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Thoracic Spine (Mid Back) Pain

The thoracic spine is the area bounded by the rib cage, between the neck and the low back. This area is  a key area of load transfer as the ribs act like springs to maintain our upright posture. This area is extraordinarily complex, has multiple joints and relies on muscles which impact the neck, low back, and shoulder blades.

Osteoarthritis and  DISH

Osteoarthritis is when the joint cartilage degenerates. The inflammation from the process can be painful and often leads to the joint and surrounding structures stiffening up.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a hardening of your ligaments surrounding the joints, leading to stiffness. 

Physiotherapy works to reduce stiffness in the thoracic spine with hands on Physiotherapy, heat and prescription of movement and strengthening exercises. 

Postural Related Pain

Postural pain often has no injury, rather a buildup tension or pain over time. There is no "bad" posture, however maintaining a position for a long period of time can stress the structures in and around your spine.

Physiotherapy aims to determine what postures are stressing the middle back and will work with you to provide relief from pain and tension and to modify aggravating activities. 

Scheuermann's disease

Scheuermann's disease predominantly effects children between the ages of 10 and 15 during their growth spurt, with more males affected than females. During the growth spurt, bony stress leads to an abnormal growth of the spine, causing the middle of the back to become more rounded. This results in a wedging of the bones, where the back of the bone grows at an accelerated rate compared to the front. Usually this disease only causes mild symptoms, generally associated with growth pains through the middle of the back or stiffness. This can even be found incidentally in older age through x-rays of surrounding areas without having any previous symptoms. Majority of the time Scheuermann’s disease is mild and can be effectively managed with physiotherapy, with a very rare case requiring further intervention. Physiotherapy aims to reduce pain levels through heat and movement, education and exercise. Your physiotherapist will develop a home program to ensure you do not lose range of motion, or strength during this painful time. This will help to reduce the stress on the bones in the back and surrounding areas. 



This condition arises in childhood generally during the child’s growth spurt and effects more females than males. Scoliosis results in bony deformity leading to wedging of the bones in the spine and can affect the middle of the back and low back. This deformity or wedging occurs at the side of the vertebrae leading to a lateral curve, and compensatory rotation to help fix posture to remain in an upright position. Scoliosis can be painful or just appearance driven. Physiotherapy aims to do an in-depth assessment, including referral for x-rays to ascertain your Cobb Angle (the degree of the curve), the amount of deformity and the likelihood of your condition to progress or cause concern into adulthood. If scoliosis is deemed mild, physiotherapy will work with you to improve your strength and posture through a series of exercise progressions. These aim to assist in gaining control of the deformity through muscular strength, as well as increase your tolerance to gravity. If you have a larger degree of scoliosis you may need to see a specialist regarding bracing and in rare cases surgical correction.

Costochondritis / Tietze Syndrome (front of chest pain)

Both these conditions are characterized by a swelling at the front of the ribs where the costal cartilage attaches from the rib to the sternum. Tietze syndrome commonly affects the 3rd/4th/5th ribs, with reddening and swelling, and morning stiffness. Costochondritis is an acute/chronic injury to the cartilage resulting in long term inflammation. This can be caused from infections, acute trauma to the ribs or chronic stress. Costochondritis and Tietze syndrome both affect your ability to move the thoracic spine and breath deeply/cough due to pain. Physiotherapy, in conjunction with your doctor (anti-inflammatory medication) will assist to reduce inflammation, decrease stress due to joint stiffness and muscular tightness. Further we can develop strategies to ease pain during functional activities and sleeping.

Contact Free Movement Physio to book an appointment for a one on one consultation to discuss your Thoracic spine concerns. 

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