Gareth Sneath, PT, MCPA, Grad Dip Man Ther, MScCH
July 2015

There are many reasons why patients experience pain symptoms. It is common in practice to see patients with pain in the upper back, or “thoracic” spine, that area around, between or below the shoulder blades. Whilst sometimes associated with a whiplash type injury there are also those patients who deny any traumatic cause for their symptoms. What are some causes of thoracic spine pain? Below is a brief explanation of three causes, one degenerative, one postural and one due to a condition called osteoporosis which can produce a fracture of the vertebrae.

1 Degenerative conditions (discs, facet joints) in the middle to lower part of the neck can refer pain into the thoracic area. There may not always be much in the way of neck pain per se however the cause of the thoracic symptoms is in the neck. Clinically we can determine if this is the case by carefully examining movements of the neck to see if they aggravate the thoracic pain. You can also do your own evaluation by asking yourself if the pain gets worse when moving your neck in certain directions or does it worsen when adopting certain neck postures.

2 If your thoracic pain is worse after adopting certain prolonged (usually stooped) positions the symptoms may be related to postural overloading of the neck or upper back tissues. Think how it feels at the end of a long day after sitting in front of your computer. If it is worse, then consider changing posture by sitting more upright to evaluate the effect. Look at your posture from the side in a mirror. Does it feel “normal” to sit in a slumped posture with your head poking forward? If so, it’s time for change. (This is how most of us tend to sit which can overload the thoracic curve causing postural pain over time) I tell patients to “go tall” in sitting or standing and to work on their ability to maintain a more upright position more consistently. This can take some time and effort to develop tissue tolerance and muscle endurance

3 In some older patients, particularly post menopausal females, osteoporosis (thinning of the bone) is a fairly common diagnosis (1 in 4 females will develop this condition) If you experience sudden onset of pain in the thoracic spine after lifting, bending, twisting or stooping this may indicate a fracture of the vertebral body. X-Ray evaluation confirms or rules out a fracture. Once the acute symptoms have settled down and sufficient healing has occurred an important part of treatment involves developing muscle strength and endurance particularly for the back muscles. These need to be diligently performed and supervised initially to ensure appropriate technique.

There are many potential causes of pain symptoms and the above information gives some brief insight into three of them. Evaluation by your health care professional can help to determine the cause of your symptom(s) before deciding on the appropriate treatment. This process begins with taking your history so giving some thought to when your symptoms started and why plus what makes them worse or better is very important. This information along with a physical examination and consideration of any other medical tests is very useful in determining the cause.