Thoracic Spine Pain — Causes, Symptoms, and Treatment
Thoracic spine pain is a common problem that affects people of different ages. It is important to understand that the causes of this pain are not always directly related to the spine itself.
One of the most common yet underestimated causes is myofascial trigger points — localized areas of muscle tension. These are often responsible for thoracic spine pain that may radiate to the chest, shoulder blades, or even mimic problems with internal organs.
One of the most common yet underestimated causes is myofascial trigger points — localized areas of muscle tension. These are often responsible for thoracic spine pain that may radiate to the chest, shoulder blades, or even mimic problems with internal organs.
Содержание:
Why Does the Thoracic Spine Hurt: Main Causes
Nature of Pain in the Thoracic Spine
Symptoms Accompanying Thoracic Spine Pain
When to See a Doctor Immediately
Diagnosis of Thoracic Spine Pain
Treatment of Thoracic Spine Pain
Exercises for Thoracic Spine Pain
Prevention of Thoracic Spine Pain
Frequently Asked Questions (FAQ)
Sources and References
Why Does the Thoracic Spine Hurt: Main Causes
Nature of Pain in the Thoracic Spine
Symptoms Accompanying Thoracic Spine Pain
When to See a Doctor Immediately
Diagnosis of Thoracic Spine Pain
Treatment of Thoracic Spine Pain
Exercises for Thoracic Spine Pain
Prevention of Thoracic Spine Pain
Frequently Asked Questions (FAQ)
Sources and References
Why Does the Thoracic Spine Hurt: Main Causes
The sources of thoracic spine pain can include the following structures:
- Bones and intervertebral discs (the spine itself) — quite rare
- Nerve tissue — not common
- Muscles — the main and most common cause of pain
- Ligaments and fascia — quite common
- Heart — quite rare, and the pain is specific
- Lungs and pleura — rare, and accompanied by complaints of breathing difficulties
- Esophagus, pancreas, stomach, aorta — rare
The most common cause of thoracic spine pain is not the spine itself, but the muscles and fascia.
Palpation of Muscles for Thoracic Spine Pain
Muscles of the Thoracic Spine That Cause Pain
The muscles of the back are arranged in layers and separated by fascia. Each layer of muscle can produce pain that mimics spinal pain. The muscles most susceptible to pathology that cause pain complaints are:
Superficial muscles:
Superficial muscles:
- Trapezius muscle
- Latissimus dorsi
- Rhomboid (major and minor)
- Levator scapulae
- Serratus posterior (superior and inferior)
- Erector spinae (spinalis, longissimus, iliocostalis)
- Transversospinal muscles (semispinalis, multifidus, rotatores)
Muscles, like any organ, are susceptible to their own disease — myofascial pain syndrome.
Sedentary Lifestyle and Desk Work
Sedentary work and back pain are closely linked: prolonged time in one position leads to chronic muscle overload and poor circulation. Physical inactivity and spinal problems are a common issue among office workers.
It is precisely during prolonged sitting that myofascial trigger points form, causing thoracic spine pain from sitting, as well as a sensation of stiffness and burning between the shoulder blades.
It is precisely during prolonged sitting that myofascial trigger points form, causing thoracic spine pain from sitting, as well as a sensation of stiffness and burning between the shoulder blades.
Physical inactivity (lack of movement) leads to the development of muscle pathology, which later spreads to the spine
Postural Disorders and Scoliosis
Postural disorders and back pain are not directly dependent on each other. That is, scoliosis itself does not hurt and does not lead to thoracic spine pain.
There are two types of scoliosis: structural and functional.
There are two types of scoliosis: structural and functional.
- Structural scoliosis — when there is true skeletal asymmetry, such as unequal leg length, differences between the right and left pelvic bones, or wedge-shaped vertebral deformity. This type of thoracic scoliosis is difficult to influence, but it does not cause pain.
- Functional scoliosis (or scoliotic posture) — a condition where muscles, through uneven tension, alter the position of bones, causing pathological spinal curves. The main cause of this type of scoliosis is the formation of trigger points in the muscles, which then shift the position of the bones.
A combination of both types of scoliosis can occur: part is due to differences in bone size between the right and left sides of the body, and part is caused by asymmetric tension on the bones from muscles with trigger points.
Postural Changes and Thoracic Kyphosis
Thoracic kyphosis is formed primarily due to an imbalance between the muscles of the anterior and posterior sides of the torso.
When a person sits for a long time, the spine rounds, the back muscles become elongated and tense, and in this position they "freeze" — that is, they lose their range of motion due to the formation of trigger points.
