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Mid Back (Thoracic) Pain

The thoracic spine, also known as the mid back, is made up of 12 individual vertebrae and a pair of ribs associated with each segment. The primary purpose of your thoracic spine and rib cage is primarily structure and protection, but is also responsible for your trunk movement. Pain through the mid back can present in a multitude of ways due to the huge number of structures including vertebrae, muscles, ligaments and organs.

Most common complaints are stiffness and aching pains - often from being in the same position too long, whether it be desk workers sitting for 8 hours or nurses on their feet for 8 hours. This is commonly a combination of overused and under-utilised muscles and joints.

Some more acute injuries of the thoracic spine and rib cage are caused from every day activities, lifting something and twisting can cause facet sprains or rib sprains. Alternatively, injuries can occur from something as simple as coughing or sneezing.

Common Structures Injured Facet Sprains. A common injury, presented as sharp pinching pains on movement and can have a dull ache when relaxing. This is often caused by lifting and twisting, sleeping in awkward positions and can be aggravated from contact sports.

Muscle Strains. There are many muscles running throughout your thoracic spine, including muscles supporting the scapula and shoulder, the intercostal muscles between your ribs and the large latissimus dorsi muscle which is commonly aggravated in cricket players and gym goers. Muscle injuries normally have a specific incident that caused the strain and will be frustrating with movement and daily activities, usually associated with a dull ache and weakness in the associated motion of the muscle.

Rib sprains. A very painful injury. Often a rib sprain can cause such acute chest pain that it may be mistaken for a heart attack. Rib sprains cause pain with breathing and movement in most directions. Commonly caused by sneezing or coughing fits.

Disc injuries. Unlike the lumbar spine, disc injuries are rarely seen in the thoracic spine, this is due to the changes in the curve of the spine and the weight transfer going through the joints. Disc injuries in the mid back are usually because of a more traumatic injury, eg, lifting overhead, or car and bike accidents.

Assessment and Management Once the location of the injury has been isolated, management will be tailored to the injury. Techniques will include manual therapy (remedial massage, joint therapy and assisted stretching) to facilitate recovery. Times for healing are dependent on the tissue involved and aggravating factors present. Ligaments can take 2-12 weeks and muscles can take 2-3 weeks depending on the severity of the injury.

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