Thoracic Back Pain
What is thoracic back pain?
Thoracic back pain refers to pain felt in the upper and middle part of the spine, known as the thoracic spine (T1-T12). This region extends from the base of the neck to the bottom of the ribcage and is less mobile than the cervical (neck) and lumbar (lower back) spine due to its connection with the ribs.
Symptoms of thoracic back pain
- Dull, aching, or sharp pain in the upper/mid-back
- Stiffness and limited mobility in the spine
- Pain that worsens with movement, posture, or deep breathing
- Muscle tightness or spasms in the back and shoulders
- Radiating pain to the ribs, chest, or shoulders (if nerves are involved)
- Tingling, numbness, or weakness (less common, but can occur with nerve compression)
Causes of thoracic back pain
- Muscle strain and postural pain – Prolonged sitting, slouching, or overuse of muscles.
- Joint dysfunction – Stiffness or irritation of the facet joints or costovertebral joints (rib joints).
- Thoracic disc protrusion – Disc herniation causing compression of the spinal cord or the spinal nerve roots (radiculopathy).
- Osteoarthritis – Physiological changes to the spinal joints, leading to pain and stiffness.
- Scoliosis and kyphosis – Abnormal spinal curvature.
- Compression fractures – Common in osteoporosis, causing sharp pain.
- Referred pain – Conditions like heart problems, lung disease, or gastrointestinal issues can mimic thoracic pain.
Other specific thoracic spine disorders:
- Thoracic outlet syndrome (TOS)
- Inflammatory spondyloarthropathy e.g. Ankylosing Spondylitis
- Schmorl’s nodes
- Scheuermann’s
Key red flags – When to seek medical help
- Severe or worsening pain without a clear cause.
- Numbness, weakness, or tingling in the arms or legs.
- Pain that does not improve with rest or worsens at night.
- Unexplained weight loss, fever, or history of cancer.
- Loss of bladder or bowel control (emergency sign of spinal cord compression- cauda equina)
How can Physiotherapy help with thoracic pain?
Physiotherapy helps reduce thoracic back pain by improving mobility and prevent future issues. A physiotherapist tailors treatment based on the cause of pain, whether it’s muscle strain, joint dysfunction, nerve compression, or posture-related stiffness.
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Reduce pain and inflammation
- Manual therapy- Joint mobilisation and manipulation.
- Soft tissue release – Massage and trigger point release.
- Dry needling – Targets deep muscle knots for pain relief.
- Heat or ice therapy – Ice for acute pain, heat for chronic tightness.
Improve mobility and flexibility
- Cat-Cow stretch – Helps with spine flexibility.
- Thoracic extension over a foam roller – Helps correct a rounded back.
- Seated thoracic rotations – Improves twisting mobility.
- Wall angels – Improves posture and rib mobility.
Strengthen weak muscles
- Scapular retractions – Help with posture.
- Planks and core activation – Provide support for the spine.
- Superman exercise – Strengthens the lower thoracic and lumbar spine.
- Resistance band rows – Strengthens the mid-back muscles.
Improve breathing patterns
- Diaphragmatic breathing – Reduces stress and upper back tension.
- Rib mobilisation exercises – Helps with costovertebral joint stiffness
Education and prevention strategies
- Teach self-management techniques for pain relief.
- Provide a personalised home exercise program.
- Guide lifestyle changes to prevent future pain.
Advice on posture and ergonomics
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By Amelia Boland, Physiotherapist
