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Thoracic Back Pain by Amanda Schamrel


“I have pain in the thoracic area, should I be concerned?”


Pain experienced in the thoracic region is often met with worrying thoughts about the cause of the pain. This is not without reason because the pain in this area can be caused by a range of conditions other than musculoskeletal causes.


Physiotherapists are trained to screen and monitor for signs and symptoms that would suggest serious pathology which can be a fracture, metastatic (Cancer), metabolic or visceral. A clear and thorough analysis of previous and present history and a physical examination need to take place for this reason and any red flags will be sent for further investigation.


Can it be ambiguous? Yes, pain can originate from various organs and can still behave mechanical i.e., be affected by jolting/jarring, movement and breathing. Thoracic musculoskeletal pain can also mimic visceral pain characteristically. This means that monitoring and clinical reasoning is an ongoing process by your medical team.


What do you need to know about thoracic spine pain? The thoracic spine is between the neck and the lower back. It is commonly thought of as the upper back but spans the length of your rib cage. Thoracic back pain is less common than neck or lower back pain but is often associated with neck or lower back pain.


A study found a 10 percent prevalence of thoracic spine pain over a 1-year time frame. Thoracic spine pain is found across age groups but becoming less common in older age suggesting that thoracic spine pain is not likely associated with degenerative changes. There is evidence that thoracic spine pain is most common in people who have sitting occupations, like driving or desk-bound jobs, and where there is sustained or repetitive trunk flexion and a lack of recovery or change of task. It is also more common in women and tall people.


If the pain is of musculoskeletal origin in the thoracic spine what could be the cause?


Certain conditions of the cervical spine do refer to pain into the upper thoracic area and will be considered in the assessment. Neural tissue disorders are very rare in the thoracic spine and disc prolapse is often asymptomatic and does not usually cause compression of the neural structures. This is due to the anatomy of the thorax. Most back pain is linked to minor sprains that can be very painful but have an excellent prognosis with physiotherapy.


Musculoskeletal conditions in the thoracic spine can be either a movement impairment or a loading or control disorder. Movement impairment is due to pain and/or stiffness arising from the joint, disc or neural structures. A motor control disorder will present with normal range of movement but incorrect control and loading of the area during movement. The source of pain can also be the joint between the rib and the adjacent vertebrae, called the costovertebral joint. A study of prevalence in clinical practice showed 13% to be a thoracic spine disorder as opposed to 1.6% being rib pain.


A physiotherapist’s role is to help restore pain-free range of motion and ultimately function. This is done through not only manual therapy but rehabilitation that is patient-specific, education, load management, and lifestyle management.


References:

Briggs et al; Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskeletal Disorders 2009.

Finucane and Downie et al; International Framework for Red Flags for Potential Serious Spinal Pathologies. JOSPT 2020.

Roquelaure et al; Incidence and Risk Factors for Thoracic Spine Pain in the Working Population: The French Pays de la Loire Study. Arthritis Care and Research 2014.

Southerst; the effectiveness of non-invasive interventions for musculoskeletal thoracic spine and chest wall pain: a systemic review by the OPTIMa collaboration.

Journal of Manipulative Physical Therapy 2015.



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