Additionally, the shoulders roll forward, and the pectoral muscles (major and minor) become shortened, which exacerbates thoracic kyphosis.
When a person sits for a long time, the spine rounds, the back muscles become elongated and tense, and in this position they "freeze" — that is, they lose their range of motion due to the formation of trigger points.
Additionally, the shoulders roll forward, and the pectoral muscles (major and minor) become shortened, which exacerbates thoracic kyphosis.
Thoracic kyphosis is formed due to damage to the muscles of the thoracic spine and shortening of the pectoral muscles. To correct thoracic kyphosis to a physiological level — the back muscles must be treated.
Thoracic Osteochondrosis
Thoracic osteochondrosis is what imaging studies of the back reveal, and it is blamed for all complaints. In reality, osteochondrosis is a natural process of maturation, aging, and degeneration of the spine — but it does not cause pain. Just as wrinkles appear on the face with age, osteochondrosis forms in the spine, and this process is physiological.
The following are mistakenly attributed to symptoms of thoracic osteochondrosis:
The following are mistakenly attributed to symptoms of thoracic osteochondrosis:
- Back and spinal pain
- Restricted mobility (stiffness)
- Neurological disorders (damage to nerves exiting the spine)
- Muscle spasms
MRI of the Thoracic Spine with Osteochondrosis
The image shows an MRI of an adult woman with multiple signs of thoracic osteochondrosis.
The most interesting part is that this patient has no complaints regarding the thoracic spine.
The most interesting part is that this patient has no complaints regarding the thoracic spine.
Protrusions and Intervertebral Hernias
Conditions such as thoracic disc protrusion or intervertebral hernia can cause pronounced pain syndrome, but rarely. Thoracic disc herniation and its symptoms include pain, restricted mobility, and sometimes radiation to the chest or intercostal neuralgia. However, these complaints arise on the basis of muscular pathology and complement it.
Over 97% of all intervertebral hernias occur in the lumbar spine and neck — the thoracic spine is rarely prone to herniation due to its limited range of motion.
Over 97% of all intervertebral hernias occur in the lumbar spine and neck — the thoracic spine is rarely prone to herniation due to its limited range of motion.
Even when a herniation or protrusion is present, a significant portion of the pain is caused by the muscles and trigger points — which create pressure on the spine and are actually the cause of osteochondrosis and herniation formation.
Muscle Overstrain
One of the most common causes is muscle pain in the thoracic spine. Overstrain of the back muscles and its symptoms include dull pain, a feeling of tightness, and tenderness upon pressure.
Here, myofascial trigger points play a key role — they form due to overload, stress, and poor posture and become the primary source of chronic pain.
Here, myofascial trigger points play a key role — they form due to overload, stress, and poor posture and become the primary source of chronic pain.
Muscle overload of the back muscles leads to the formation of painful muscle bands in the muscle tissue — and this is what will cause the pain.
Injuries and Bruises
Of course, not all thoracic spine pain is caused by muscles. Back injuries account for some cases. They can be classified into mild and severe:
Mild back injuries — without damage to bones or the spinal cord:
Mild back injuries — without damage to bones or the spinal cord:
- Bruises
- Sprains and ligament tears (distortions)
- Subluxations
- Vertebral displacements
- Vertebral fractures (compression, fractures of the arches and processes, comminuted fractures)
- Fractures complicated by damage to the spinal cord or spinal nerves
Traumatic thoracic spine pain is always preceded by an event — a fall, car accident, impact, and so on. Traumatic pain is inflammatory, so the pain is accompanied by swelling, redness, and localized increase in temperature.
Diseases of Internal Organs
Sometimes pain in the chest and back is not related to either the spine or the muscles. Internal organs and thoracic spine pain are an important diagnostic consideration, as the heart, aorta, lungs, pleura, esophagus, pancreas, or gallbladder can produce referred pain in the back region.
If the pain in the back is caused by damage to the organs of the thoracic or abdominal cavity, there will be complaints from those organs — respiratory disturbances, digestive issues, or cardiac complaints.
Nature of Pain in the Thoracic Spine
Let's examine what types of thoracic pain exist.
By character: aching, pulling, constricting, shooting, stabbing, piercing, burning, tingling
By duration: constant, intermittent (waxing and waning)
Different types of back pain can indicate different sources of the problem — from the spine to the muscles or internal organs. At the same time, the nature of spinal pain often depends not only on structural changes but also on the condition of the muscles.
