In a lengthy letter, a reader describes unbearable pain in the thoracic part of the spine that has been going on for two years and hasn’t subsided even with physiotherapy and chiropractic treatment.
She seeks advice.

In our practice, thoracic spine pains are not uncommon.
Most often, it is a so-called “facet syndrome” where there is reduced mobility of one of the small joints, causing pain, sometimes very acute. Conveniently, it either passes quickly without treatment or is easily treated with mobilization or manipulation techniques (chiropractic).

This is followed by pain due to soft tissue pathology, which encompasses a wide range of possible causes, all of which heal more slowly, requiring longer therapy and patient discipline, including regular exercise. Then there are the intervertebral disc herniations, which although much less common than those in the neck or lower back, can cause problems and require longer recovery. Sometimes, despite the efforts of doctors, therapists, and patients, the pain does not decrease or returns repeatedly. Interestingly, this phenomenon, so specific to the thoracic spine, has been known for a long time and was detailed by the pioneer of manual therapy in Europe, Dr. Cyriax, back in the 1960s.

In such cases, a classical clinical examination is not sufficient. Additional diagnostics are necessary, primarily referring to an MRI. It should show the condition of the discs, small joints, and the muscles surrounding the spine. If it does not indicate a probable cause of the pain, additional specific examination of the mobility of the scapula and cervical spine is necessary to see if there are any “blockages” in a dynamic context that irritate the sensitive soft tissues. Sometimes a neurological examination and EMG are required, and depending on the case, the internal or pulmonary status should be determined by qualified specialists, as some lung or internal organ diseases can show symptoms as middle back pain.

Only after the diagnosis is established can an individual therapeutic approach be created with promising possibilities for success.