How to fix a Twisted spine

twisted spine

A twisted spine is where the torso is rotated towards one side.

It involves rotation of the lumbar and/or thoracic spine.

This can lead to:

  • Symptoms (such as pain and tightness) occurring on one side of your body
  • One shoulder in a more forward position
  • Asymmetrical posture
  • Uneven muscle development and strength

The content presented on this blog post is not not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. For more information: Medical disclaimer.


How to fix a twisted spine

Before starting the exercises: Make sure to address the following 2 points:

1. Address Pelvis Rotation

rotated pelvis

Since the torso is directly connected to the pelvis, any rotation in the pelvis will result in the spine being orientated in a twisted position.

Before you start any of the exercises to fix your twisted spine: Make sure that your pelvis is in a neutral position!

(Note: In some people – fixing the position of the pelvis will automatically improve the twisted orientation of the spine.)

How to tell if your pelvis is rotated:

a) ASIS method

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Locate the Anterior Superior Iliac Spine (ASIS).
    • These are the pointy bones that are located at the front of both of your hips. (see above)
    • (Use Google if you are not sure where they are.)
  • Place a finger at the front of each of these bony land marks.
  • Question: “Is one side more in front of the other?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

b) Thigh position

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Look down at the front of your thighs.
  • Question: “Is one thigh more forward as compared to the other side?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

(Note: Having your knee bent may give inaccurate results.)

c) Buttock position

twisted pelvis

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Take a downwards facing shot of the back of your hips.
  • Question: “Is one butt cheek more forward?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

(Note: Having uneven glute muscle size may give inaccurate results.)


How to Fix a Rotated Pelvis:

I have covered every exercise that you will need to do in this blog post: 
How to Fix a Rotated pelvis.


2. determine the direction (and level) of your twisted spine

At this stage – I am going to assume that your pelvis is in a neutral position (ie. not rotated).

The next step is to determine which direction and the levels your spine is twisting towards relative to the pelvis.

Note: I have listed 6 different tests to help you determine this.

(The more tests that confirm the same finding, the more reliable the result.)


Starting position for all tests:

  • Stand with your feet shoulder-width apart and level with each other.
  • Make sure that your pelvis is in a neutral position.

a) Belly button

(This tests for any rotation involved at the Lumbar spine.)

Instructions:

  • Look down at your belly button.
  • Question: “Which direction does it face?”
Results:
The side as to which the belly button is facing suggests that your Lumbar spine is twisting towards that same side.

(Note: Asymmetrical tension in the abdominal region, past abdominal surgeries etc can affect the position of the belly button.)

b) Lower ribs

(This tests for any rotation involved at the Lower Thoracic spine.)

Instructions:

  • Place your finger on the same points of the lower ribs. (see above)
  • Aim for Rib 7 or 8 if you know how to locate and trace yours ribs accurately.
  • Question: “Is one side more forwards?”
Results:
The side which is further behind is the side the LOWER Thoracic spine is rotating towards.

c) Chest region

(This tests for any rotation involved at the Middle Thoracic spine.)

Instructions:

  • Place your finger tips on the same points at the front of the rib cage.
  • Look downwards.
  • Question: “Is one side more forwards?
Results:
The side which is further behind is the side the MIDDLE Thoracic spine is rotating towards.

d) Sternal end of clavicles

(This tests for any rotation involved at the Upper Thoracic spine.)

Instructions:

  • Place your finger tips on the sternal ends of the clavicles. (see above)
  • Question: Does one side feel more forwards?
Results:
The side which is further behind is the side the UPPER thoracic spine is rotating towards.

e) Shoulders

how to tell if you have a twisted spine

Instructions:

  • Look down at the front of your shoulders
  • Question: Is one shoulder more forward than the other?
Results:
The net rotation of the spine is towards the the side that is further behind.

(Note: The results can be skewed if you have Rounded Shoulders or Uneven Shoulders.)

f)  Downward shot of the back

rotated torso

Instructions:

  • Take a photo from the above head position.
  • Find the line of your pelvis. (Orange line)
  • Find the line of your torso. (Red line)
  • If these 2 lines are not parallel, then you have a rotated torso relative to your pelvis.
Results:
The net rotation of the spine is towards the the side that is further behind.