By character: aching, pulling, constricting, shooting, stabbing, piercing, burning, tingling
By duration: constant, intermittent (waxing and waning)
Different types of back pain can indicate different sources of the problem — from the spine to the muscles or internal organs. At the same time, the nature of spinal pain often depends not only on structural changes but also on the condition of the muscles.
In many cases, the key role is played by myofascial trigger points — localized areas of tension that can generate different types of pain and alter its intensity, character, and duration.
Aching and Dull Pain
Dull pain in the thoracic spine is a classic manifestation of latent or dormant trigger points. During static work, the back muscles require a significant amount of energy to maintain contraction. However, they do not receive enough glucose and oxygen because blood supply to the muscles decreases due to lack of movement. As a result, the muscle tissue becomes damaged, and a sensation of heaviness appears, which then develops into aching pain.
The main causes of aching back pain are muscle overstrain from static load, which then progresses to damage to muscle tissue — in other words, muscle pathology.
Acute, Shooting Pain
Acute pain in the thoracic spine can occur suddenly and significantly restrict movement. Patients describe it as a shooting pain in the thoracic spine that prevents them from turning or taking a deep breath, or as a "stake in the back."
Acute pain is characteristic of both non-specific pain (i.e., muscular) and specific pain (i.e., spinal or organ-related).
When trigger points are activated by some provoking factor, they can produce shooting pain that can be confused with neuralgia.
Acute pain is characteristic of both non-specific pain (i.e., muscular) and specific pain (i.e., spinal or organ-related).
When trigger points are activated by some provoking factor, they can produce shooting pain that can be confused with neuralgia.
Shooting pain in the thoracic spine can be caused by damage to organs or the spine, but more often — by active trigger points in the muscles.
Burning Pain in the Chest
Burning pain in the chest, behind the sternum, and radiating to the spine is not characteristic of muscular pathology — it is more suggestive of heart problems.
In coronary syndrome (when the coronary arteries are narrowed due to spasm or atherosclerosis), the heart muscle experiences hypoxia — a lack of oxygen. The myocardium becomes damaged, and this manifests as burning in the chest and thoracic spine.
In coronary syndrome (when the coronary arteries are narrowed due to spasm or atherosclerosis), the heart muscle experiences hypoxia — a lack of oxygen. The myocardium becomes damaged, and this manifests as burning in the chest and thoracic spine.
Burning and retrosternal pain are characteristic of angina and heart disease — immediate medical attention is required.
Pain with Inhalation or Movement
If back pain occurs during inhalation, this may indicate involvement of the muscles and fascia that participate in the act of breathing. The ribs rise, the chest volume increases — during this time, the back muscles must stretch, while the diaphragm contracts. If trigger points are present in the involved muscles, they will interfere with this process and cause pain.
Also common is pain with movement in the thoracic spine, which worsens with torso rotation or raising the arms. During rotation, the rotator muscles of the spine are engaged. When raising the arm, the latissimus dorsi muscle must relax — and it is this muscle that produces pain between the shoulder blades.
Pain Radiating to the Chest, Shoulder Blade, or Neck
Sometimes patients report that back pain radiates to the chest or spreads to other areas. This phenomenon is called pain radiation and can occur for two main reasons:
1. Neuropathic pain (extremely rare in the thoracic spine) — this involves nerve damage. It can occur with shingles (herpes virus) , but in that case, the pain is accompanied by rashes along the dermatome (the skin area innervated by the affected nerve segment). Nerve entrapment in the intervertebral foramen can also occur, but this is rare.
2. Myofascial pain. Trigger points can be located not only in the spine area but also in the shoulder blade, chest, or neck itself.
1. Neuropathic pain (extremely rare in the thoracic spine) — this involves nerve damage. It can occur with shingles (herpes virus) , but in that case, the pain is accompanied by rashes along the dermatome (the skin area innervated by the affected nerve segment). Nerve entrapment in the intervertebral foramen can also occur, but this is rare.
2. Myofascial pain. Trigger points can be located not only in the spine area but also in the shoulder blade, chest, or neck itself.
Pain under the shoulder blade and in the spine can radiate to the arm and neck. Often, not just one muscle is affected, but several — which is why the pain radiates to other adjacent segments.
Symptoms Accompanying Thoracic Spine Pain
The symptoms of thoracic spine pain can vary significantly depending on the cause. It is important to pay attention not only to the pain itself but also to accompanying manifestations that help more accurately identify the source of the problem. Often, it is additional signs of back problems that indicate the involvement of muscles, nerves, or even internal organs.
In many cases, myofascial trigger points play a key role in the formation of symptoms — they can cause not only pain but also a number of other unpleasant sensations.
