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Indigestion? Or is it actually mid-back pain?
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
So far we’ve approached neck pain and lower back pain but there is an often forgotten about but crucially important part of our spines connecting the two areas:
The Thoracic Spine (or mid-back) consists of twelve different vertebrae and is unique in having 24 ribs attached. The ribs curve forwards and broadly join at the sternum (at the front) to form the Thoracic / Rib Cage which has the essential job of protecting our vital organs such as the heart and lungs.
It is vital that our thoracic spines function well as they are strongly involved in enabling us to have good sitting, walking, running and breathing mechanics as well as helping to maintain good organ function.
Common complaints
The source of the majority of mid-back pain will be due to one of the following structures:
- Muscle strains, particularly the thoracic erector spinae and intercostal muscles.
- Ligament sprains, either of those between the vertebrae or between rib and vertebra.
- Joint capsule irritation or strain. There are a lot of joints throughout the thoracic spine both between vertebrae and between the rib and vertebra and any one of these may become a problem.
Apart from specific injuries, most mid back pain will be the result of damage to one of the above structures because of postural problems or due to issues in other areas of the spine. There are also certain illnesses that will cause or contribute to problems, but we’ll cover some of them later.
Postural problems
The normal (front to back) curve of the Thoracic Spine is called a kyphosis and should curve gently and evenly throughout the length of the Thoracic Spine. Many of us have variations on this shape but broadly many spines will curve too little (hypokyphosis) or too much (hyperkyphosis.)
Additionally there can be a lateral (left to right) curvature of the spine called a scoliosis. This can be a problem in the thoracic spine particularly because the effect of the curvature will cause disruption of the function of the rib cage.
The main problem however is not really just the shape of the thoracic spine, more where and how well it moves. Day to day activities such as sitting, driving, standing and lifting will all place what amount to repetitive strains on the various local structures.
Frequently many problems originating in the mid-back will cause us problems in the neck, shoulders and low back. As I’ve mentioned before if one area of the spine doesn’t do its job properly another area of the spine will have to over-work to compensate!
Much of our expertise as osteopaths lies in identifying (and treating) these problems.
Links to your organs!
The organs in the chest cavity receive some of their nerve supply from the thoracic spine. Therefore there is the potential for problems of the organs to cause problems in the thoracic spine (called a Viscero-Somatic response) and vice versa where an issue with a particular spinal level can cause dysfunction in the organ supplied by the related nerve (a Somato-Visceral response).
A classic example of this would be a patient that suffers frequently from indigestion: a very common complaint. Many of these patients will also feel mid-back and sternum pain.
After seeing their GP it is established that there is no worrying cause for the indigestion and the problem is managed by medication.
The big question is which is causing which?
- The indigestion could be irritating the nerves supplying the oesophagus or stomach and therefore causing the back pain.
or
- There is mid-back pain and dysfunction causing the indigestion.
- There is a spinal problem that the patient is not aware of: they only feel the indigestion!
Treatment of thoracic spine dysfunction will almost certainly be helpful, more so in the last two scenarios – and that’s where the services of a health professional such as your local osteopath can fit in!
Other causes of mid-back pain or dysfunction
- Disc pathology
- Arthritic / wear and tear changes
- Respiratory problems such as asthma and chronic bronchitis
- Osteoporosis.
- Ankylosing spondylitis
- Scheurmanns Disease
- Heart, gallbladder, liver and stomach disorders
Self help
The exercises mentioned in the topics on neck and low back pain are all relevant here. The neck pain topic also includes a quick exercise to help with seated posture.
Breathing!
We don’t need to be reminded to breathe of course, but how we breathe is important.
Many of us, especially those with asthma or frequent respiratory tract infections or allergies tend to breath into the upper chest which will not use the diaphragm properly and will often cause reaction in the muscles around the mid-back and neck.
- Try lying comfortably on your back. Using relaxed breathing put your hands on your tummy. As you breath in gently try to let the lower part of the lungs expand so that your tummy will push your hands up. As you breath out again the tummy will deflate and your hands will slowly drop. Repeat this for a few minutes everyday until you can do it standing. You can then remind yourself to breath like this throughout the day.
Sidebending
- Stand with your feet shoulder width apart. Slowly slide your right arm down the side of your right leg. The aim with this is to focus the movement between your shoulder blades, so it is important not to go as far as possible (the further you tip over the more you will incorporate the lumbar spine, which is not the object here).
- Repeat this several times each side throughout the day.
Lying on a towel
- Loosely roll a medium sized towel. Place the towel on the floor and carefully lie back onto it from a seated position keeping your knees bent. The towel should be in line with your spine not across it. Support your neck with a pillow for comfort.
- Allow your shoulders to open and relax over the towel and feel your spine lengthen gently. Lie like this for a few minutes in the evening initially, and gradually increase the time and frequency as feels comfortable.
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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