THORACIC BACK PAIN

Thoracic Spine Pain

Are You Suffering From Pain in Your Middle & Upper Back?

Our Physiotherapy Services in Burlington Is Here To Provide Relief!

Have you ever experienced severe pain in the area between your scapula area? Are you having difficulty with breathing due to pain in the back? Do you feel constant pain in the back along your bra strap?

While the full impact of thoracic spine disorders (pain in the top or middle of the back) is not fully appreciated, recent research found that the occurrence of thoracic spinal pain over a 1-year period ranged between 3% and 55% with most occupational groups having medium of about 30%. Research investigating a working population showed that thoracic spine pain occurs in 5 out of 100 male workers and 10 out of 100 female workers. Thoracic spine pain also coexists with neck and/or low back pain in 41% of males and 36% of female workers with back pain.

The thorax consists of the thoracic spine, the rib cage, and the sternum in the upper back. The thorax is a fairly rigid structure whose function is to provide a stable base for several muscles to control the head, neck and shoulders, to protect internal organs, and to create mechanical support for breathing.

The structure consists of 12 thoracic vertebrae and 12 corresponding ribs on each side. A natural thoracic curve (rounding) is created by a bony slope of 3.8 degrees from back to front at each vertebral body, which creates a 45-degree kyphotic angle for the entire thoracic spine.

Book an appointment with Cogent Physical Rehabilitation Center today to learn more about how physiotherapy can help with your pain in your thoracic spine.

WHAT IS CAUSING PAIN IN AT THE TOP AND MIDDLE REGIONS OF MY BACK?

Thoracic spine pain conditions are often caused by problems of mechanical musculoskeletal origin in the joints and soft tissues. The potential causes of thoracic spine pain include referral from other structures, such as the cervical spine (neck); stomach issues; fractures from osteoporosis or malignant cancer; spinal infections; and mechanical musculoskeletal conditions.

Osteoporosis

Thoracic Mobility Deficits

Thoracic Mobility Restrictions With Referred Pain To The Upper Extremity

Thoracic Mobility Restrictions With Neck Pain

Thoracic Mobility Restrictions With Shoulder Pain

Thoracic Mobility Restrictions With Back Pain

Thoracic Clinical Instability

Thoracic Outlet Syndrome

Osteoporosis is a condition associated with loss of bone density most common in women after menopause and that can result in vertebral fractures and excessive deformity in the thorax. Osteoporosis leads to nearly 9 million fragility fractures yearly worldwide. Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level trauma. For example, a fall from a standing height or less.

Certain areas of the thoracic spine tend to further stiffen and become a source of mechanical pain and mobility restriction symptoms due to postural stresses and the body's response to stresses, strains, and injury. People who sit for more than 7 hours per day and participate in less than 150 minutes per week of moderate physical exercise are more likely to experience thoracic mobility restrictions, even when young and healthy.

Pain associated with rib dysfunction is often provoked with deep breathing with the location of the pain slightly sideways to the affected thoracic vertebrae. Symptoms may be referred sideways along the length of the rib angle. Stiffness in the thoracic spine also leads to muscle imbalances, such as weakness of the parascapular muscles (lower trapezius/middle trapezius) and tightness of the pectoral (chest) muscles, with an increased rounding of the thoracic spine and forward head posture.

Upper thoracic mobility restrictions with upper extremity referred pain is a type of thoracic spine disorders that involve tingling and pain in the upper extremity with or without symptoms into the neck or head. This condition is associated most commonly with peak stiffness at T3–T4 or T4–T5 spinal segments and a positive median nerve test. After treating the restricted segment, the upper extremity symptoms subside and an immediate improvement in the median nerve test is noted, with improved mobility and reduced upper extremity symptoms.

The main feature of thoracic mobility restrictions with neck pain is complaints of stiffness in the thoracic spine mobility deficits with movement of the neck. The symptoms reported do no extend beyond the shoulder area.

Thoracic spine extension (bending backwards) and some degree of rotation and lateral flexion (side bending) are crucial to achieve full and pain free movement of the shoulder to lift the hands upwards with the fingers pointing or sideways. Loss of upper and middle thoracic mobility has been shown to lead to increased strain and impingement placed on the rotator cuff muscles of the shoulder, especially at the end range of shoulder motions, which may lead to impingement syndrome, tendonitis, and tears of the rotator cuff.

Thoracic hypomobility is commonly associated with many low back pain conditions. The stiffness may be caused by muscle holding of the erector spinae muscles that originate in the middle and lower thoracic spine and connect into the thoracolumbar fascia. These global back muscles guard to protect the painful low back condition or to compensate for weak deep local muscles of the lumbar spine, leading to stiffness in the thoracic spine.

Although less common, clinical instability of the thoracic spine may occur in one or more of the following situations:

With systemic hypermobility
With severe postural deviations, such as excessive kyphosis and thoracic scoliosis
After trauma, such as a motor vehicle accident
After thoracic surgery, such as thoracotomy or thoracic laminectomy.

Clinical signs and symptoms are similar to instability in other regions of the spine and include achiness with sustained upright postures, relief of pain with recumbent positions, abnormal active movements, and hypermobility, weakness of the thoracic erector spinae and multifidus and the middle and lower trapezius muscles. Patients may present with mid-thoracic rotation instability syndrome shown by a “fixation” of the mid-thoracic segment that becomes hypermobile after correcting the fixation.

Thoracic outlet syndrome (TOS) is a generic diagnosis for those individuals who exhibit symptoms characteristic of entrapment of the brachial plexus and the subclavian-axillary vessels as they arch across the first rib from the thorax and follow the brachial plexus.

The symptoms most commonly associated with TOS result from the involvement of the ventral rami of C8 and T1 (or the inferior trunk of the brachial plexus) and the ulnar nerve. TOS may manifest as either a vascular (arterial or venous) or neurogenic condition. The vascular TOS can be further subdivided into arterial or venous.

Arterial TOS is caused by compression of the subclavian artery, and patients complain of arm fatigue and tingling during arm movement and exertion. Patients may present with arterial thrombosis or distal ischemia and gangrene related to emboli lodging in the digital vessels if the compression is not removed.
Venous TOS is caused by compression of the subclavian vein leading to venous engorgement, upper extremity edema, pain, cyanosis, fatigability, and a feeling of stiffness in the upper arm.

How Can Physiotherapy Help With Thoracic Spine Pain?

Physiotherapy treatment has been shown to be of great assistance for patients with thoracic spine pain. Patients diagnosed with osteoporosis can benefit from a program of progressive weight-bearing, resistive exercises, posture, balance, endurance, and bone density in an exercise program guided by a physiotherapist. Manual therapy delivered by a physiotherapists has also been shown to be effective for stiffness in the thoracic spine and includes movements to improve thoracic, lumbar and hip mobility, rib mobilization techniques, instruction in mobility, self-mobilization, and postural exercises for the different types of thoracic spine problems.

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Scheduling an appointment at our Burlington physiotherapy clinic is the only way to determine what a physiotherapist recommends for your thoracic spine pain.

ARE YOU SICK AND TIRED OF UNRELENTING PAIN DUE TO THORACIC BACK PAIN?

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Physical exercises vary widely from general land-based or aquatic exercise to neck-specific endurance, strength, stretching or McKenzie exercises. When exercise was compared with no treatment or placebo, or evaluated as an additional treatment for neck pain, strength, endurance, motor control and stabilizing exercises were beneficial in chronic neck pain, cervicogenic headaches and cervical radiculopathy.