straighten your posture, and posture isn't a strong predictor of pain. Move often through the day, add a few rotations, and strengthen the upper back if a rounded back bothers you; our posture guides cover the rest.
Rotation drills suit a golf warm-up, and better golfers turn further, but flexibility wasn't linked to clubhead speed, while strength and power were. Our golf warm-up and golf sessions cover both.
An upper back that can straighten gives your arms more room overhead. Combine the extension work here with our shoulder mobility guide's wall check and moves.
Most of the evidence is for a therapist's manual therapy, which wasn't better than a placebo in pooled trials, and adding upper back exercises to shoulder exercises changed strength more than pain. Our shoulder pain guides have the plan.
Upper back exercises added to neck rehab improved posture and mobility but not pain in one trial. Strength training for the neck and shoulders has better support for neck pain, as our fascia upper back guide sets out, and our neck pain guide has the plan.
The upper back stiffens and curves a little with age, and exercise improved posture in some studies of adults over 45. Gentle rotation, extension and back strengthening suit most older adults; the NHS asks adults over 65 for strength, balance and flexibility work on at least 2 days a week.
Our upper back mobility routine turns and arches the upper back, then strengthens the muscles that hold it, in 12 minutes. At a desk, the 3-minute desk movement break adds a few rotations every hour.
A 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA 15-minute routine that moves your neck, upper back and lower back through bending, arching, side bending and twisting, then holds the spine steady.
15 minBeginner12 movesNo equipmentA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallA 15-minute routine for cyclists: hips, upper back, chest, neck and wrists through the ranges riding doesn't use, plus back and neck endurance.
15 minBeginner12 movesA foam roller, A wallA 10-minute golf warm-up: brisk marching, then the hip and trunk turns, hinge, side bend, lunge and jump from the one trial of a golf warm-up, twice through.
10 minBeginner9 movesA wallA 25-minute yoga class for golfers: upper-back and hip rotation done evenly both ways, a hip hinge, one-leg balance, back endurance and forearm stretches.
25 minBeginner18 movesA wall, A stepA 25-minute Pilates class for golfers: upper-back and hip rotation, trunk control, side-hip strength and one-leg balance, done equally on both sides.
25 minBeginner19 movesA wallA 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.
3 minBeginner5 movesA bench or box, A wallA quick stretch break you can do beside your desk: neck, back, chest, wrists, hips and quads.
5 minBeginner7 movesA wallGentle rolling for the upper back and lats, rotation and segmental spine work, then two easy strength moves. Exercise is what back-pain guidelines recommend.
15 minBeginner11 movesA foam rollerTwenty-five minutes of back-strengthening yoga for posture: arm and leg reaches, face-down back lifts and standing poses with the arms raised.
25 minBeginner15 movesNo equipmentA 20-minute Pilates routine for posture: breathing, head and shoulder-blade control, back strength and upper-back mobility, with no loaded rounding.
20 minBeginner13 movesA wall, A bandThese plans give one day a week to our daily mobility routine, which includes thoracic rotations.
A 12-week workout plan for men over 50: three strength days with power and balance work, cardio and recovery, at the gym or at home, with a 4-day option.
3 training days45 minBeginner3 days a weekA 6-week workout plan for strength and fitness: two strength days, a circuit and two cardio sessions a week, with simple fitness tests in weeks 1 and 6.
3 training days45 minBeginner3 days a weekA 12-week workout plan in three phases for strength, muscle and fitness: three full-body days and two cardio sessions a week, with tests in weeks 1 and 12.
3 training days45 minBeginner3 days a weekA 12-week calisthenics plan for beginners: three bodyweight sessions a week with push-up, pull-up, squat and dip ladders, and a bar if you have one.
3 training days40 minBeginnerWith osteoporosis or a past spinal fracture, avoid repeated or loaded deep rounding of the back, and bend from the hips. The osteoporosis guide covers impact and lifting.
Twisting should be safe if you do it smoothly and comfortably. Slow down and shorten fast or forceful twists, and leave out the added weight.
