Pain and stiffness caused by thoracic spine injuries are generally located in the upper to mid back region. Thoracic pain is most commonly associated with poor posture, occupations and hobbies. Pain and stiffness will commonly present gradually, or after a period of increased computer time such as during exam periods or busy periods at work. However pain can also occur suddenly, such as following an awkward lift or reach.
Thoracic pain is often associated with muscle tension of the shoulders, the neck and low back. Physiotherapy treatment involves mobilisation and soft tissue techniques, alongside specific exercises which aim to decrease pain and restore mobility and normal function.
Pain caused by rib injuries most commonly present in the chest or upper to mid back regions. Rib injuries often occur following a cold or flu and will often be painful when taking a deep breath, during coughing, and whilst laughing. Direct trauma to the chest and back can also be a cause of rib fractures and sprains.
Common causes of thoracic spine or rib pain include:
Posture-related Pain or Tension
This is a common issue seen at Hawker Place Physiotherapy and Pilates, due to the high number of office workers and public servants in Canberra. Posture-related pain is commonly found in the mid to upper back, neck and around the shoulder blades. This may involve tense muscles, intervertebral joints or the rib joints.
Pain in this area typically worsens over time especially with stationary tasks such as computer work, driving and reading. Physiotherapy will involve a comprehensive assessment of neck, thoracic and shoulder joints and muscles as well as assessing the way you move, sit, stand.
Treatment may involve techniques to reduce muscle tension such as massage, dry needling, stretching or joint mobilisations. You will undoubtedly have some home work after physiotherapy to optimise posture and to strengthen the postural muscles to help prevent pain recurrence.
Rib Fractures
Rib fractures can result acutely from trauma such as severe coughing or a direct blow, as well as over time from repetitive loading activities such as rowing.
Rib stress fractures are different from traumatic fractures in that they appear as a weakened area of the bone rather than a crack or break. Stress fractures most commonly occur in athletes, particularly rowers.
Typically with a rib fracture you will experience pain when taking deep breaths or coughing. There may also be pain locally over one or more ribs when pressed. Traumatic rib fractures are characterised by a sudden onset of pain, whereas stress fractures will often be associated with a gradual onset of pain, first in the general chest or back regions, then becoming more localised.
A period of rest combined with physiotherapy will help you to return to your usual sports and activities.
Costochondritis
Chostochondritis is the inflammation of the cartilage located within the joints that connect the ribs to the sternum (breastbone). Patients with chostochondritis commonly experience chest pain on either side of the sternum. The joint will be tender to the touch and the pain will often be aggravated by a slouching posture and exercise.
Chostochondritis is a self-limiting condition, which means that it should resolve over time. It can appear in both children and adults.
It is important that if you are experiencing chest pain you consult a medical professional to distinguish chostochondritis from cardiac causes of chest pain.
Physiotherapy can be helpful to address any postural changes and stiffness in related areas of the body.
Scoliosis
Scoliosis is an abnormal curvature of the spine and is the most common spinal disorder in children and adolescents. It is characterised by a sideways curvature of the spine, often in combination with abnormal rotation of the spinal vertebrae.
Common characteristics of patients with scoliosis include;
- Sideways curves of the spine (may look like an ‘S’)
- Significant differences in shoulder height
- Side lean body posture
- Clothes may not hang properly
- Some patients can experience muscle and joint pain
- In severe cases, breathing may be affected due to secondary deformation of the rib cage
Scoliosis can be structural and non-structural. Structural scoliosis has deviations that are unable to be, or can only partially be, corrected. Non-structural scoliosis results from posture, or muscle compensations around the spine and can be corrected with physiotherapy and exercise.
