Possible causes and targeted therapy
Among the possible causes that can lead to pain in the thoracic spine area are
- Scoliosis
- Degeneration and blockages
- Intercostal Neuralgia
- Spondylitis, Spondylodiscitis
- Slipped disc
- Injuries of the thoracic spine
- Tumors of the thoracic spine
When viewed from behind, the normal spine is straight. In scoliosis, however, there is a lateral bend or curvature. The incidence of the disease is reported very differently and varies between 0.13% and 13.6%.
It is certain, however, that girls are affected about four times more frequently than boys.In the majority of scolioses, the exact cause is still unknown (idiopathic). It is suspected that during growth, i.e. especially during puberty, the vertebral bodies grow unevenly and asymmetrically. This results in a twisting or torsion of the spine, which should not naturally be present.
Due to the initial painlessness in childhood, scoliosis is often discovered by chance, e.g. during sports lessons or by parents. Due to the malpositioning, children often have an accompanying shoulder or pelvic obliquity. The severity of scoliosis can vary greatly: In the majority of cases, the spine is only slightly curved and causes cosmetic problems at best.
In contrast, a full-blown scoliosis, if untreated, can cause severe deformities and health problems! In principle, all sections of the spine can be affected. However, the most common are shifts and deformations of the thoracic spine.
Through the connection with the ribs, a so-called “rib hump” is sometimes created. During the growth phase, affected persons very rarely suffer from pain. Due to the permanent incorrect loading, however, painful signs of wear and tear already develop in young adulthood.
With increasing age, the pain in the area of the thoracic spine leads to an instinctive protective posture. As a result, the back muscles are greatly overstrained and cause additional discomfort. The deformation can lead to such a degree that both breathing and cardiac performance are restricted.
The degree of severity of the deformation is decisive for the therapy of scoliosis. Slight curvatures can be treated with targeted physiotherapy. If, on the other hand, patients suffer from advanced scoliosis, wearing a corset or surgery may be indicated.
Early detection is therefore of great importance! Because only if scoliosis is detected in time can pain be prevented in adulthood. For example, the pediatrician examines the correct curvature of the thoracic spine in 9-10 year-old children, e.g. by means of the “preventive test”: For this purpose, the child bends forward as far as possible with unclothed upper body and closed, stretched legs.
This makes it easy to detect asymmetries or differences in level, such as a rib hump. In the thoracic spine, we find two different types of joint: The small vertebral arch joints (Articulatio zygapophysiales, facet joint, vertebral joint) are located in pairs between the articular processes of two adjacent vertebrae. They guarantee great mobility within the spinal column.
In the thoracic spine, however, the range of motion is greatly reduced compared to the other sections. The reason for the limited mobility is the rib head joints (Articulatio capitis costae) and the rib hump joints (Articulatio costotransversaria). They are each formed by a part of the rib and small joint surfaces of the thoracic vertebral bodies.
Together with the sternum, the bony thorax is thus formed. If degenerative, i.e. wear-related changes now take place, they primarily affect the joints of the thoracic spine. Slipped discs (disc hernias), as they often occur within the lumbar spine, for example, are extremely rare.
With increasing age, permanent incorrect strain or posture, the small joints of the thoracic spine can therefore be affected. In this context one often speaks of “joint blockages”. Temporary blockages can occur due to the degenerative damage to the joint surfaces described above, but also due to changes in the muscles and ligaments.
In addition to restricted mobility, accompanying symptoms such as pain in the affected area are characteristic. Patients often describe belt-like pain and pronounced sensitivity to pressure in the affected area.
- Vertebral body
- Intervertebral disc
- Spinal Cord Nerve Root
- Intervertebral hole (Neuro foramen)
- Vertebral joint
- Spinal process of the vertebra (palpable on the back as the rear end of the vertebra)
If degenerative, i.e. wear-related changes now take place, they primarily affect the joints of the thoracic spine.
Slipped discs (disc hernias), as they often occur within the lumbar spine, for example, are extremely rare.With increasing age, permanent wrong load or body posture, the small joints of the thoracic spine can be affected. In this context one often speaks of “joint blockages”. Temporary blockages can occur due to the degenerative damage to the joint surfaces described above, but also due to changes in the muscles and ligaments.
In addition to restricted mobility, accompanying symptoms such as pain in the affected area are characteristic. Patients often describe belt-like pain and pronounced sensitivity to pressure in the affected area. In manual medicine and chiropractic therapy, such blockages are released through targeted mobilization.
