Pain and injury in the middle of your back (your thorax) is less common than pain in your neck (because of the significant mobility up here) or your lower back (because of the significant load this area supports). But when pain does occur, it can be extremely uncomfortable. Why?
Here is a joint from the middle of your thoracic spine, we are looking down on it. It has attachments to the joint above and below, but also to ribs on either side. Along the front of the vertebrae a bundle of blood vessels runs, inside your chest cavity. At each level a vein an artery and a nerve split from the main vessel to innervate or supply blood to the muscles between your ribs.
So, imagine each and every time your breath, especially when you take a deep breath or when you raise your arms overhead, your ribs move. The ribs lift upwards and rotate slightly expanding your rib cage outwards and allowing you to fill your lungs.
A dysfunction in this movement can put an increased load on one of the many joints in your rib cage, can cause a neural tension (or a “pinched” nerve) or a muscle spasm or tightness between the ribs or vertebral joints. Due to the nature of the spinal nerves and extensive branches around the rib cage, the pain associated with altered movement patterns can be extreme and debilitating.
Unlike a sore finger you can splint, or an ankle you can strap its often hard to “escape” thoracic spine. Taking a deep breath, reversing the car out of the driveway or simply brushing your hair causes sharp and often radiating pain.
First things first.
We need to see how you move to identify the underlying cause. Can we change the pain? If we alter your shoulder mechanics/position does your range of pain-free movement improve? OR if we “mimic” a more mobile rib cage, are you able to turn further? All of these assessment tools allow us to create a meaningful and successful treatment plan for you.
What if its not going to plan?
Frequently when patients visit us for thoracic pain, they have already made a trip to their GP. It is totally understandable. Thoracic pain is associated with a lot of anxiety; could it be a heart attack? Have I broken a rib? Is it my kidneys? As physios we are equip to flag any and all of these more complex health issues. We ask very specific questions to allow us to identify causes that aren’t musculoskeletal in nature.
Let’s get started.
We will aim to identify what movement or position it is that improves your pain and/or function. Next, we will replicate this- be it with tape or postural awareness training. From here we will use soft-tissue mobilisation/joint manipulation to keep this range of movement or joint position. Finally, every patient’s biggest complaint…. The homework. We can’t help it! When something needs to be strengthened or stretched to maintain this pain-free position, one 30min physio session often isn’t enough!
We use your home exercises to reinforce to your body the “better” position to allow pain reduction and improved function. We promise never to overload you and we will never give you “fluff”, the exercises are always meaningful and with purpose.
Have thoracic pain you are worried about? Let us help. Call us on 8544 8484.
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