Thoracic Back Pain: what it is, identifying, preventing, and treating it

Pain in the upper and lower back, in the region known as the thoracic spine, is almost as common an ailment as lower back pain. The thoracic spine is the region below the neck and above the ribcage with 12 backbones with disks ranging from the T1 to T12 vertebrae.The thoracic spine or the middle and upper back, as it is also commonly called, plays an important role in the body: it anchors the rib cage to protect vital chest organs, such as the lungs and heart, and provides core stability to the body.

While the cervical or lower spine is built for mobility, the middle and upper back provides your body proper stability. There are various ways in which the muscles, ligaments, bones, and disks in the spine can injure nerves in the thoracic spine and cause back pain.

Symptoms of thoracic back pain

Symptoms of middle and upper back pain vary with the cause of the pain.

Some common symptoms of mid back pain because of daily activity or extra exertion during exercise or added activities during the weekend are:

• Dull pain
• Muscle ache
• Muscle stiffness or tightness
• Sharp or shooting pain
• Tenderness
• Burning sensation
• Headache

The above symptoms are typical of musculoskeletal strain, though they are known to occur with spinal injuries as well. However, if your thoracic pain is related to the nerves, bones, or disks of your thoracic spine, you will experience:

• Chest pain
• Numbness or tingling in your legs, chest, or arms
• Incontinence (loss of bowel control and/or bladder leakage)
• Pain down the legs
• Pain in the lower back
• Weakness in your legs or arms

What causes thoracic or middle back pain?

Some common causes of thoracic back pain related to daily lifestyle are:

• Overuse injuries: Also known as overuse injuries. This involves repeatedly using the thoracic part of the spine (for sport or work) for prolonged durations.
• Muscular irritation
• Lack of muscular strength
• Poor posture or sitting or standing in a slouched position for long durations.
• Prolonged sitting at a computer
• Using a backpack
• Obesity: There is a strong correlation between obesity and back pain. When body weight increases, so does the risk of back pain.

Middle or upper back pain can also be caused by some medical conditions. Though they are less common, thoracic back pain is likely to originate from them as well. They are:

• Trauma or injury from sports-related activities or whiplash from a car accident.
• Degenerative, metabolic, inflammatory, infective, or neoplastic conditions.
• From medical conditions such as osteoporosis, osteoarthritis, ankylosing spondylitis, or Scheuermann’s disease.

Preventing thoracic back pain

You can also work towards preventing everyday musculoskeletal strain that, over prolonged periods, causes thoracic back pain:

• Improve your posture:

  - Keep your shoulders back while standing

  - Avoid slouching while sitting or standing

  - Take breaks to stand and stretch if you sit for long durations of time through the day.

  - If you have a sedentary job that requires you to spend long hours at the desk, use an ergonomic chair that supports your back properly and adjust your computer monitor, mouse, keyboard, and mouse positioning to maintain good posture while working.

• Change your sleeping position: If you sleep on your back, you are more likely to cause misalignments in your spine and have upper back pain. It is suggested that you sleep on your side in the foetal position with a pillow between your knees.

Treatment for thoracic back pain

Though middle or upper back pain is painful and inconvenient, it is usually not a cause of serious concern. Many cases settle down on their own over time without any specific treatment. However, medical treatment and intervention should be sought immediately when the pain develops suddenly and severely, as in the cases of accidents and other injuries, and worsens progressively.

Treatment for thoracic back pain ranges from home remedies and everyday changes to surgeries. They include:

Home remedies:

Musculoskeletal strain can be treated at home with:

• Gentle stretches and rotations
• Application of ice to reduce inflammation and pain
• Heat compress to ease stiffness and improve mobility
• OTC pain medication such as paracetamol, ibuprofen.

Medical treatments:

• Prescription medication: Prescription anti-inflammatory or muscle relaxants may be given by your doctor to ease your middle or upper back pain. If depression is suspected to play a role, anti-depressants for long-term use may also be prescribed.
• Injections: Pain medication is injected at trigger points to provide relief and as means to pursue interventions such as exercise and physiotherapy.
• Physical therapy: Physical therapy and chiropractic care may be combined with medication or other interventions to ease and treat thoracic pain.
• Surgery: Surgery is rarely sought as means to provide relief for upper or middle back pain, but it can be chosen as the course of action if the problem is in the spine as in the case of vertebrae fracture, deformity, or a herniated disc.

The most common procedures for thoracic spine injury are:

• Spinal laminectomy/spinal decompression: Bony walls of the vertebrae may be removed by surgery to ease pressure on the nerves.
• Microdiscectomy: A minimally invasive procedure can be carried out to remove a spinal disc that is bulging and pressing on a nerve causing pain.
• Vertebroplasty or kyphoplasty: A glue-like bone cement can be injected to repair compression fractures caused by osteoporosis.

The outlook or prognosis for thoracic back pain depends on your general level of fitness, age, and the underlying cause. Most cases of upper or middle back pain resolve by themselves with some rest and without explicit medical intervention within a week or two. It is advisable to resume normal activities gradually to interfere with the recovery and avoid risking re-injury. Medication, physical therapy, and surgeries are often reliable and means to provide long-term relief from thoracic back pain. To learn more about pain in the thoracic spine, its prevention, and treatment, consult the orthopaedicsurgeons at the Sagar Brain & Spine Institute, the best orthopaedic hospital in Bangalore.