With osteoporosis, ask before rolling the upper back or ribs: the NHS notes that a cough or sneeze can sometimes break a rib. UK experts advise avoiding positions that round the spine a lot. In a case series of 3 rib fractures after spinal manipulation, the patients were aged 57 to 77 and two had thinning bones. Gentle rotation is the usual swap, as our upper back pain guides say.
With osteoporosis, skip the foam roller unless a physiotherapist has cleared it.
Back pain and stiffness that persists in a teenager or young adult. Ankylosing spondylitis tends to start at that age and can affect the whole spine.
With ankylosing spondylitis, follow your rheumatology team's advice and our ankylosing spondylitis guide, which covers the exercises for it (our suggestion).
Arching back tends to bring stenosis symptoms on. Skip back extensions and other arching moves if they bring on leg symptoms, as our spinal stenosis guide says.
Twist gently if you have a disc problem, sacroiliac joint pain or recent spinal surgery, and get assessed first if twisting brings on leg symptoms.
If you're already very flexible, put your time into strength and control through the range you have. Stretch only areas that feel genuinely tight, and only to a mild pull, and avoid hanging at the end of your range or pushing joints back past straight. The strength and control moves below are a place to start, and our hypermobility guide has a full routine, the evidence and the warning signs. If you do Pilates, our Pilates for hypermobility guide covers which moves to adapt.
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In later pregnancy, do the rotations sitting, standing or on all fours rather than lying on your back or over a roller, and follow our pregnancy guide (our suggestion, following its advice to keep time flat on your back short after the first trimester).
If you get chest pain or pressure, feel faint or dizzy, are unusually breathless, or your heart races or beats irregularly during exercise, as our plans advise.
For chest pain that comes on suddenly and doesn't go away, feels tight or like squeezing, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, light-headedness or breathlessness; severe difficulty breathing; someone who faints while exercising; palpitations that don't go away, or come with chest pain, shortness of breath or feeling faint; or a headache that starts suddenly and is extremely painful, especially while lifting or straining, or comes with numbness or weakness, difficulty speaking or loss of vision. The NHS says a bleed on the brain may be more likely when lifting something heavy. Don't drive yourself to A&E.
Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
Call 999: sudden, severe pain in the tummy or back, which can come with breathlessness, pale or grey skin, or collapse. It can be a burst abdominal aortic aneurysm, most common in men aged 65 or over and in people who smoke or used to smoke.
Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
See a GP if pain spreading down a leg hasn't improved after a few weeks of home treatment, is getting worse or stops your normal activities. Sciatica on both sides, or weakness or numbness in both legs that's severe or getting worse, is a 999 call or a trip to A&E.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
Pain at the top of the back, between the shoulders, rather than in the lower back.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, worries you, or you're struggling to cope.
Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.
Unexplained weight loss, or a lump, swelling or change in the shape of your back.
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Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
Same day (urgent GP appointment or NHS 111): severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in the arms or legs; pins and needles in an arm along with neck or arm pain; or pain between the shoulder blades.
Same day: clumsiness in your hands, or numbness, pins and needles or weakness in one or both arms, that is getting worse; problems with balance or walking since the neck pain started; or neck pain with a severe headache.
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Arm weakness or numbness that keeps getting worse, severe pain that painkillers and rest do not touch, or an unexplained fever.
No improvement after 6 weeks of exercise, or arm symptoms still there beyond 6 to 12 weeks.
Dizziness, light-headedness or tingling into an arm during the neck moves are stop signs, not sensations to push through.
Stop straight away if you feel any pain or become unwell, the NHS says, and contact 111 if your symptoms worry you or don't go away.
Pain you'd call mild to moderate, no more than about 5 out of 10, that settles within an hour or so, with your back no worse the next morning, is acceptable; if it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing. Stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. That's our back pain guides' rule.
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Ask for an urgent GP appointment or get help from NHS 111 for a headache that's triggered or made worse by coughing, sneezing, bending down or exercising. In the US, contact your doctor or urgent care.
