Most Important and Most Ignored by PTs: The Thoracic Spine

Ever had that neck pain that just never quite went away? Or that low back pain that, despite getting some therapy on it, keeps coming back? Tight shoulders? Or hips? Something still feels off and it just doesn’t seem like this is from “normal aging”.

I’m willing to bet there’s an area that has been overlooked by your therapist or chiropractor: The Thoracic Spine and its attached ribs.

What is it?

The thoracic spine and ribcage are our mid back and torso. There are twelve vertebrae, each with a rib attached on either side that wraps around to meet our sternum in the front. This forms the rib cage that surrounds our organs and is traditionally thought to solely serve as a “protective role” for the vital organs. This middle region of the spine is less flexible than the cervical spine (your neck) above it and the lumbar spine (your low back) below. It doesn’t even hurt that often. But don’t be fooled. This part of your body may not move much, but even so, when it gets restricted and tight, it’s often the main culprit behind the other, more familiar ailments we see each day.

What does it do to cause problems?

Clinically, when we see restrictions and tightness in the thoracic spine, we see muscles elsewhere in the body go into spasm as a result. This is because tight vertebral joints in the spine can be responsible for changes in muscle tone in other parts of our body. For more on how this works, read our post on Why Your Spine Health Is Most Important of All. We can stretch these other muscles and joints all we want, but until the underlying thoracic spine tightness is addressed, we won’t make much progress.

Our hip muscles, for example, will often tighten up not because of any problem within the hip joint, but in response to the stiffness in this middle back region. The same thing happens in the shoulder, and even other parts of the spine: the neck above and low back below will never have good mobility if there are persistent issues in the middle, thoracic region.

Video: How we loosen the Hips simply by treating the Lower Thoracic Spine

Video: Loosening the Shoulder by treating the Ribcage

So, there is an important “order of operations” for you and the therapist. The spine as a whole is important to address early in physical therapy treatment for any body part, and this middle, thoracic region of the spine is the specific place to start “untangling the knot”. I’ve made the mistake of trying to skip this critical first step, only to end up starting over and treating the thoracic spine first like I should have.

The thoracic spine, if not properly addressed, can be the cause of persistent problems with neck pain, headaches, TMJ disorder, any shoulder or arm pain, low back pain, pain with breathing, and any hip or leg pain. It can play a role in nearly every musculoskeletal dysfunction, and needs to be considered in every rehabilitation program. It’s like salt as an ingredient with all your recipes; it’s not flashy, but nearly every dish out there calls for it and doesn’t quite stand up without it!

If you haven’t had this looked at, talk to your therapist. Too commonly it’s overlooked and under-treated, and it may be that last piece of the puzzle.