Your mid-back (or thoracic spine) is the section between the base of your neck and the bottom of your rib cage. It is made up of 12 vertebrae and 12 connecting ribs; 10 ribs connect to a sternum (breastbone) at the front (the bottom two are floating and are not attached at the front). Compared to the neck and low back, it is not a very mobile area of the spine as it is locked up in a barrel shape of your rib cage, designed to protect your vital internal organs such as the heart and lungs. It is often the source of pain, discomfort and stiffness. The joints between vertebrae can reduce in mobility and the ribs where they attach onto the vertebrae, or the sternum, can be areas of discomfort and lack of mobility. Thoracic pain is affected by our lifestyles and daily activities. For example:
Prolonged sitting
Slouching over a desk
Slouching on a sofa
Looking at your phone.
Lifting and carrying
Looking after small children
As we age, we lose height in our vertebrae and this can be particularly pronounced in the thoracic spine (mid-back) and can be a site for compression fractures caused by osteoporosis. Issues with the thoracic spine can lead to the forward hunched and rounded shoulder posture we call upper-crossed posture
The apex of this curvature for women, is around the bra-strap level and is a very common area of complaint. Side to side deviations of the thoracic spine, called a scoliosis, are often centered around this area too.
It can be a tricky area to mobilise at home, particularly into extension as it quite likes to flex (bend forward) and do a little bit of rotation but not much else. It is important to check with your healthcare practitioner as to whether thoracic mobilisation is appropriate for you. My favourite exercises are as follows:
Thread the Needle for Rotation
Starting on all fours, raise one up straight towards the ceiling,
then 'thread' it through under your torso, until you outer shoulder area touches the floor. Repeat x 5 on both sides.
Cat-Camel for Flexion/Extension
On all fours, shoulders over wrists and hips over knees, slowly move through arching your back really focusing on separating your shoulder blade and pushing your mid-back towards the ceiling. Then arch your back sinking your sternum towards the ground. Repeat x 5.
This can be modified if you find it hard to put pressure on your wrists or knees or if you are pregnant (avoid arching your back, just return to neutral as seen in the picture). Please ask your healthcare practitioner for advice.
Laying flat on floor
This can be done with arms extended out to sides or above your head and is a passive stretch to open up the front of the chest and through your mid back.
Extension over back of chair
Sitting in a chair with a low back, extend your mid back over the back of the chair to give a more focused extension at each level of the spine.
Avoid using gravity or your body weight to encourage the spine into extension, for example lying on a tennis ball or foam roller, as you don't have the same control over pressure and degree of movement. If you go too hard or it is painful, muscle guarding makes the exercise counterproductive.
Rehabilitation
Alongside stretching and mobilising the thoracic spine, it is important to address any weak areas in your mid back, neck and shoulders. Strengthening your lower scapular stabilisers and deep neck flexors, whilst lengthening your pectorals and neck extensors, can help reduce the affects of upper crossed posture and lessen mid-back pain.
Ensuring you have a correctly fitted bra to give you sufficient support is also very useful in preventing mid-back pain from recurring. This is particularly important whilst exercising or for those who are pregnant, postnatal or breastfeeding.
If you would like to learn more about how we diagnose, treat and manage mid-back or thoracic pain, get in touch
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