Numbness and Tingling
One of the unpleasant symptoms is numbness in the thoracic spine or a sensation of "crawling goosebumps." Patients also often describe tingling in the spine and on the skin, which may spread to the chest area or between the shoulder blades.
Sensory changes (altered sensation) indicate nerve involvement — either compression or inflammation. It is important to understand what exactly is causing the nerve compression — it could be the spine itself in the intervertebral foramen or soft tissues.
After the nerve exits the spine, it passes through fascia and muscles. It sometimes happens that affected muscles can also compress nerves and cause neuropathies.
Sensory changes (altered sensation) indicate nerve involvement — either compression or inflammation. It is important to understand what exactly is causing the nerve compression — it could be the spine itself in the intervertebral foramen or soft tissues.
After the nerve exits the spine, it passes through fascia and muscles. It sometimes happens that affected muscles can also compress nerves and cause neuropathies.
Trigger points can cause not only pain complaints but also sensory disturbances, and they can also compress nerves — since nerves pass through soft tissues.
Stiffness of Movement
Stiffness in the thoracic spine often accompanies the pain syndrome. The patient feels that it is difficult to straighten up, turn, or take a deep breath. Limited mobility of the spine occurs, especially after sleep or prolonged time in one position.
When trigger points form, the ability of muscle fibers to slide, contract, and elongate is sharply reduced — meaning it is not the bones that restrict movement, but the muscles. Essentially, the muscles fixate the bones, and the range of motion decreases.
When trigger points form, the ability of muscle fibers to slide, contract, and elongate is sharply reduced — meaning it is not the bones that restrict movement, but the muscles. Essentially, the muscles fixate the bones, and the range of motion decreases.
Morning stiffness in the thoracic spine is characteristic of myofascial pain syndrome of the thoracic spine.
Increased Pain with Prolonged Sitting
During prolonged sitting, our body position is maintained by muscular work. Muscles require a lot of energy and a good supply of nutrients for catabolism (maintaining the vital functions of muscle cells).
Back pain when sitting occurs because, without movement, blood flow (microcirculation) in the muscles decreases, and tissue perfusion cannot keep up with demand. Muscle cells experience starvation — and as a result, painful muscle bands form in them.
Back pain when sitting occurs because, without movement, blood flow (microcirculation) in the muscles decreases, and tissue perfusion cannot keep up with demand. Muscle cells experience starvation — and as a result, painful muscle bands form in them.
Prolonged static load leads to the formation of trigger points and increased pain in a prolonged sitting posture.
Dizziness and Weakness
Dizziness and weakness in the context of thoracic spine pain are not directly related to each other. The most common causes of these conditions are:
- Blood pressure disorders (hypertension and hypotension) — both high and low blood pressure can impair arterial blood supply to the brain
- Cardiovascular causes — decreased cardiac output and reduced vascular tone lead to insufficient cerebral circulation, causing dizziness and weakness
- Anemia (low hemoglobin) — the blood's ability to carry oxygen to organs and the brain is reduced
- Endocrine pathologies — low glucose levels. The brain consumes up to 20% of glucose; when it is deficient, such complaints may occur
- Intoxications, stress hormones, neurological and vestibular causes
It is important to understand that diseases in a person can be combined. That is, dizziness may have its own causes, while thoracic spine pain may be caused by trigger points.
When to See a Doctor Immediately
Typically, back pain is a non-life-threatening condition, but there are situations when seeing a doctor for back pain is necessary. Below are dangerous symptoms of pain in the chest and thoracic spine.
The following symptoms and complaints should never be ignored, as they are dangerous signs and require immediate medical attention.
Severe sudden chest pain
The cause of sharp chest pain may be angina (angina pectoris) or myocardial infarction. The heart is located in the thoracic cavity (mediastinum), in front of the spine in the thoracic region.
Here are the cardiac symptoms:
Here are the cardiac symptoms:
- Sensation of pressure and burning in the chest
- Pain may radiate to the thoracic spine, neck, jaw, and left arm
- Pallor and cold sweat
- Weakness, dizziness
- Nausea and vomiting may occur
- Fear of death
These are signs of a heart attack — you need to call an ambulance immediately.
It is important not to miss a heart attack and not to mistake it for an exacerbation of thoracic osteochondrosis.
It is important not to miss a heart attack and not to mistake it for an exacerbation of thoracic osteochondrosis.
