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Thoracic pain and mobility deficits

We often see patients with both thoracic pain with range of motion/mobility impairments. The first question we ask is whether this person is truly stiff or are their muscles guarding as a protective mechanism, limiting range of motion. Often, patients with hypermobility (more flexible joints) have limited range of motion as their nervous system is sending signals to their muscles to guard as a protective mechanism. In these cases, we figure why muscles are guarding and take appropriate action.

In other cases, people have stiffness. This may be due to arthritis or just general hypomobility (lacking joint movement). Often these patients have central and/or one-sided thoracic spine pain and limitations in range of motion that consistently reproduces symptoms. Depending on the cause, treatments include:

  • Manual therapy to increase mobility
  • Spinal manipulations as a “control/alt/delete” for the nervous system to decrease muscle guarding, reduce pain and improve strength
  • Strengthening/motor control (coordination) exercises
  • Stretches
  • Dry needling to decrease muscle tone


  • “Neck Pain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice,” Vol. 47, No. 7, 2017, pp. 511-512. Journal of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2017.0507.

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