(Note: Uneven muscular bulk can give the illusion of a rotation.)

Exercises to fix a Twisted Spine

Note: The following exercises address a twisted spine that is rotated towards the RIGHT side.

(If you have a spine that is rotated to the left, do the same exercises but on the other side mentioned.)


Read this:

  • As the spine can rotate and counter-rotate at multiple levels, it would be impossible for me to cover all of these different combinations.
  • Which specific muscles you need to target is really dependent on which level of the spine is your rotation coming from.
  • Focus on the muscles that are relevant to you.
  • Although I have listed all of the main muscles that are responsible for twisting the spine, you do not need to address them all!
  • You will need to do a bit of experimentation on yourself and see what works for you.

1. Releases

Instructions:
  • Place a massage ball directly underneath the target muscles.
  • Apply as much of your body weight onto the massage ball as tolerated.
  • Make sure to cover the entire length of the muscle.
  • Continue for 1-2 minutes.

Muscles to release on the RIGHT side:

Target muscles
(Note: Look on Google to see the exact location of these muscles!)
  • Erector Spinae (Iliocostalis, Longissimus)
  • Latissimus Dorsi
  • Internal Obliques
  • Intercostals (Thoracic spine)

a) Longissimus/Iliocostalis

b) Latissimus Dorsi

c) Internal Oblique

d) Intercostals

Muscles to release on the LEFT side

Target muscles
(Note: Look on Google to see the exact location of these muscles!)
  • External obliques
  • Rotatores/Multifidus
  • Psoas (Lumbar Spine)

a) External obliques

 

b) Rotatores 

2. Stretches

Muscles to stretch on the RIGHT side:

a) Iliocostalis/Longissimus

Instructions:

  • Sit down on a chair.
  • Hunch forwards as much as possible.
  • Place your left hand at the back of your head.
  • Place your right hand on the outside of the left knee.
  • Pull your head down in the direction of the left knee.
  • Whilst maintaining this pressure, start to bend your torso towards the left knee.
  • Aim to feel a stretch on the right side of your back.
  • Hold for 30 seconds.
  • For more stretches: The 11 Best Erector Spinae Stretches

b) Latissimus Dorsi

Instructions:

  • Assume the position above.
  • Hold onto a door frame with your right hand.
  • Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
    • Use your body weight to sink into the stretch
  • Twist your pelvis away.
  • Aim to feel a stretch on the right side of your torso.
  • Hold for 30 seconds.

c) Internal Obliques (Front)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Lie down on your stomach.
  • Keep your pelvis connected to the floor.
  • Push your belly button into the floor.
  • Prop yourself up onto your hands (or elbows) and arch backwards.
  • Turn your torso towards the left.
  • Aim to feel a stretch in the Right abdominal region.
  • Hold for 30 seconds.

d) Internal obliques (Back)

(For Lumbar+ Lower Thoracic spine.)

 

Instructions:

  • Whilst standing, lean all the way over to your left side.
  • Twist your torso towards the left by placing your hands on your left knee.
  • Allow your right leg to lift and dangle.
    • Keep it relaxed!
  • Allow gravity to pull your right leg down.
  • Rotate your pelvis towards the right.
  • Aim to feel a stretch in the right side.
  • Hold for 30 seconds.

e) Intercostal

Instructions:

  • Place your right hand on top of a table.
  • Lock your elbow straight.
  • Lean some of your weight into the right hand.
  • Glide your torso towards the right.
  • Aim to feel a stretch on the right side of your rib cage.
  • Hold for 30 seconds.

