What is thoracic joint dysfunction and how does it happen? Why does my mid back hurt?
Thoracic mechanical intersegmental joint dysfunction is a area of the thoracic spine that demonstrates improper movement. This improper movement most commonly results in local discomfort. Research suggests two basic origins of ISJD, mechanical and reflexive. Mechanical dysfunction arises from an outside force acting on a segment for either; a brief trauma or an extended period of overuse. Some experts believe the cause of altered joint mechanics may begin from an imbalance between the associated muscle groups (3). Psychological and emotional factors may contribute. Hypomobility of these joints in the back is thought to produce concurrent increased local nociceptive (pain) activity and (4,5,6,7).
ISJD may give rise to a self-perpetuating cycle of discomfort in which the negative effects of hypomobility are perpetuated by inflammation, muscular hypertonicity (via Hilton's Law) and imbalance. Joint dysfunction is rarely an isolated event as dysfunction in one segment often leads to involvement of other segments and the spine as a whole (3). Longstanding joint dysfunction is thought to result in premature degenerative change (8).
How common is thoracic joint dysfunction?
While the specific incidence of thoracic intersegmental joint dysfunction is difficult to estimate, complaints involving the thoracic region compromise of approximately 15% of all spinal problems. (9) The one-year prevalence of thoracic spine pain is estimated at 17%, much lower than the frequency of cervical and lumbar complaints. (10) Thoracic spine pain has received considerably less attention than its cervical and lumbar counterparts, yet can be equally disabling (11-13).
Who is affected by thoracic joint dysfunction and pain?
Thoracic spine complaints affect all age groups. (14) Up to 10% of adolescents have experienced thoracic spine pain that has interfered with school or leisure activities (15). The use of backpacks seems to correlate with adolescent thoracic spine pain (15-16). Adolescent females are affected slightly more frequently than males (16).
What are the symptoms of thoracic joint dysfunction?
Clinically, thoracic intersegmental joint dysfunction presents as one sided/midline back pain. Thoracic ijoint dysfunction has the potential to disrupt the biomechanics in associated areas of the spine, costovertebral joints, and shoulder, thereby producing distant secondary complaints. (11,17,18). Thoracic dysfunction has been related to problems in the neck, shoulder, arms, and anterior chest (22,56,57). Thoracic ISJD may alter normal respiration and contribute to breathing difficulties (11).
Global and intersegmental motion deficits are the hallmarks of thoracic joint dysfunction (19). Doctors routinely use motion palpation to determine an areas excess or decrease in movement (24-26). Clinicians must also assess costovertebral (rib) joints, as movement of the thoracic spine is intimately coupled with rib function (27-31).
Are x-rays or other imaging necessary?
Plain film radiography (x-ray) is of limited value except in cases of trauma (44). Radiographs are appropriate for patients with “red flags”. Radiographs may be needed to rule out suspicion of vertebral compression fractures.
Advanced imaging may be appropriate for patients with a history of major trauma, severe neurologic compromise, or suspicion of vertebral infection (45). However, MRI demonstrates the presence of thoracic disc herniation in 37% of asymptomatic patients, and disc bulge in 53%. (58)
What are the best conservative treatment options for thoracic joint dysfunction?
Treatment should focus on restoring joint mobility, stretching hypertonic tissues, and correcting postural faults. Manipulation has proven benefit in the treatment of thoracic spine complaints (32,47,48). Improvement is noted after an average of three to six treatments (32,48). Thoracic spine manipulation has been shown to immediately increase muscle strength (51). Home self-mobilization on a foam roller, ball, or other apparatus may improve outcomes (54,55).
Motion limitations often involve contractile elements as well as joints. Myofascial release and stretching may be necessary to address the paraspinal, intercostal, and shoulder girdle musculature. Postural abnormalities, including an increased kyphosis or rounded shoulders are associated with thoracic spine pain (52).
Therapy modalities, including ice, heat, ultrasound, or e-stim may provide temporary benefit. (53)
At the Creekside Chiropractic & Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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