Numbness of the hands and weakness in the limbs
Numbness of the hands indicates nerve tissue involvement. Numbness should be assessed according to several parameters:
- Severity of numbness in thoracic spine pain: complete (total loss of sensation) or partial — if partial, estimate how much sensation is reduced (20%, 50%, 80%)
- Duration of numbness: constant or temporary (episodic) — and estimate how many hours per day the person experiences it (5 minutes, 1 hour, or 10 hours total per day)
- Dependence on posture: does the degree of numbness change with posture or movement? The person may "walk it off" and the numbness resolves
- Number of limbs involved: one part of an arm/leg, two limbs on the same side, three or four limbs
Numbness and weakness in a limb indicate involvement of nerve tissue in the pathological process. Such complaints require urgent diagnostic evaluation.
Pain after trauma
If thoracic spine pain was preceded by an injury — for example, pain appeared after a fall, impact, or car accident — it is important to rule out spinal injury. Seek immediate evaluation if:
- Pain is increasing
- A sensation of pulsation in the back
- Local swelling appears
- Posture has changed
- Deformity is visible
- Crepitus (a crunching sound of bones) is present
- Numbness or shooting pain in a limb has developed
If thoracic spine pain was preceded by an injury — an orthopedic trauma evaluation is required.
Diagnosis of Thoracic Spine Pain
Diagnosis of thoracic spine pain consists of several stages:
- Primary physical examination: based on complaints, additional diagnostic methods are ordered
- Confirmatory examination: instrumental, laboratory, and functional methods are performed
- Final stage: based on all collected data, the diagnosis and the cause of the pain and complaints are established
Diagnosis of thoracic spine pain is carried out in stages: during the primary examination, depending on the complaints, confirmatory tests are ordered.
Physical Examination and Medical Consultation
During the primary examination, the physician first takes a medical history:
- Complaints (history of present illness) — detailed description of current complaints: intensity, duration, what brought them on, etc.
- General medical information: past surgeries, allergies, regular medications, harmful habits, whether the patient is under regular care for other conditions
- General physical examination: general condition, blood pressure, skin assessment, lymph node tenderness, body position and physique
Next comes the most important stage — palpation diagnostics for thoracic spine pain. The physician must localize the patient's pain through deep, sliding palpation — that is, palpate it.
First, the physician palpates healthy muscle areas — places where the patient does not complain of pain. The physician should palpate latent trigger points and show the patient what muscle pain feels like on their own body.
First, the physician palpates healthy muscle areas — places where the patient does not complain of pain. The physician should palpate latent trigger points and show the patient what muscle pain feels like on their own body.
Next, the thoracic spine area where the patient experiences pain is carefully palpated. The goal is to palpate the source so that the patient feels that this specific location is producing their familiar pain.
If the pain resembles the previous pain (pain upon palpation of trigger points), the physician suspects a trigger point and performs:
If the pain resembles the previous pain (pain upon palpation of trigger points), the physician suspects a trigger point and performs:
- Diagnostic dry needling of the trigger point
- Ischemic compression (intensely kneading the tightness in the muscle)
- Range of motion testing — stretching the muscle
Then, using tapping and percussion on the spinous processes of the vertebrae, the physician examines the spine itself for pain. It is important not to confuse spinal pain with pain of the interspinous and supraspinous ligaments. More often, it is the ligaments that hurt, not the spine itself.
Radiography (X-ray)
X-ray of the thoracic spine can be divided into two types:
- Standard X-ray in frontal and lateral projections — used to determine whether there is bone damage, i.e., vertebral fractures, especially if trauma preceded the pain
- Functional X-ray with flexion and extension views — used to assess spinal mobility
If an X-ray reveals osteochondrosis or reduced spinal mobility, this does not mean that the problem is in the spine itself.
MRI and CT of the Spine
MRI of the thoracic spine is performed when indicated — specifically, in the presence of neurological complaints:
- Numbness in a limb
- Severe loss of strength in a limb
- Burning and tingling sensation in the arm and hand
The presence of pain alone is not an indication for an MRI — thoracic spine pain must be accompanied by neurological complaints.
Laboratory Tests and Additional Examinations
For thoracic spine pain, the following tests may be ordered (but they are not specific — a spinal diagnosis cannot be made based on these tests alone):
- Complete blood count (CBC) — for infections, indirect signs of tumors, anemia
- Urinalysis — for kidney function and disease
- C-reactive protein (CRP) — for inflammation
- Blood biochemistry — phosphorus, calcium, uric acid (to assess bone condition)
- Vitamin D
Urine and blood tests are not specific — meaning a diagnosis for back pain cannot be made based on them.