Experienced chirotherapists can often restore full mobility within a few minutes. However, it may take several days before the muscle tensions and pain subside. To relieve the pain, patients often take medication such as anti-inflammatory drugs (e.g. ibuprofen).
However, if there is a suspicion of a larger injury, such as fractures in the area of the thoracic spine, manual therapy must not be used under any circumstances. This is because the jerky and powerful movements of the therapist can, under certain circumstances, aggravate existing fractures (e.g. fractures of the vertebral body). Since the ribs are connected to the thoracic spine, local blockages can be extremely unpleasant.
Because of our breathing, the thorax rises and falls permanently and provokes pain in the blocked costal vertebral joint. It is not uncommon for physicians to summarize such pain conditions as thoracic spine syndrome (BWS syndrome for short). At the lower edge of the ribs, the intercostal nerves (Nervi intercostales) run, whereby the lowest 12th rib is referred to as the subcostal nerve.
In the clinical picture of intercostal neuralgia, patients experience belt-shaped pain radiating from the thoracic spine or front chest. The symptoms often come suddenly and in attacks. Not infrequently, additional discomfort or numbness occurs in the affected area.
The cause is often to be found in wear-related changes in the thoracic spine. Characteristically, the pain can be provoked by certain positions, e.g. rotary movements. In the first place, the therapy is based on the patient’s level of suffering.
Intercostal neuralgia can be treated with pain medication, possibly also injection therapy with local anesthetics. In any case, the symptoms described above must also include diseases that are not related to the thoracic spine. For example, the herpes zoster virus (“shingles“) causes similar symptoms, but accompanied by typical reddish and blistery skin rash.
However, acute heart attacks, pulmonary embolism or other organ diseases can also cause pain in the thoracic spine at first. If a vertebral body becomes inflamed, this is known as spondylitis. If the adjacent intervertebral disc is also affected, it is called spondylodiscitis.
First and foremost, general complaints such as fever, night sweats, loss of appetite or tiredness are in the foreground. In addition, there is extreme pressure and knocking pain in the area of the affected vertebral body. Due to the massive infection in the body, the classic inflammation values (BSG, CRP) in the blood are increased.
In the past, there was a high risk that spondylitis was not detected in time. Permanent paralysis was often the result. Fortunately, nowadays it is possible to treat the disease early enough in almost all cases.
Thus, the prognosis is favorable due to strict bed rest, plaster casts, drug treatment and surgery. Herniated discs in the area of the thoracic spine are extremely rare and a real rarity. In addition, occurring cases are usually well treatable.
If a herniated disc nevertheless causes symptoms, those affected describe severe pain in the affected segment. In very rare cases, neurological complaints are added. These include paralysis, paralysis and sudden incontinence.
As soon as such symptoms, in addition to the actual pain in the area of the thoracic spine, occur, you must in any case immediately consult a doctor. Simple fractures of the vertebral bodies can occur as a result of sports or leisure accidents. Often these are injuries resulting from serious traffic or work accidents.After such events, clear hematomas (“bruises”) are almost always visible in the area of the fracture.
Those affected sometimes feel severe pain and a pronounced sensitivity to pressure. Fortunately, the thoracic spine usually shows stable fractures where no neurological complications are to be expected. In such cases, it is sufficient to rest in bed on a flat surface for a certain period of time and then perform physiotherapeutic exercises.
The most common tumors in the thoracic spine are metastases, primary tumors are rarely found. Basic diseases can include tumors in the thyroid, lung, prostate or breast area. Those affected usually consult a doctor because they feel a dull pain in the affected spinal column section.
Often there is a so-called “shaking pain”: physical activities that are accompanied by small vibrations of the spine, such as jogging or jumping, cause the pain described above. Another indication may be sudden fractures in the vertebral bodies. If the tumor spreads, it can also put pressure on the adjacent spinal cord or emerging nerve roots.
A variety of neurological symptoms can be the result. The spinal column can be divided into four sections. In addition to the thoracic spine, the cervical and lumbar spine and the sacral spine (sacrum) form a functional unit.
In the middle section we find the thoracic spine. It consists of 12 vertebrae and, together with the 12 pairs of ribs and the sternum, forms the bony thorax. Naturally, the thoracic spine describes a convex curvature to the back (dorsal), the so-called kyphosis.
In contrast, the cervical and lumbar spine are convexly curved forward (ventrally). The physician then speaks of a lordosis.
