Thoracic Spine Pain

Keywords; thoracic spine pain, chiropractic help, scheuermanns disease, tietzes syndrome.


Deep upper back pain is rarely serious but frequently can be extremely irritating. Metastases from known cancers of the lungs and breast should be kept in mind, but they are very much the exception that proves the rule.

There are twelve thoracic vertebrae, each attached via three joints to a rib bilaterally; thus six in total. They are then connected to the breastbone anteriorally. The midback stretches from the base of the neck to the bottom of the ribcage; that's about a hundred in total.

This means that each thoracic vertebra has twelve joints associated with it. 

  • Two facets with the vertebrae above and below.
  • One disc.
  • Six costo vertebral joints between the vertebra and the two ribs.

That's a great many, each with supporting ligaments and muscles, making it a complex and frequently painful area.

The mid back is far stronger 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 may subluxate or 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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Modelled on the famous James Herriott, the vet in harness, Preston's stories are mostly light, giving insight to the chiropractic coalface.

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 & Scheuermanns disease

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, use the search this site facility. 

Another fairly common condition, Scheuermanns disease causes an increased kyphosis affecting teenagers. It results in 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 young people.

What is quite often seen in the practice, in young to middle aged adults, is a scheuermann like thoracic deep achy pain. The structural changes, and abnormal cartilage make the spine very stiff. Adjusting the midback feels like thrusting 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 with an increased kyphosis. Sometimes there is a scoliosis and loss of disc space with mild degenerative changes, but without the typical bone changes associated with the disease.

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 incurable diabetes, for example, require regular occasional management by their doctors.

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, an occasional, but regular chiropractic adjustment in, saves nine barrow loads of thoracic spine pain.


Tietzes syndrome

The attachments of the ribs firstly to the spine via the

  1. Costo spinal joints, rib pain treatment and secondly,
  2. in front, to the breastbone, costosternal ches pain.

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 or pain 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.

SPINAL INFECTION

Very occasionally, depending on the society, bacteria may attack the spine. It's a favourite nesting place for people suffering from acquired immuno deficiency syndrome and tuberculosis.

More rarely, an epidural, such as is commonly today used in childbirth, 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

  1. Inspiration pain, but bilaterally. A sprung rib commonly causes pain with deep breathing, but it's unilateral; on one side only.
  2. Extreme pain on using a hyperextension technique. They are rarely painful; when they are, it's a sign for your chiropractor to look further.


She's doing okay, all things considered, but despite 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 illness in developed countries like the United States, mostly from medication. 

Metastatic bone disease is fortunately an uncommon finding in chiropractic practice, but a case could walk in tomorrow; no doubt we miss them sometimes, especially since chiropractors are taking less xrays since the Lancet report that 7 percent of cancer is caused by ionising radiation.

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 S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Hypermobility is more difficult that too stiff in my opinion. Chiropractic is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

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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.

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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.


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