Treatment of Thoracic Spine Pain
After determining the types of pain, it is necessary to begin treatment of thoracic spine pain. Since the spine itself does not cause pain — rather, the soft tissues around the spine do — these are what need to be treated. Below are the main, supportive, and additional treatment methods.
The main effective treatment methods for the thoracic spine include:
1. Mechanical kneading of trigger points (myopressure, myotherapy) — applying pressure to painful knots in the thoracic spine using fingers, palms, and elbows with the goal of squeezing them out and inactivating them. The criterion for effectiveness is increased elasticity and softness of the muscle.
2. Trigger point dry needling (dry or with drug injection) — trigger points in the thoracic spine are palpated and punctured using a fan technique. The criterion for effectiveness is a local twitch response (LTR) — that is, tension is relieved by rupturing the membranes of damaged muscle cells.
3. Passive muscle stretching (spray-and-stretch method or post-isometric relaxation) — the goal is to restore the anatomical range of motion in the thoracic spine. The criterion for effectiveness is a new, increased range of pain-free motion.
4. Shockwave therapy — applying sound waves to painful tightness in the thoracic spine. The criterion for effectiveness is softening of the muscle band. Requires 200–400 impulses per trigger point
The main effective treatment methods for the thoracic spine include:
1. Mechanical kneading of trigger points (myopressure, myotherapy) — applying pressure to painful knots in the thoracic spine using fingers, palms, and elbows with the goal of squeezing them out and inactivating them. The criterion for effectiveness is increased elasticity and softness of the muscle.
2. Trigger point dry needling (dry or with drug injection) — trigger points in the thoracic spine are palpated and punctured using a fan technique. The criterion for effectiveness is a local twitch response (LTR) — that is, tension is relieved by rupturing the membranes of damaged muscle cells.
3. Passive muscle stretching (spray-and-stretch method or post-isometric relaxation) — the goal is to restore the anatomical range of motion in the thoracic spine. The criterion for effectiveness is a new, increased range of pain-free motion.
4. Shockwave therapy — applying sound waves to painful tightness in the thoracic spine. The criterion for effectiveness is softening of the muscle band. Requires 200–400 impulses per trigger point
To treat the thoracic spine — you need to treat the muscles around the spine.
Drug Therapy
Drug Therapy
Medications are used as supportive methods for temporary symptom relief, but they do not cure the underlying cause of the disease. Although if the spinal pain is of infectious origin (thoracic spinal tuberculosis or osteomyelitis), then medications become the primary treatment — but these are extremely rare situations.
Medications are used as supportive methods for temporary symptom relief, but they do not cure the underlying cause of the disease. Although if the spinal pain is of infectious origin (thoracic spinal tuberculosis or osteomyelitis), then medications become the primary treatment — but these are extremely rare situations.
- NSAIDs and painkillers: used to reduce pain if the pain is unbearable. However, muscle treatment must follow.
- Muscle relaxants (centrally acting) and antispasmodics: reduce the excitability of affected muscles around the spine, but do not restore muscle cells.
- Topical agents — gels, ointments, patches: substances may reach the affected tissue and relieve pain. There is usually no swelling or inflammation in the thoracic spine. Symptomatic effect only.
- Antibiotics: for bacterial spinal infection — primary treatment method.
- Antivirals: for herpetic involvement of the thoracic spine (shingles).
- Vitamins, micronutrients: supportive, non-specific treatment — not primary.
Medications are generally classified as supportive, symptomatic treatment methods for thoracic spine pain.
Physiotherapy
Physiotherapy is used in the treatment of thoracic spine pain, although the effectiveness of some methods is questionable. Below are the methods available and the claimed or expected effects:
- Magnetotherapy: believed to affect tissues and dilate blood vessels, enhancing microcirculation and promoting faster recovery.
- Laser therapy (low-level laser therapy): also claimed to enhance regeneration in the area of inflammation — although note that inflammation is usually absent in back pain; the pain is of a different nature.
- Electrotherapy (electrophoresis): claimed to enhance and increase the delivery rate of therapeutic substances to the affected area and source of pain.
- Cryotherapy (exposure to low temperatures): initially causes vasospasm from cold, followed by hyperemia, which is supposed to accelerate recovery of damaged tissues.
- Ultrasound therapy: believed to increase fluid flow from the intercellular space into cells and back, facilitating the elimination of metabolites that cause pain.
- Decompression therapy (spinal traction): believed to stretch the spine and spinal ligaments, increasing space for nerve exit from the spine and reducing pain symptoms.
