Pain in the Thoracic Spine / Shoulder Blades

It is estimated that about 3% of people suffer from pain in the thoracic spine. In the study population, aged 35-45 years, 66% had back pain in the past year. Of these, 15% had symptoms in the thoracic spine, 56% in the lower (lumbar) spine, and 44% in the neck (cervical) spine (Linton et al, 1998).

Why such a low prevalence rate?

One theory for the lower prevalence percentage of the cervical and lumbar spine is that due to the lower mobility of the thoracic spine, less mechanical damage occurs, which accounts for 90% of all back pain, thus drastically reducing the prevalence in the thoracic spine.

Differences in ranges of motion across spinal levels

Cervical spine

• Flexion ≈ 80°

• Extension ≈ 50°

• Lateral flexion ≈ 45°

• Rotation ≈ 80°

Thoracic spine

• Flexion and Extension: limited due to ribs

• Lateral flexion ≈ 60°

• Rotation ≈ 30-35°

Lumbar spine

• Flexion ≈ 70-90°

• Extension ≈ 55°

• Lateral flexion ≈ 35°

• Rotation ≈ 70°

Why are the ranges of motion different?

The anatomy of the discs varies depending on their level because they have different functions and the loads they must withstand.

Cervical vertebrae

Thoracic vertebrae

Lumbar vertebrae

Neurodynamic problems of the thoracic spine

Neurodynamic problems often occur in the thoracic spine due to the position of the shoulder blades, thoracic spine, nerves, and muscles in that area.

Often, problems with the cervical spine project pain into the thoracic spine due to the direction of the nerves that exit the spinal canal in the cervical spine.

Mobilizing the cervical spine often reduces symptoms of pain in the thoracic region/scapula.

How can you help yourself?

Start with positioning, ask yourself questions: in which position does the pain increase, in which does it decrease. If the pain is acute, try to stay in pain-free positions throughout the day, then start exercising the stability of the cervical spine and mobilizing the shoulder blades.

Exercises

The starting position is on all fours.

1. Get into a quadruped position.

2. Keep your pelvis STABLE

3. The head is in a neutral position (you are NOT looking in front of you, but at the floor)

4. “Falling” with your upper back between your shoulder blades while keeping your elbows EXTENDED

5. Feel the shoulder blades coming together.

6. "Lift" your upper back and feel your shoulder blades separate.

7. Repeat

The same exercises CAN and SHOULD be performed in a sitting position.

The principles of performing the exercises are the same as in the quadruped position.

You may find it easier to perform the exercises in a sitting or all-fours position, try both.

Find a comfortable chair.

DO NOT lean your back against the back of the chair.

Raise your outstretched arms to approximately 90°.