The thoracic spine is that portion of the spine that is located below the neck and above the low back. It is often referred to as the “mid-back.” Thoracic spine tightness refers to a sensation of stiffness, tension, or discomfort in the thoracic spine. There are multiple causes of thoracic spine tightness, which will be reviewed along with both conventional and advanced treatment options.
How Does Tightness in the Thoracic Spine Feel?
Thoracic spine tightness can significantly impact one’s well-being and level of activity.
The most common complaints include:
- Tightness or stiffness
- Dull, pressing pain
- Limited range of motion
What Causes Tightness in the Thoracic Spine?
There are a number of potential causes of thoracic spine tightness. The most common include:
Thoracic Disc Injury
The thoracic spine is composed of 12 bony building blocks, which stack one upon another. They are called the vertebral bodies. Sandwiched between each of the bony building blocks is an important shock absorber that is referred to as a disc. The discs are labeled according to the two vertebral bodies they are situated between.
For example, the lowest thoracic disc is situated between the T11 and T12 vertebral bodies. Accordingly, it is identified as the T11/12 disc. Thoracic discs are susceptible to both injury and degeneration. Examples include disc bulges, protrusions, herniations, and extrusions. All can cause significant tightness in the thoracic spine.
Thoracic Facet Injury
A thoracic facet is a small, paired joint found at each level of the thoracic spine. It plays an important role in limiting the range of motion and absorbing the forces of daily life. It also provides stability in the thoracic spine. Because of this, it is susceptible to injury and degeneration, both of which can lead to pain and tightness in the thoracic spine.
Ligaments are thick pieces of connective tissue that connect bone to bone. They provide important stability in the body and thoracic spine. Ligaments can be injured, torn, or stretched, compromising stability. Instability in turn can create injury, pain, and tightness in the thoracic spine.
Costotransverse Joint Injury
The costotransverse joint is unique to the thoracic spine. It is formed by the union of the rib and the transverse process of the spine. There is a right and left costotransverse joint at each level of the thoracic spine.
Like the facet joints, each one is lined with cartilage and surrounded by a thick capsule. The joint can be injured or become degenerative, causing pain, restriction in range of motion, and tightness in the thoracic spine.
Thoracic Spine Central Canal Stenosis
The central canal is a bony column located on the backside of the spine that contains the spinal cord and cerebral spinal fluid. Stenosis refers to narrowing. Narrowing of the thoracic spine central canal can be due to a number of different causes, including disc protrusion, facet overgrowth, ligament thickening, and slippage of one or more of the vertebral bodies.
Symptoms vary, depending upon the severity of the narrowing. One of the symptoms is thoracic spine tightness.
Extensive screen time and sitting have compromised our posture and spinal alignment. Neutral spinal alignment is critical for the health and proper functioning of the spine. Poor posture can compromise spine well-being leading to disc, facet, and ligament injuries. In turn, these can lead to pain and tightness in the thoracic spine.
Scoliosis is a medical condition characterized by lateral curvature of the spine. The spine bends sideways in a C or an S shape. The degree of curvature can vary. In most cases, there is also accompanying spinal rotation. The incidence varies in different countries between 2 and 13%.1
The causes of scoliosis vary and can be classified as congenital, neuromuscular, syndrome-related, and idiopathic.2
Thoracic Spine Foraminal Stenosis
The foramen is an important part of the spine. It is the bony doorway through which nerves pass as they exit the spine. There is a right and left foramen at each level of the spine. Foraminal stenosis is a medical condition characterized by narrowing of the bony doorway with subsequent irritation or compression of the exiting nerves.
The most common causes of foraminal stenosis are disc injury, facet overgrowth, ligament thickening, and bone spurs. Symptoms include pain, weakness, and thoracic spine tightness.
Muscle imbalance can cause thoracic spine tightness by exerting uneven forces on the spine. When certain muscle groups are stronger or more active than their opposing muscles, it can lead to abnormal posture and alignment of the spine.