Muscles to stretch on the LEFT side:

a) Psoas
(For Lumbar spine rotation.)

hip flexor stretch

Instructions:

  • Assume the lunge position with your right leg in front.
  • Perform a posterior pelvic tilt
    • “Tuck your tail bone underneath you” 
    • Keep your glutes contracted.
  • Make sure that your pelvis is facing forwards.
  • Lean your torso away from the side you are stretching.
  • Turn your torso towards the left.
  • Aim to feel a pulling sensation at the front of your left hip.
  • Hold for 30 seconds.

b) External obliques (Front)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Stand with a wide stance.
  • Bend your torso towards the right.
  • Reach your left arm backwards as you twist your torso towards the left.
  • Aim to feel a stretch in the left front abdominal region.
  • Hold for 30 seconds

c) External obliques (Back)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Lie down on your back with your arms spread out on the floor.
  • Cross the left leg across the body
  • Aim to feel a stretch in the left back region.
  • Hold for 30 seconds.

3. Joint mobilization

If your joints are stiff, it will make it very difficult to introduce any change into the twisted spine.


a) Spinal Segmentation

 

Instructions:

  • Whilst standing, wrap your arms around an exercise ball as much as you can. (see above)
    • Try to get your fingers tips to touch.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time all the way to the pelvis.
    • Think about: “Creating a wave in your spine”
  • From here, reverse your movements back to the beginning.
  • Remember to go slow!
  • Repeat 20 times.

b) Rotation

spinal rotation exercises

Instructions:

  • Sit down on a chair.
  • Place your hand on the outer side of the opposite knee
  • With the other hand, grab onto the back of the chair.
  • Rotate your spine. (Look behind you.)
  • Use your hands to help push you further into range.
  • Oscillate in this position for 30 repetitions.
  • Repeat on the other side.

c) Side Decompression

Instructions:

  • Sit on your side whilst leaning on your elbow or hand.
  • Bow your torso towards the floor.
  • Aim to feel a stretch at the side of your torso.
  • To increase the stretch, take deep breaths into the area of stretch.
  • Hold for 30 seconds.
  • Repeat on the other side.

If you would like more exercises to help get your spine moving,

Check out this blog post: 17 Thoracic spine exercises.


4. Strengthening exercises 

Aim to move at the levels where your rotation is originating from (ie. Upper vs Middle vs Lower torso).


Target muscles:

Left side:

  • Internal obliques
  • Latissimus dorsi
  • Intercostals
  • Erector Spinae group

Right side:

  • External obliques
  • Rotatores

a) Wall twists

(For Middle to Upper Thoracic rotation.)

Instructions:

  • Assume a wall plank position.
  • Keep your pelvis and belly button facing forwards at all times.
  • Twist your torso towards the left.
  • Repeat 30 times.

b) Rotation

 

Instructions:

  • Assume the 4 point kneel position.
  • Do not move the pelvis.
  • Using your left hand, reach over and behind you.
  • Aim to rotate in the area where your rotation is originating from.
  • Aim to feel the muscles in the left side of your back.
  • Repeat 20 times.

c) Rotation (4 pt kneel) 

Instructions:

  • Assume the 4 point kneel position.
  • Do not move the pelvis.
  • Using your right hand, reach under and towards the left.
  • Aim to rotate in the area where your rotation is originating from.
  • Aim to feel the muscles in the right side of abdominal region.
  • Repeat 20 times.

d) Seated rotation

strengthening exercises for a twisted spine

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level:
    • Maintain equal weight distribution between each hip.
    • The knees should be level.
  • Cross your hands over your stomach.
  • Proceed to rotate your torso towards the LEFT.
    • Do not initiate this movement with your left shoulder blade.
    • (Do not let the hands/arm slide over your belly.)
  • Aim to rotate in the area where your rotation is originating from.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets

e) Seated rotation with resistance

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level:
    • Maintain equal weight distribution between each side.
    • The knees should be level.
  • Using both hands, hold onto a thick resistance band that is anchored to your right side. (see above)
  • Proceed to rotate your torso towards the LEFT.
    • Do not initiate this movement with your arms.
    • Your arms should stay in line with the center of your body at all times.
  • Aim to rotate in the area where your rotation is originating from.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets

f) Pallov press hold

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level.
    • Keep equal weight distribution between each side.
    • The knees should be level.
  • Using both hands, hold onto a thick resistance band that is anchored to your right side. (see above)
  • Center your torso:
    • Belly button facing forwards
    • Rib cage equal on both sides
    • Sternal ends of collar bone equal
  • Extend your arms directly in front of you.
  • Do not let the resistance band rotate you to the right side.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets.
  • Progression: Increase the resistance.

