Crisis Plan Series
Acute thoracic (upper back) pain
Acute thoracic (upper) back pain could also be painful and debilitating. Pain is often felt at the interscapular (between the shoulder blades) or scapular (shoulder blade) region, sometimes radiating through or around to the chest on either side. Other than the thoracic spine, neck and shoulder movements could also be restricted. Cough or sneeze and even deep breathing may also be painful. As discussed in the last few newsletters, the patient must clearly understand the source and cause of the condition so as to promote recovery and prevent future aggravations. Other than the required medications, the Crisis plan for mechanical thoracic back pain includes immediate re-positioning of the thoracic (upper back) spine to its best alignment.
The most common source of mechanical thoracic back pain is spinal, including the costo-vertebral and costo-transverse joints where the rib joins the spine. The joints could be injured from a sudden exertion such as a sneeze, cough, or heavy lifting. But these incidents could well be the last triggering factors of a chronic long-standing postural problem in the thoracic spine. No matter what the primary cause of the injury is, restoring and maintaining spinal movements promise quickest pain relief. Once again, maintaining good spinal posture is vital. The normal thoracic kyphosis (forward bending curve) should not be exaggerated. Patients with severe pain may feel more comfortable hunching over, but this could only provide short-term relief. It actually causes further stiffening and pain in the thoracic spine. The patient should be advised to straighten up as much as possible. Thoracic back pain seldom needs bed rest or back brace. Static positions such as prolong sitting and standing should be avoided. Gentle postural and mobility exercises touching the edge of the pain should be encouraged:
Heat may also help to relax muscle spasms. Such thoracic dysfunction often responses to gentle localized quick thrust manipulation well as long as it is done carefully and specifically. Relief could sometimes be instant. Faster and better recovery is expected comparing with injuries in the neck and low back as long as it is seen promptly. Recurrence is also less common if the patient continues his postural and mobility exercises.
The most common source of mechanical thoracic back pain is spinal, including the costo-vertebral and costo-transverse joints where the rib joins the spine. The joints could be injured from a sudden exertion such as a sneeze, cough, or heavy lifting. But these incidents could well be the last triggering factors of a chronic long-standing postural problem in the thoracic spine. No matter what the primary cause of the injury is, restoring and maintaining spinal movements promise quickest pain relief. Once again, maintaining good spinal posture is vital. The normal thoracic kyphosis (forward bending curve) should not be exaggerated. Patients with severe pain may feel more comfortable hunching over, but this could only provide short-term relief. It actually causes further stiffening and pain in the thoracic spine. The patient should be advised to straighten up as much as possible. Thoracic back pain seldom needs bed rest or back brace. Static positions such as prolong sitting and standing should be avoided. Gentle postural and mobility exercises touching the edge of the pain should be encouraged:
- scapular retraction (shoulder blades backward movement) and rotation (rolling),
- thoracic extension (upper back backward bending) and rotation (turning),
- neck and shoulder movements.
Heat may also help to relax muscle spasms. Such thoracic dysfunction often responses to gentle localized quick thrust manipulation well as long as it is done carefully and specifically. Relief could sometimes be instant. Faster and better recovery is expected comparing with injuries in the neck and low back as long as it is seen promptly. Recurrence is also less common if the patient continues his postural and mobility exercises.
Luck LI
Musculoskeletal Physiotherapist
Musculoskeletal Physiotherapist