upper thoracic pains are produced by tearing of connective tissues around the upper 
 thoracic joints or upper thoracic muscle spasms1 , 
 2 . upper thoracic pain commonly occurs 
 in repetitive or prolonged bending , twisting or sitting activities , such as computer work or 
 industrial work involving combinations of these activities3 , 4 . sometimes , patients 
 experience sudden upper thoracic pain during a movement such as picking up a pencil4 . a study suggested that increased thoracic 
 kyphosis may be associated with higher spinal loads and abnormal trunk muscle force in an 
 upright stance1 . thoracic kyphosis might 
 also accelerate degenerative processes and contribute to thoracic dysfunction and thoracic 
 pain2 . clinicians suggest that a 
 stretching and strengthening rehabilitation program for thoracic pain reduces symptoms and 
 pain , and improves function2 . the purpose 
 of this study was to investigate the effect of thoracic stretching , a thoracic extension 
 exercise , and exercises for cervical and scapular posture on thoracic kyphosis angle and 
 upper thoracic pain . the study subject was a 36-year - old male , who complained of upper thoracic pain at the t14 
 level , and had a forward head posture and rounded shoulders . ethical approval was granted by 
 yonsei university faculty of health science human ethics committee , and the subject provided 
 written informed consent before participating in the study . he had complained of continuous 
 upper thoracic pain for 3 months , but had not undergone any specific treatment for this 
 condition . the pain consisted of mechanical upper thoracic pain without radiating pain . when 
 he performed thoracic forward flexion in the standing position with his knees fully 
 extended , he experienced pain and stiffness at the t14 level . a dolorimeter ( fabrication 
 enterprises , white plains , ny , usa ) was used to measure the pressure pain threshold of the 
 upper thoracic region . before making measurements with the pressure dolorimeter then , we applied pressure 
 with the dolorimeter to the right side of the body to measure the pressure pain . the 
 reliability of pressure pain threshold measurements is greater than 0.8 . a dual inclinometer ( acumar , lafayette instrument , 
 lafayette , usa ) was used to measure the thoracic kyphosis angle . the feet of the 
 inclinometer were placed over the processes of the first and second thoracic vertebrae and 
 over the twelfth thoracic and first lumbar vertebrae . measurements were made in a relaxed standing position with the subject adopting a 
 natural posture . the initial thoracic kyphosis angle was 47. then , the subject performed 
 thoracic stretching ( session 1 ) , a thoracic extension exercise ( session 2 ) , and muscle 
 exercises for cervical and scapular posture ( session 3 ) . the three sessions each lasted 10 
 days , and we measured the upper thoracic pressure pain threshold and thoracic kyphosis angle 
 after each session . session 1 : the subject performed a stretching exercise , using a roller to hinge the upper 
 back backwards over the roller in the supine position . the subject was instructed that he 
 would feel stretching or tightness in the mid - back , should take care not to overextend the 
 neck . for 10 days , he performed five sets of 30 repetitions of the stretching exercise 
 daily . session 2 : the subject performed thoracic extension exercises . while sitting on a 
 chair , he clasped both arms behind his head , gently arching backwards and looking up . for 10 
 days , he performed five sets of 30 repetitions of the thoracic extension exercises daily . session 3 : the subject performed individual strengthening exercises for the muscles 
 associated with the cervical spine and scapula position . he placed the middle of the band around 
 the back of his head and grasped the ends of the band in front of his head . keeping his neck 
 in a neutral position with the chin slightly tucked , he extended his elbows , stretching the 
 band forward , while keeping his neck stable . the band was put around a solid object at about waist level . holding one end of 
 the thera - band in each hand , with his elbows at his sides bent to 90 degrees , he pulled the 
 band backwards to move his shoulder blades toward each other . he performed both exercises 
 for 10 days , with five sets of 30 repetitions of each per day . the upper thoracic pressure pain threshold increased after session 1 ( 3.8 lb ) , session 2 
 ( 4.5 lb ) , and session 3 ( 6.0 lb ) , compared to the initial threshold of 3.5 lb . the thoracic 
 kyphosis angle decreased after session 1 ( 46 degrees ) , session 2 ( 44 degrees ) , session 3 ( 40 
 degrees ) , compared to the initial angle of 47 degrees . recently , treatments for thoracic pain have focused on reducing the thoracic kyphosis 
 angle . for this , upper trunk muscle activation might have positive effects on vertebral 
 loading , trunk control , and balance5 . our 
 results show that muscle strengthening exercises , i.e. , 
 sessions 2 and 3 , were more effective for upper thoracic pain than simple stretching 
 exercises , i.e. , session 1 . increased thoracic kyphosis 
 posture is commonly accompanies a forward head posture or rounded shoulders5 , 6 . therefore , we added session 3 , consisting of neck and scapula retraction exercises , to the 
 standard treatment  thoracic stretching ( session 1 ) and thoracic extension exercises 
 ( session 2 ) . we observed the greatest changes in thoracic pain and kyphosis angle after 
 session 3 . we believe that intervention for thoracic pain or kyphotic thoracic correction 
 should include not only treatments for the muscles used in thoracic extension , but also 
 treatment for the cervical and scapular muscles . this study was limited in that it involved 
 only a single participant . for generalization
[ purpose ] the purpose of this study was to investigate the effect of thoracic 
 stretching , a thoracic extension exercise and exercises for cervical and scapular posture 
 on thoracic kyphosis angle and upper thoracic pain . 
 [ subject ] a 36-year - old male , who 
 complained of upper thoracic pain at the t14 level with forward head and round shoulders , 
 was the subject . 
 [ methods ] he performed thoracic stretching ( session 1 ) , a thoracic 
 extension exercise ( session 2 ) , and muscle exercises for cervical and scapular posture 
 ( session 3 ) . [ results ] the upper thoracic pressure pain threshold increased after session 
 1 , session 2 , and session 3 . 
 the thoracic kyphosis angle decreased after session 1 , 
 session 2 , and session 3 . [ conclusion ] 
 we suggest that intervention for thoracic pain or 
 kyphotic thoracic correction should use not only an approach for extending the thoracic 
 muscles , but also an approach treating muscles in the cervical and scapular region .