Keywords: thoracic spine pain, chiropractic help, Scheuermanns disease, Tietzes syndrome, deep upper back pain
Deep upper back pain is rarely serious but frequently can be very irritating. Metastases from known cancers of the lungs and breast should be kept in mind, but they are very much the exception.
There are twelve thoracic vertebrae, each attached via three
joints, marked with an X below, to a rib on each side, thus six in total, which in turn is
joined to the breastbone. It stretches from the base of the neck to the
bottom of the ribcage. 12 x 8 = 96 rib joints.
This means that each thoracic vertebra has eight joints associated with it.
The midback is far more stable than the neck and lumbar spine because of the stabilising effect of the rib cage.
Nevertheless, a good sneeze, particularly if twisting at the time, or a bout of bronchitis will frequently subluxate, sprain, one of those joints causing severe pain with each breath. It feels like someone is stabbing you in the back with a rusty knife.
Each vertebra is attached by a rib to the breastbone, sternum, thus giving the whole chest a certain rigidity. This makes it far less liable to the serious disc injuries associated with the neck and the lower back.
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Of course, occasionally tragic things happen in the practice. Right now I'm treating a very elderly lady. Twenty years ago I had to break the news to her husband that his thoracic spine pain was caused by multiple myeloma.
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Thoracic spine pain
Seen from the side, the thoracic spine has a natural curve called a kyphosis.
This "kyphosis" provides the spine with a certain amount of 'give' when for example jumping from a height onto the ground. A straight spine would experience too much axial compression, and fracture the bones.
THORACIC SPINE PAIN CaseFile
The case history of a young rugby player who after a tackle
experienced very severe midback pain. Fracture or subluxation? It can
test every clinician. Hot from the field he enjoyed a glass of our
Lemon drop drink recipe ...
Causes of Osteoporosis
However, the kyphosis can increase for pathological reasons causing thoracic spine pain. The most common is the so called kyphotic, bent, spine of the elderly. It is usually associated with osteoporosis and anterior wedging of the vertebrae, as seen in this MRI of a spine with an anterior compression fracture. For more on the causes of osteoporosis, click here. Causes of osteoporosis.
Another fairly common condition, Scheuermanns disease causes an increased kyphosis affecting teenagers. It causes pain usually between the shoulder blades, and less commonly in the low back, and is the cause of the poor posture and slumped shoulders seen in about five percent of teenagers.
What is quite often seen in the practice, in young to middle aged
adults, is a scheuermann like thoracic deep achey pain. The structural changes, and abnormal cartilage make the spine very stiff. Adjusting the midback feels like adjusting into concrete, and a hard physical manipulation just increases the pain. What's needed is more frequent gentle adjustments.
It has many of the hallmarks of scheuermanns, a stiff and rigid thoracic spine, an increased kyphosis, sometimes a scoliosis, loss of disc space with mild degenerative changes, but without the typical bone changes associated with scheuermanns.
I call it a light form of scheuermanns, as it has so many similar clinical features, but without the gross xray changes, and is managed in much the same way. All disease seems to come in severe and mild forms. Thoracic spine pain is common, and this condition can never be cured. An occasional, but regular treatment is what keeps the pain at bay. How frequent? Talk to your chiropractors! There are so many variables. Perhaps four to eight weeks.
There are often objections to regular chiropractic treatment. It's no difference in medicine; patients with diabetes for example, incurable, require regular occasional management by your doctor.
If these joints are not brought into movement, then the hyaline
cartilage, starved of nutrients and oxygen, degenerates and on xray it
just looks like typical osteoarthritis. A stitch in time, or, in our
context, a chiropractic adjustment in time, saves nine barrow loads of thoracic spine pain!
The attachments of the ribs firstly to the spine via the
Both of these joints, at the back between the shoulder blades, and in front at the breastbone are common cause of thoracic spine pain seen in every chiropractic clinic. Sometimes, if it irritates the intercostal nerve, it may follow the rib to the sternum.
This latter condition, sometimes called Tietes syndrome is quite often, if it affects the ribs on the left, confused with a heart attack because the pain is directly over the heart, and may be increased wih exercise which stresses the heart, as in angina, but also the rib sternum joint when breathing deeply.
What may catch any chiropractor out, in it's early stages, and presumably your medical doctor too, is an attack of shingles. This is a viral condition causing a nerve type pain that follows the rib. After a few days the vesicles appearand his her face will be red! But I've never had a case of shingles that I've treated inadvertently, that has gone on to become a chronic nerve pain, as can happen.
Thoracic Outlet Syndrome
The upper thoracic spine is a unique area for two reasons. Firstly,
it is an area of change, where the highly flexible neck meets the very
rigid mid-back. The C6-T2 area is thus very prone to injury and tingling
in the arm. Thoracic outlet syndrome.
The second reason is the presence of the shoulderblades or scapula(e). These large flat bones are the anchor points for many of the large shoulder muscles, shoulder anatomy and are themselves firmly anchored to the thoracic spine.
As you can appreciate, there are a great many muscles, ligaments, joints and bones in the mid-back. The injuries associated with them are not usually serious, but are the cause of many niggling, aching pains between the shoulder blades.
Very occasionally, depending on the society, bacteria may attack the spine. It's a favourite nesting place for people suffering from AIDS and tuberculosis.
More rarely, an epidural, such as is commonly today used in child birth, may introduce bacteria to the spinal fluid, where they are free to travel. A recent case, was a puzzler for all concerned.
The key signs for this chiropractor were:
She's doing okay, all things considered, but even after extensive
antibiotic treatment, the vertebra has crumbled. Even the commonest medical procedures occasionally have devastating side effects. Doctor caused disease is the third most common disease in developed countries like the United States, mostly from medication.
Metastatic bone disease is fortunately an uncommon in chiropractic practice, but a case could walk in tomorrow.
Both lung and breast cancer have a tendency to metastasise to the ribs and thoracic spine. All doctors, and chiropractors especially, need to be aware that an abnormal presentation, particularly if there is a history of smoking or breast cancer, may indicate something other than routine spinal subluxations.
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
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