Thoracic Back Pain

Original Editor - Lucinda hampton

Top Contributors - Nupur Smit Shah, Lucinda hampton, Kim Jackson and Aminat Abolade  

Introduction

Thoracic back pain is common throughout life but is not as well studied as neck pain or low back pain. Thoracic back pain is more often due to serious spinal pathology than neck or low back pain but thoracic back pain is also prevalent among healthy individuals without any serious underlying cause.

Epidemiology

The range of prevalence estimates of thoracic back pain in the general population is broad because of many factors eg the different definitions and duration of thoracic back pain included.

Prevalence data ranged from

• 4.0-72.0% (at any one time)
• 0.5-51.4% (seven-day)
• 1.4-34.8% (one-month)
• 4.8-7.0% (three-month)
• 3.5-34.8% (one-year)
• 15.6-19.5% (lifetime).

Higher prevalence for thoracic back pain in children and adolescents, females > males.

In children and adolescents, thoracic back pain associated with:

• Female gender,
• Postural changes associated with backpack use,
• Backpack weight
• Musculoskeletal symptoms, participation in specific sports,
• Chair height at school
• Difficulty with homework.
• Poorer mental health

In adults, thoracic back pain associated with:

• Concurrent other musculoskeletal symptoms
• Difficulty in performing activities of daily living.
• Lower grade male white-collar workers were more likely to report TSP (17%) than male workers in other occupational categories
• Upper grade female white-collar and professional workers were more likely to report TSP.

Aetiology

Thoracic back pain occurs

• As a result of trauma or sudden injury
• Through strain or poor posture over time
• From inflammatory, degenerative, metabolic, infective and neoplastic condition.
• From conditions such as primary and secondary osteoporosis (especially vertebral fractures and hyperkyphosis arising from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann's disease

The most common cause of thoracic back pain appears to originate from

• Muscular irritation
• Lack of strength,
• Poor posture,
• Prolonged sitting at a computer,
• Using a backpack,
• Overuse injuries (such as repetitive motion), or
• Trauma (such as a whiplash injury caused by a car accident or as a result of a sports injury).

Asymptomatic thoracic disc herniations are relatively common but symptomatic disc herniations are rare. They occur in approximately 5 in 1,000 disc herniations presenting in a clinical setting.

Thoracic spine pain can be complex issue. The thoracic spine is compromised of 12 vertebrae and this part of the spine joins with the ribs to make the costovertebral joints. This part of the spine is often injured as a result of poor postural habits and structures which can cause pain include joints, muscles, ligaments, nerves and discs.

Physiotherapy

Physiotherapists are university trained in the assessment and treatment of spinal problems. Early and acute treatment focuses on understanding the diagnosis, reduction in pain and poor movement patterns and restoration of range of motion.

Physiotherapists treat thoracic spine pain using a variety of techniques including:

• Soft tissue massage, muscular and trigger point releases
• Light thoracic spinal mobilisations for pain relief
• Firm thoracic spinal mobilisations for stiffness
• Manipulations
• Modalities such as heat, ice and TENs
• Protection such as compression, padding, strapping
• Support braces or tape assisted posture retraining
• Muscular stretches
• Range of motion and breathing exercises
• Postural training for core and alignment
• Muscular strength and endurance exercises
• Dry needling
• Manual handling, ergonomics, technique training, education and advice
• Sport, work, hobby specific retaining