Pain in the mid-back or thoracic spine usually arises in similar ways to pain in the lower back or neck, except that disk protrusions are less common and nerves are less likely to be trapped. Thoracic pain should always be investigated by a doctor.
Acute attacks may be caused by a fall or stumble, repeated heavy lifting, an awkward bend, a violent twist or wrench, a cough or sneeze, or a trivaial uncoordinated movement, such as turning over in bed or getting up from a chair. The actual physical causes are probably due to mechanical dysfunction: a facet or rib joint strain, a muscle strain or more rarely a disk strain or protusion. More long-standing pain that develops gradually may be related to scoliosis.
The thorax bhouses important organs, such as the heart and lungs which can refer pain to the front, side, or back of the chest. Symptoms include central or one-sided thoracic pain: it may hurt more when coughing, sneezing or breathing and it invariably hurts to rotate the trunk in one direction more than the other. Central severe pain that is made worse by bending forward or backward and radiates through to the front directly is more suggestive of a disk problem. In an older person who is coughing violently, a stress fracture of a rib is a possibility. Similarly a young athlete may develop a stress fracture through repetitive strain or may pull or tear one of the large muscles of the back in a violent movement. Pain that is constant, unaffected by movement or position and worse at night may signify underlying illness or disease. Pain may be referred to the abdomen or as low as the groin in any of the above conditions.
It is important that you rule out any potentially serious causes of thoracic pain as it may be linked to diseases of the heart, aorta, lungs, and pancreas or kidneys. Infection in a kidneys. Infection in a disk or vertebra involves the thoracic spine more than any other areas of the back. Very rarely, the cause of pain is secondary cancer.
Once your doctor has referred you, your therapist will perform a thorough assessment. Your therapist may:
· Perform Spinal Mobilization and Manipulation and Trigger–point Therapy.
· Suggest acupuncture.
· Use Strapping.
· Teach you about posture, ergonomics and deep breathing techniques.
Your Therapist may advice you to:
· Stretch your Thoracic Spine with seated back extensions, upper back stretches, roll-down stretches, seated twist stretches and corner chest stretches.
· Strengthen your deep spinal stabilizers with single arm and led raises.
· Strengthen your abs with four-point supine knee lifts.
If you are experiencing less pain and are able to perform specific stabilizing exercises for your thoracic spine, your therapist may advice you to:
· Perform doorway chest stretches progressing to wall sit presses.
· Use a form roller to release trigger points with exercises such as thoracic form rollers and lat form rollers.
· Add lat band rows, upper-back band rows and prone shoulder squeezes.
· Increase your level of endurance by increasing the number of reps and number of sets as pain allows.
If you are free of pain and able to maintain good stability within your thoracic spine, your therapist may advice you to:
· Progress to functional exercises and sensorimotor training such as single-leg stands.
· Include cardiovascular training such as aqua aerobics using a cross-trainer and running in your exercise program.
· Consider ensure further strengthening and prevent ant reoccurrence of your injury.
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