5. Posture Reset

The goal of this exercise is to have the left and right side of your back EQUALLY in contact with the ground.


Instructions:

  • Lie down on the floor.
  • Support your legs in the 90/90 position.
  • Use a thin pillow for your neck. (if required)
  • Rest your arms in the “T” or “Y” position.
  • Aim to have your ENTIRE back completely FLAT on the floor.
  • Relax in this position for 15-20 minutes.

6. Avoid bad habits

There is absolutely no point in performing all of these exercises if you continue to place your body in the position which has lead to your twisted spine in the first place!


Here are some suggestions:

a) Workstation ergonomics

Place your computer screen and keyboard directly in front of you.

Avoid twisting your body to look at a screen.

b) Sleeping position

I generally encourage people to sleep on their back.

The reason being – it promotes the most symmetry of the body.

c) Sports

If you are involved with a sport which requires you to mostly rotate to one side (e.g Tennis, Rowing etc), it is a good idea to balance out the other side with the recommended exercises!

d) Driving

Be aware that reaching out to hold onto the steering wheel with one hand can lead to a twisted spine.

7. Maintaining neutral spine

Pay more attention to the position of your torso.

Here is a quick way to check if your torso is in a neutral position:

Check points:

  • Belly button facing forwards.
  • Front of rib cage equal.
  • Shoulders level

Note: I don’t want you to think about the position of your spine ALL of the time.

(This is an easy way to get overwhelmed!)

… Just be more aware of when you could make a small adjustment to your posture.

Keep in mind – the exercises will help keep your spine in a more centered position naturally over time.

8. Other things to consider

scoliosis

Along side having a twisted spine, it is common to have side bends in your spine as well.

If you also have side bends in your spine, please check out the following blog post:

Check out this post: Scoliosis exercises

9. Understanding counter-rotation

With a twisted spine – it is common for counter-rotation to occur at certain parts of the body.

This is your body’s automatic attempt to:

  • a) “de-rotate” your spine and
  • b) keep your head level.

The areas that compensate for the rotation in the spine are generally where people will experience their pain.

Main areas:

a) Neck

The neck can attempt to compensate for a twisted spine.

For example:

For a twisted spine to the RIGHT:
The muscles that rotate the neck to the LEFT will be recruited to keep the head more level.

As a result – pain can develop in the following muscles:

Left side:

  • Semispinalis
  • Posterior scalenes
  • Levator scapula
  • Sub-Occipital

Right side:

  • Sternocleidomastoid
  • Upper trapezius
  • Anterior scalenes

b) Shoulder blade

The shoulder blade can attempt to compensate for the twisted spine.

For example:

For a twisted spine to the RIGHT:
The muscles that control the LEFT shoulder blade will be recruited to bring the shoulder backwards.

As a result – pain can develop in the:

c) Spinal segment above the rotation

This is where a particular section of the spine has attempted to partially/fully/over counter-rotate the twist in the spine.

For example:

For a twisted spine to the RIGHT:
The muscles on the LEFT side of the back will be recruited to counter-rotate the section above where the twist occurs.

As a result – pain can develop in the muscles that rotate the torso towards the left:

Left side:

  • Erector Spinae
  • Latissimus Dorsi

Right side:

  • External Obliques

What does this means for you?

If your symptoms predominantly occur on one side of the body, addressing your twisted spine may help completely eliminate your symptoms!


What to do next

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!

77 thoughts on “How to fix a Twisted spine”

  1. Hey Mark! I’ve been following you for a while now and keep coming back to your website. Top-notch information as always!

    Regarding the post you made, could I ask some guidance? For reference, I found I have:

    – Twisted pelvis (right side rotates towards the back, left side is more forward)
    – left hip hike
    – rib flare (left side)
    – loss of IR at left hip
    – loss of ER at right hip
    – weak left gluteus medius (training helped my gait and hip hike!)