- Vibration therapy: believed to relax microspasms in muscles and restore innervation.
- Shockwave therapy for thoracic spine pain: the primary effective method. An infrasound wave passes through tissues (skin, subcutaneous fat, healthy muscle) and first strongly compresses the muscle band, then creates a cavitation effect (vacuum) and expands it. After a certain number of impulses (200–400 per site), the affected muscle cells are ruptured (their membranes break) and the muscle softens. Inflammation begins at the trigger point site, aimed at maximizing tissue repair.
An effective method is shockwave therapy. Painful tightness is softened by the action of infrasound waves. The sound wave first strongly compresses the trigger point and then decompresses the tissue (vacuum and cavitation effect). This causes rupture of damaged cells, followed by regeneration of healthy muscle cells.
Therapeutic Exercise (Physical Therapy)
Therapeutic exercise for thoracic spine pain is helpful — if you understand the purpose of the exercises. The goal of therapeutic exercise is to stretch the affected muscle fibers and restore maximum range of motion to the thoracic muscles. In other words, strengthening and building up the muscles is not necessary — this would aggravate and chronicize trigger points.
The affected muscle (with painful bands) is isolated, and an exercise is selected to stretch it.
The affected muscle (with painful bands) is isolated, and an exercise is selected to stretch it.
The goal of therapeutic exercise is to restore the anatomical range of motion to hard and inelastic (affected) muscles — not to strengthen them.
Massage and Manual Therapy
Massage of the thoracic spine is one of the effective methods. Massage techniques and dosage of massage are selected based on:
- Force of impact
- Duration
- Depth of impact
- Massage techniques
- Post-isometric relaxation
- Spray-and-stretch (when pain upon stretching is relieved with a coolant)
- Joint mobilizations (applied to the costovertebral joints and facet joints)
Effective massage and manual therapy techniques — myopressure, myotherapy with elements of ischemic compression, muscle stretching.
Exercises for Thoracic Spine Pain
Exercises for thoracic spine pain are not the primary treatment method, but they will help prevent pain recurrence. The goal of the exercises is to maintain maximum range of motion in the muscles and joints of the thoracic spine.
Perform the following exercises:
Perform the following exercises:
- Child's pose — sit on your heels, round your spine in the thoracic region, stretching the erector spinae muscles
- Bringing the raised arm behind the head — stretches the latissimus dorsi muscle
- Seated side twists (you can brace against your thighs or hold onto the back of a chair) — stretches the rotator muscles of the spine
- Bringing the chin to the chest — stretches the portions of the trapezius muscle
The goal of the exercises is to maintain the anatomical range of motion and prevent muscles from freezing in a shortened state.
Stretching the Back Muscles
Along with stretching, joint mobilization can also be performed. To do this, take a massage foam roller with a diameter of 15–20 cm and place it under your thoracic spine. Wrap your arms around your neck and bring your chin to your chest.
Lie on the roller, lift your buttocks off the floor so that your weight is on your feet and on the roller against your back. Begin slow rolling over a range of about 20 cm in the thoracic spine.
You may hear cracking or popping sounds — this is mobilization of the spinal joints. However, it is incorrect to think that the vertebrae have "fallen into place."
Lie on the roller, lift your buttocks off the floor so that your weight is on your feet and on the roller against your back. Begin slow rolling over a range of about 20 cm in the thoracic spine.
You may hear cracking or popping sounds — this is mobilization of the spinal joints. However, it is incorrect to think that the vertebrae have "fallen into place."
Complement back muscle stretching with self-massage and joint mobilization using a foam roller.
Strengthening the Muscle Corset
There is a belief that you need to strengthen and build up the muscles of the thoracic spine so they don't hurt, and to support and stabilize the spine. This is a mistaken belief — because by building up the muscles, we only increase the formation and persistence of trigger points, even though there may be temporary improvement during the exercises. To keep muscles healthy, they need to be stretched, not strengthened.
If you "strengthen" muscles, trigger points in them become chronic. A muscle is not weak — a muscle can be sick, and one of the manifestations of the disease is reduced function, i.e., weakness.
Exercises for Office Workers
For those who spend long hours in a sitting position, it is recommended to stand up and perform short stretching exercises:
- Forward bends — to stretch the back of the thighs and the spine itself
- Cat-cow stretch — to stretch the muscles of the torso from the back and front
- Side bends — for the erector spinae muscles
- Back rolls (with chin and legs tucked in) — to stretch the longissimus and spinalis muscles
During prolonged sitting, it is recommended to stand up and stretch every 45–60 minutes for 2–3 minutes.
