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
- 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.
If your pain is in the region between the neck and the shoulder, between or around the shoulder blades or you have both neck and upper back pain, odds are the neck is involved. This is especially true if you also have neck pain.
To determine if a patient needs to be sent to another provider for an X-ray, MRI or other form of medical imaging, we want to be 100% certain a red flag is not present.
For the spine, there is not always a clear black and white answer of the specific anatomical structure causing thoracic pain/symptoms and patients often get hung up on wanting a firm anatomical diagnosis.