    Now, I’m adressing these with succes, but I still have a nasty pain when rotating my spine towards the left side. It’s mostly mid back where the pain is. Doesn’t hurt when rotating to the right, not when actively stretching that side. It only hurts when rotating towards that side.

    Any clues as to what might be the issue?

    Reply
    • Hi Sydney,

      I am guessing your left lumbar side is in more relative extension as compared to the right side. (hence leading to the left rib flare.) When you rotate left, you are probably also extending further which then compresses everything on the left side. When you rotate right, you are decompressing and likely why there is no issue here.

      If you slightly rotate your pelvis to the left and depress the left rib flare, does it still hurt?

      Mark

      Reply
  2. Hi Mark, I recently checked your post it’s amazing. Mark I’m 35 years age and fitness trainer, I have right side twisted thoracic and hips I’m trying so hard to fix it but it’s not that effective and I would like you to help me in fixing it please I recently had a girl baby and I’m in too much pain near my ribs so please please help me I don’t mind paying the fees

    Reply
  3. Hi Mark,
    Thank you for explaining this so clearly and you have helped me way beyond my expectations.
    Would you have any information on how to relieve knee pain? I have osteo arthritis and cannot completely straighten or bend my knee. I walk 2 miles a day which relieves a lot of my pain and maintains my mobilty. I would be so grateful for your suggestions.
    Thank you very much.
    Bev

    Reply
  4. Hi Mark,

    THANK YOU for your work, you’re a life saver.

    Regarding the twisted pelvis and spine – should we first determine our pelvis rotation (mine is left) and do corrective exercises for that condition and then after that asses our spine rotation and work on it or is it recommended to work on both at the same time?

    I’m confused with point #2 where you say “At this stage – I am going to assume that your pelvis is in a neutral position (ie. not rotated).” Does this mean we should force it to be neutral for the assessment or correct our pelvis and after some time go to #2?

    Thank you.

    Reply
    • Hello Kristijan,

      If your pelvis is rotated and you have a twisted spine, I would address the pelvis rotation first.

      Sometimes addressing the pelvis will automatically improve the twisted spine.

      Mark

      Reply
  5. Man, why do you not have a youtube channel? You should start one! most rehab/prehab channels don’t delve into half of the info you talk about. This article is like $500 worth of a physical therapy session. I’ve been looking for this information for so long and just found your website yesterday. And you’re giving this much detailed info away for FREE? You, sir, are the man! Thank you so much

    Reply
    • Hey Mike,

      You left a really nice comment. Thanks!

      And yes – all this information for you guys for free. I try to make it as detailed as it needs to be.

      Hope it serves you well.

      Mark

      Reply
  6. Hi Mark, I’m a professional golfer that played at a very high level until running into biomechanical issues. It’s been about 15 years of struggling and after spending a lot of $$$$ on many many therapists (all kinds) I still haven’t been able to restore my rotation/pivot. I’ve fixed many things but still seem to struggle with alignment. I’ve had 2 separate MRIs and X-rays and nothing is wrong. I can fake a straight position but really feel like I’m rotated to the right in my thoracic spine. Should I follow the full program you’ve laid out and is there anything specific to golf you could further recommend?

    Reply
    • Hey Larry,

      If rotation/pivot is your main goal:

      1. Make sure to reclaim full rotation in your thoracic spine. You can do rotation-based drills such as the ones listed here. The exercises will also help you decompress your rib cage which is important for rotation.

      2. Work on your diaphragmatic breathing. Breathing inefficiently can lead to compression of the rib cage.

      3. Make sure that you have full internal (leading leg) and external rotation (trailing leg) in the hips.

      4. Make sure that your feet have the ability to pronate (collapse arch) and supinate (create an arch)

      5. Lat stretches will help!

      6. If you’re starting out in a rotated/counter rotated position, focus on the exercises mentioned in this blog post for the appropriate direction.

      Hope this helps.

      Mark

      Reply

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