Kyphosis is a spinal condition characterized by excessive, abnormal rounding of the upper back. It causes the thoracic spine to curve forward, creating a hunchback appearance. It increases with age, leading in many cases to pain, restricted range of motion, and muscle tightness.
Vertebral Body Slippage
The vertebral bodies stack one upon another to form the spine. Sandwiched between each of the vertebral bodies is a disc. Nerves exit through the foramen at each level of the spine. Trauma, fracture, and ligament instability can lead to vertebral body slippage.
If the vertebral body slips forward, it is referred to as anteriolisthesis, whereas if it slips backward, it is referred to as retrolisthesis. Slippage can cause disc injury and nerve irritation or compression. In turn, this can lead to pain, extremity weakness, numbness, and thoracic spine tightness.
Vertebral bodies are susceptible to injury and damage. This includes fracture, where a portion of the bone is broken. Symptoms vary and can include pain, muscle spasms, and thoracic spine tightness.
Thoracic Spine Sprain
Thoracic spine sprains are a frequent problem that can occur when the ligaments in the middle back area get injured. This can lead to troublesome symptoms like pain, stiffness, and muscle spasms, making it difficult to move comfortably and perform your everyday activities.
The good news is that there are treatment options readily available, ranging from simple techniques like applying heat or taking over the counter medication, to more advanced regenerative treatments like Platelet-Rich Plasma (PRP) and bone marrow concentrate.
Read More About Thoracic Spine Sprain
Thoracic radiculopathy is a painful medical condition that affects both men and women alike. Pain, paresthesia, decreased sensation, and weakness are the major symptoms. Radiculopathy refers to the whole complex of symptoms that can be caused by irritation or compression of a nerve root in the spine. Thoracic radiculopathy is irritation or compression of a thoracic spinal nerve. Causes of radiculopathy in the thoracic region are thoracic disc injuries, thoracic facet arthritis, ligament thickening, facet cyst, unstable rib attachments, and bone spurs. Diagnosis of thoracic radiculopathy can be difficult. Treatment options vary upon severity and when appropriate should always start with conservative care.
Read More About Thoracic Radiculopathy
Bulging Disc In Thoracic Spine
A bulging disc in the thoracic spine is a serious medical condition that occurs when the outer layer of the disc weakens, causing it to bulge outward and put pressure on nerves and the spinal cord. The disc has two components, a soft center and a thick outer layer, and weakening or tears in the outer layer can lead to a bulge. Symptoms include pain, numbness, and weakness in the affected area. The thoracic spine is that portion of the spine that resides below the neck and above the low back. It is commonly referred to as the mid-back. A bulging…
Read More About Bulging Disc In Thoracic Spine
Cysts are abnormal, closed sacs that contain fluid, gas or semi-fluid material. They can develop in various parts of the body. They can vary in size from very small to large and can be located within organs, tissues or bones.
Cysts can be either benign (non-cancerous) or malignant (cancerous). Most cysts are benign. They occur due to a number of different reasons that include obstruction, infection, chronic inflammation, instability or cellular abnormalities.
So, thoracic spine cysts are abnormal, closed sacs that occur in the spine below the neck and above the low back.
Read More About Thoracic Cyst
When to Seek Medical Help
Thoracic spine tightness that persists despite conservative treatments warrants medical attention. It is an indication that you may have a significant underlying problem that needs attention, akin to the warning light in your car.
Conventional Medical Treatment Options
Conservative options, when appropriate, should always be the first line of treatment. Common treatment options for thoracic spine tightness include:
Rest and Stretching
Thoracic spine tightness is often due to over-exertion or repetitive activities. Both typically respond to rest. Stretching is important as it can help alleviate muscle spasms and compromised blood flow to the thoracic muscles.
Thoracic spine tightness can arise from a number of different sources. Physical therapy can be instrumental in identifying the muscular imbalance, weakness, and other factors responsible for the tightness. Treatment options include manual therapy, stretching, dry needling, strengthening, and posture and gait training.
Medications are often utilized in the initial treatment of thoracic spine tightness.