Speak to your GP first if you haven't exercised for some time or have medical conditions or concerns, as the NHS advises. Get advice before heavy lifting or hard straining work if your blood pressure is uncontrolled, or you have heart disease or chest pain when you're active, a pacemaker or defibrillator, diabetic eye disease, glaucoma, a hernia, recent eye or tummy surgery, or you're pregnant, as our breathing guide lists. After a recent shoulder dislocation or shoulder surgery, follow our shoulder dislocation guide or your surgical team first.
Speak to a GP first if you haven't exercised for some time, or if you have a medical condition or concerns. Get advice first, too, if you have a health problem, an injury or symptoms, have recently had a heart attack or an operation, or are pregnant or have recently given birth.
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If you have a heart condition, follow your cardiac team's advice on how hard to work, and stop for the warning signs above. People with long-term conditions may wish to ask their specialist before starting. With uncontrolled high blood pressure, avoid straining against a held breath; the high blood pressure guide has more.
The pain trials mostly test a therapist's manipulation, which wasn't better than a placebo in pooled trials, and adding thoracic mobility exercises improved posture and mobility but not pain in a neck pain trial.
Young adults who sat a lot and moved little turned about 10 degrees less in a snapshot study. That's a link, and moving more is the sensible response, not alarm.
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Slumped sitting didn't predict neck pain in young people, and in young women it went with less. Experts argue there's no strong evidence that posture causes pain, as our posture guides say.
Stretching-type work didn't change posture across 23 studies, and in the footballers' trial the back's curve didn't change. Roller extension is a mobility drill, not a posture fix.
Flexibility wasn't associated with clubhead speed across 20 studies; strength and power were.
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No trial has tested it, and stretching programmes didn't prevent sports injuries.
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The UK consensus says twisting should be safe if it's smooth and comfortable. It's fast, forceful or loaded twisting that needs care, as our osteoporosis guide explains.
Turn and arch your upper back on most days with thoracic rotations, open books, thread the needle and foam roller extension, and strengthen the upper back 2 or 3 times a week. In one trial of 42 footballers, six such exercises 3 times a week for 6 weeks added about 8 to 9 degrees of rotation. Our upper back mobility routine puts them together.
The upper and middle back, from the base of your neck to the bottom of your ribs: 12 vertebrae, each with a pair of ribs. It's where most of your trunk's turning happens.
Sit with your feet flat and knees together, hold a broomstick across your chest, and turn each way without moving your hips; young adults turned about 55 degrees in a study. Compare your two sides, and yourself over time, rather than with a chart.
The footballers' trial saw clear gains in 6 weeks, and an all-fours drill improved rotation within 2 weeks in a smaller study. People vary. Keep going 2 or 3 days a week to keep what you gain.
Probably not: in the footballers' trial rotation improved but the back's curve didn't change, and stretching didn't change posture across 23 studies. Back strengthening reduces an age-related curve a little; our kyphosis guide covers it.
Possibly a little, alongside other treatment, but the evidence is weak: manipulation by a therapist wasn't better than a placebo in pooled trials, and adding upper back exercises improved neck mobility and posture but not pain in a trial. Our neck and shoulder pain guides have the plans.
Rotation drills suit a golf warm-up, but flexibility wasn't linked to clubhead speed across 20 studies, while strength and power were. Our golf warm-up covers the drills.
For most people, yes, keeping the roller off the neck and lower back. With osteoporosis, ask a physiotherapist first. Don't roll through upper back pain that comes with chest pain, breathlessness or sweating: call 999 (911 in the US).
Gentle rotation and extension are usually fine: the UK consensus says twisting should be safe if smooth and comfortable, and back-extension exercise is part of its advice. Avoid deep or repeated rounding, especially with a weight, and ask before using a foam roller.
Often from moving it less: people who sat a lot and were inactive turned less in one study, and the upper back stiffens a little with age. New stiffness with pain at night, weight loss, a fever or a change in shape needs a GP.
A few minutes of rotation and extension on most days, plus upper back strength 2 or 3 times a week, as our upper back mobility routine does. At a desk, a few rotations every hour or so keeps you moving.
Exercise education, not a personal prescription, and clinical review of these guides is pending. Check with a GP before starting hard training if you have a heart condition, chest pain, dizziness or breathlessness when active, and stop for sharp or increasing pain. Health disclaimer.
