Back, Chest pain from the thoracic spine
(upper back)
The following is an interesting case that we may have heard of but is often confused of where the pain is coming from;
A patient presented with intense right-sided chest pain localized at the nipple area. It was painful on lifting and deep breathing. He did not have an accident and did not know how he got such on and off chest pain and cramp feeling right and left alternatively over the last 2 years. He had sought medical advice with negative results in all respiratory and cardiac examinations. Despite repeated reassurance, the frequency and severity of his "attacks" had been increasing. Since the medical diagnosis was just stress and muscle tension, he had just put up with it, occasionally had a massage to relax himself until the recent more severe attack.
On examinations, the 6th sterno-costal joint (where the 6th rib joined the chest bone in the middle) was tender but nothing else wrong was found. The thoracic spine (upper back) was therefore checked. The number 4 to number 7 spine were found stiff and painful right worse than the left with soft tissue tightness and thickening (scarring). Since no other medical and physical signs were found, his chest symptoms could very well be a referred (radiating) pain from his thoracic spine (upper back) . A series of thoracic soft tissue deep friction massage, thoracic joint manipulations, mobilizations, stretches, mobility and postural exercises were given. He responded to manipulative physiotherapy treatment well and his chest pain settled a lot with only a few treatments. It could take quite some more treatments to clear his long-standing symptoms but at least we knew then that his chest pain could very well be coming from his back.
It is of course dangerous to assume all chest pain is referred from the thoracic spine. In fact, I very much like such patients to consult their doctors to exclude any respiratory and cardiac conditions. If medical tests are proven negative, I suggest manipulative physiotherapy assessment and treatment could be used as a differential diagnostic test to see if the spine could be where the pain is coming from. Such patients with negative medical tests were often referred from doctors and even the cardiac units in the hospitals to my clinic in Australia for differential diagnostic purpose and manipulative physiotherapy treatment.
While we must be careful not to miss those life-threatening respiratory and cardiac conditions, we must also try to hunt out exactly where the patients' pain is coming from to relieve their discomfort no matter how minor we think they are as they could be huge nuisance to our patients.
Luck LI
Musculoskeletal Physiotherapist
A patient presented with intense right-sided chest pain localized at the nipple area. It was painful on lifting and deep breathing. He did not have an accident and did not know how he got such on and off chest pain and cramp feeling right and left alternatively over the last 2 years. He had sought medical advice with negative results in all respiratory and cardiac examinations. Despite repeated reassurance, the frequency and severity of his "attacks" had been increasing. Since the medical diagnosis was just stress and muscle tension, he had just put up with it, occasionally had a massage to relax himself until the recent more severe attack.
On examinations, the 6th sterno-costal joint (where the 6th rib joined the chest bone in the middle) was tender but nothing else wrong was found. The thoracic spine (upper back) was therefore checked. The number 4 to number 7 spine were found stiff and painful right worse than the left with soft tissue tightness and thickening (scarring). Since no other medical and physical signs were found, his chest symptoms could very well be a referred (radiating) pain from his thoracic spine (upper back) . A series of thoracic soft tissue deep friction massage, thoracic joint manipulations, mobilizations, stretches, mobility and postural exercises were given. He responded to manipulative physiotherapy treatment well and his chest pain settled a lot with only a few treatments. It could take quite some more treatments to clear his long-standing symptoms but at least we knew then that his chest pain could very well be coming from his back.
It is of course dangerous to assume all chest pain is referred from the thoracic spine. In fact, I very much like such patients to consult their doctors to exclude any respiratory and cardiac conditions. If medical tests are proven negative, I suggest manipulative physiotherapy assessment and treatment could be used as a differential diagnostic test to see if the spine could be where the pain is coming from. Such patients with negative medical tests were often referred from doctors and even the cardiac units in the hospitals to my clinic in Australia for differential diagnostic purpose and manipulative physiotherapy treatment.
While we must be careful not to miss those life-threatening respiratory and cardiac conditions, we must also try to hunt out exactly where the patients' pain is coming from to relieve their discomfort no matter how minor we think they are as they could be huge nuisance to our patients.
Luck LI
Musculoskeletal Physiotherapist