Although neck and lower back pain are more prevalent in clinic, we spend a lot of time treating the thorax. The thorax is the section of the body above the abdomen, including the upper back and ribcage. Good function is important for efficient breathing, but it also takes the strain off other areas of the body.
Bones of the Thorax
The spine in the thorax looks quite different to the lower back and neck. Almost every vertebra in the spine has a long protrusion on the back- this is what you can feel through skin. In the neck and lower back they are nearly horizontal, but in the thoracic spine they point downwards. This limits their movement when you lean back, but this restriction makes the spine in this area more stable. Problems with the discs between vertebrae are very uncommon in the upper back.
Attached to each thoracic vertebra is a pair of ribs. Different ribs move in a slightly different way, with the upper ribs moving like a pump handle and the lower ones flaring out like a bucket handle. These movements affect the joints at the front and back of the body, so can be a cause of back or chest pain. Always seek medical advice for worrying chest pain.
Breathing
The rib cage is home to the heart, lungs, and diaphragm. The diaphragm is a parachute shaped muscle that attaches to the lowest ribs, forming a seal between the thorax and the abdomen. Its main role is to produce negative pressure in the lungs to allow you to breathe in.
When the diaphragm is not working as well as it should, other muscles have to take over. These small muscles work less efficiently, and can become fatigued and sore, resulting in tension in the shoulders, upper back, and neck.
The Thorax and a Sedentary Lifestyle
If you spend a lot of time sitting, you will most likely find yourself in a few positions that don’t suit the thorax very well. Whether it’s computer work that keeps you sitting, or something else, a lot of what we do requires our hands to work in front of us. It might feel easier to slouch and let your shoulders drop forwards, reducing the effort required to reach in front. However, this has a knock-on effect for the rest of the body.
This position encourages the muscles on the front of the chest to tighten and shorten, and for those on the back to become over-stretched and weak. Thoracic outlet syndrome can be caused by this positioning, as it puts extra compression on the areas where vessels and nerves leave the thorax on their way to the arms. If you develop arm pain or pins and needles, we can help with muscle and joint work to restore balance to the upper back area.
Effects Above and Below the Thorax
As mentioned above, ineffective breathing can cause a strain for the muscles at the top of the back. Beyond this, you may develop headaches as the tension tracks up the neck. We can help to give you advice to prevent this happening in the first place, as well as treatment and exercises to managing the current episode.
In the other direction, thoracic dysfunction can put an increased demand on the lower back. Lost movement in the upper back might be picked up by the lumbar spine, causing other joints to overwork and become sore. We often find that patients with lower back pain also have some stiffness further up the back, and sometimes in very acute cases, work to the upper back is more effective than treating the painful area itself.
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