Thoracic Pain

Thoracic back pain is common throughout life but is not as well studied or understood as neck pain or low back pain.

Thoracic pain is more of a concern because it can be due to more serious pathology.

The most common causes are what we would call “musculoskeletal back pain” which is pain due to muscle irritation or joints that articulate with the spine.
The thoracic spine is unique because it has both facet joints at the back like the neck and lower back but also joints to the side which form rib connections. Therefore a lot of pain in the mid back can be due to rib dysfunction or irritation. If people have a curved spine or “scoliosis” it can cause more pressure on one side of the spine causing rib humping and restriction and pain. This part of the spine also has a lot of muscle attachments which can become very irritated with bad posture or from strenuous activity. Posture is a key factor for pain here, slumping over your desk weakens supporting musculature and creates muscle contractures and a lot of pain. Thoracic pain is also very common after sudden trauma such as falling over due to the muscles in between the ribs going into spasm “intercostals” which can be strained or damaged due to the sudden force.

Patients at the clinic do come in for curved spines which have been picked up on x rays of what is termed “scoliosis”. There are varying degrees but a curvature over 30 degrees is normally sufficient to warrant this diagnosis. It is good to have your child checked to see if they have a scoliosis maybe due to it running in the family or from injury or birth trauma. Chiropractors can then start treatment to reduce muscle and joint imbalances and help with alignment issues and monitor the situation as the child develops giving them strengthening exercises for the spine.

Patient will also talk about rib pain or “slipped ribs” which is normally where the thoracic spine articulates with the ribs. This can become strained and responds well to joint manipulation. Anterior rib pain on the sternum or breast bone can be very uncomfortable where these small peripheral joints “costochondrals” become inflamed. It is normally associated with thoracic restriction or slumped posture which can be addressed easily, ice packing the area can help significantly.

In the aging population thoracic pain is more of a concern as it is a common site for compression fractures due to osteoporosis, degenerative changes and even cancer. It is a common second metastases site. At the clinic we do a DEXA scan if clinically warranted to check your bone density levels to see if you have osteopenia or osteoporosis “weak bones” before starting any manipulative therapy.

A common condition in young males is Scheuermanns disease.

This affects males in their teenage years and is due to congenital wedging of the thoracic vertebrae causing a very pronounced or rounding of the mid back. The spine is very rigid with limited mobility in these patients and it cannot be corrected by changing their posture from attempting to stand up straighter. It is believed the ligaments are also thicker holding the spine in this position. Chiropractic treatment for this can be very effective as it releases the joint tension, it improves the posture and reduces the muscle tightness.

Ankylosing Spondylitis

It is a long-term (chronic) condition in which the spine particular the thoracic spine become very stiff and other areas of the body become inflamed. Again it is more common in young adolescent males.

Treatment at Sykes Verwey Centre.

Chiropractors are specialists in adjustments to the spine and joints of the body, manipulation to the facet joints and the rib articulations is very important to improve flexibility of the spine for these types of conditions. A combined treatment with some soft tissue work to release muscle spasms, whilst giving exercises to improve thoracic posture.

THE SYKES VERWEY CENTRE IS THE LEADING CHIROPRACTIC AND SPORTS INJURY CLINIC IN DEVON.
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