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What is causing my thoracic spine/upper back pain?

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. While MRIs may show lots of scary words, they are notorious for false positives and often show findings that are likely irrelevant, leading to unnecessary surgeries. A false positive finding means they show findings that are present in the vast majority of the population, including folks with no pain.

Due to this inability to identify an exact structure causing pain, even with an MRI, patients are best treated on a “sign and symptoms” approach. We look for characteristics in your presentation that show you are more likely to respond successfully to certain interventions and exercises.


  • “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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