Common examples include:
- Natural nonsteroidal anti-inflammatory agents like fish oil and curcumin
- Pharmaceutical anti-inflammatory agents. Common examples include Celebrex, ibuprofen, and diclofenac. These are powerful anti-inflammatory agents that should be avoided, due to their significant side effects. They are available in oral tablets and topical creams.
- Muscle relaxants. Patients are often prescribed muscle relaxants when thoracic spine tightness persists despite rest and anti-inflammatory agents. Common examples include Flexeril, Skelaxin, Robaxin, and Soma.
Surgery should never be a first-line treatment. In fact, surgery is rare in cases of thoracic spine tightness unless the workup has demonstrated cancer or significant disc injury that is not amenable to non-surgical treatment, chemotherapy, or radiation.
The Centeno-Schultz Approach to Tightness in the Thoracic Spine
Thoracic spine tightness can be caused by a number of different conditions. Many providers and medical practices focus on treating symptoms, with the aim of reducing them. Therefore, they provide prescriptions for different medications and referral to physical therapy with the hope that this will reduce or eliminate symptoms.
At the Centeno-Schultz Clinic, we take a different approach. We believe that the first step is an accurate diagnosis. By identifying the accurate underlying issue, patients can receive the appropriate therapy and get the best clinical results.
The process starts with a board-certified, fellowship-trained physician taking a detailed history that includes the onset of symptoms, presence or absence of trauma, aggravating factors, alleviating factors, and treatment to date.
Past medical and surgical history along with current medications and allergies are reviewed. Physical examination is performed and includes the range of motion, motor strength, areas of pain, symmetry, and neurologic function. Radiographic studies include X-rays, MRI, and CT scans, and are reviewed in detail.
When appropriate, an in-office ultrasound is performed to evaluate stability and tendon, ligament, and muscle injuries.
Bone Marrow Aspirate Concentrate
Bone marrow concentrate is one of the many orthobiologic treatment options offered at the Centeno-Schultz Clinic. Bone marrow concentrate is a powerhouse of healing that can accelerate healing. Bone marrow is aspirated under a strict, sterile technique and then processed in our state-of-the-art cellular laboratory where it is concentrated.
Bone marrow concentrate contains a number of different cells, which include stem cells. The bone marrow aspirate is then injected under X-ray or ultrasound guidance into the area of injury. Blind injections are below the standard of care at the Centeno-Schutlz Clinic, as there is no assurance the injected orthobiologics will reach the targeted tissue.
Platelet-Rich Plasma (PRP) Injections
PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…
Read More About Platelet-Rich Plasma (PRP) Injections
It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…
Read More About Prolotherapy Injections
Early Diagnosis Can Prevent Further Damage to Your Thoracic Spine
Thoracic spine tightness can be a symptom of various underlying conditions, and it’s crucial to seek professional medical advice if the discomfort persists. The Centeno-Schultz Clinic emphasizes the importance of an accurate diagnosis, employing a comprehensive approach that includes a detailed medical history, physical examination, and thorough review of radiographic studies.
With an array of cutting-edge treatments, including bone marrow concentrate, platelet-rich plasma, and prolotherapy, we strive toward optimal patient recovery. Remember, early diagnosis can prevent further damage to your thoracic spine, and a proactive approach to your health is always beneficial.
Thoracic spine tightness can arise from many different sources. Common sources include thoracic disc, thoracic facet, costotransverse joint, ligament injuries, central canal stenosis, poor posture, scoliosis, muscle imbalance, foraminal stenosis, kyphosis, vertebral body slippage, and compression fractures.
When thoracic spine tightness persists despite conservative therapy, this is an alert that you have a problem that warrants further evaluation. If left untreated, the underlying issue in many cases can get worse. Pay attention to persistent thoracic spine tightness as your body is telling you that there is a serious problem.
- Balmer GA, MacEwen GD. The incidence and treatment of scoliosis in cerebral palsy. J Bone Joint Surg Br. 1970 Feb;52(1):134-7. PMID: 5436198.
- Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 2007 Nov;12(9):771-6. doi: 10.1093/pch/12.9.771. PMID: 19030463; PMCID: PMC2532872.