Prevention of Thoracic Spine Pain
The foundation of preventing thoracic pain is self-massage of trigger points in the thoracic spine. It is recommended to perform this 2–3 times per week for 25–30 minutes for active muscle pain, and 10 minutes to maintain a healthy back and spine.
Equipment to use:
Equipment to use:
- Massage balls — rubber, foam, or tennis ball. You can take two balls and place them in a sock. Place this setup to the right and left of the spinous processes of the spine and perform self-massage while lying on your back.
The foundation of prevention is self-massage of trigger points and stretching the muscles afterward, as well as avoiding prolonged static load.
Posture Control
Posture and body position in space, as well as performing repetitive movements, can lead to thoracic spine pain. Posture should be neutral — that is, engaging the minimum number of muscles to maintain an upright standing position. In a seated position, support for the lumbar and thoracic spine is important. The most ergonomic sitting posture is considered to be with a 135-degree angle between the torso and thighs.
When sitting, provide lumbar support and thoracic spine support. It is important that the armrests are adjusted to the height of your elbows.
Workplace Ergonomics
In addition to back support from a chair or seat, symmetry of the workspace is important. Avoid constant movements in one direction — for example, a person constantly looking to the left at a computer monitor. Try to ensure that both halves of the body are involved in movement and static load equally.
Ensure your workspace has armrests so that your shoulders are not raised upward or your arms lowered too far down. This can lead to trapezius muscle damage and the development of thoracic spine pain.
Proper Sleep Habits
For thoracic spine pain, the goals are to:
The recommended position is on your back with a low pillow (unless there are indications for a high pillow, such as gastroesophageal reflux disease).
Mattress selection for back pain is not critical — you can choose a medium-firm mattress.
- Maintain physiological curves (kyphosis and lordosis)
- Ensure maximum muscle relaxation
- Ensure even distribution of body weight on the sleeping surface
The recommended position is on your back with a low pillow (unless there are indications for a high pillow, such as gastroesophageal reflux disease).
Mattress selection for back pain is not critical — you can choose a medium-firm mattress.
The quality and quantity of sleep are also important, as muscles rest and regenerate primarily during sleep — because the nervous system stimulates them less.
Frequently Asked Questions (FAQ)
1. Why does the thoracic spine hurt during inhalation?
During inhalation, some of the back muscles must stretch to allow the chest volume to increase. As the muscles stretch, their trigger points are activated — and this causes pain.
2. How dangerous is thoracic osteochondrosis?
Thoracic osteochondrosis itself is not dangerous. What is usually meant by osteochondrosis is actually complaints of back pain. Typically, this is benign muscle pain. However, there is a risk of it becoming chronic pain, and over time, the muscles can extrude a spinal hernia.
3. Does spinal osteochondrosis go away on its own?
Osteochondrosis does not go away — just as wrinkles on the face do not disappear. However, muscle pain that is mistakenly attributed to osteochondrosis can go away on its own. Trigger points will transition into a dormant form.
4. How to relieve tension in the thoracic spine?
The sensation of "tension" most likely refers to the activation of trigger points in the thoracic spine. They can be massaged, needled, stretched, or warmed.
5. How to treat a pinched nerve in the chest?
First, it is necessary to understand whether there really is a pinched nerve — and if so, where and what is causing it. Pinched nerves in the chest are extremely rare. Complaints are much more likely to be caused by trigger points rather than a nerve.
6. How to know if you have thoracic osteochondrosis?
If you experience stiffness in the thoracic spine, heaviness turning into fatigue and pain — these are manifestations of myofascial pain syndrome, which is usually mistaken for osteochondrosis. As for actual osteochondrosis, it can be found by getting an MRI.
The information is provided for informational purposes only and does not replace a medical consultation. If symptoms occur, please consult a specialist.
Sources and References
List of Sources and References:
- Myofascial Pain Syndrome. National Center for Biotechnology Information (NCBI), 2025.
- Myofascial pain syndrome — Symptoms and causes. Mayo Clinic, 2024.
- Lam et al. Myofascial Pain: Clinical Review. ScienceDirect, 2024.
- Widespread Pressure Pain Sensitivity and Trigger Points in Thoracic Spine Pain. Pain Medicine / ResearchGate.
- Myofascial Trigger Points and Spinal Pain. PMC (PubMed Central).
- Myofascial Trigger Points in Thoracic Spine Disorders. Fernández-de-las-Peñas et al., PMC.
- Trigger Points and Chronic Pain Mechanisms. Frontiers in Medicine, 2024.