The thoracic spine sits between the cervical spine above and the lumbar spine below, providing attachment for trunk muscles as well as a firm support for the 12 ribs that form the ribcage to protect the chest cavity/lungs/heart. The thoracic spine naturally should have a mild kyphosis, or forwards curvature which helps to counter the natural lordosis curvatures of the cervical and lumbar spines.
Thoracic spinal movement is significantly less than the cervical and lumbar areas of the spine, mainly due to the restriction of the ribcage which limits flexion, extension and particularly side-flexion movements of the thoracic spine. Although the thoracic vertebrae are labelled as T1 through to T12, the spine functions as a whole, and movement of segments above and below the thoracic spine need to occur to allow full, smooth functional movements.
For example, for cervical rotation to occur, the top 4 thoracic vertebrae (T1-4) also exhibit some rotation to contribute to the movement. Without this thoracic contribution, the cervical spine does not rotate as far.
The thoracic spine also provides attachment sites for many of the significant postural muscles that help to keep the scapulae positioned well and to keep the thoracic kyphosis in an optimum position. These muscles include upper/middle/lower trapezius, rhomboids and levator scapulae.
So what problems can occur, and why?
The thoracic spine’s significance cannot be understated when it comes to one’s posture. A stiff thoracic spine will typically tighten in an excessively kyphotic position, which then has a “domino effect” up to the cervical spine, which is then forced to compensate into an excessive lordosis to keep the head up straight. This extra load on the neck results in compression of the facet joints (therefore reducing the available neck range of motion, causing pain and often headaches) as well as extra pressure on the posterior aspects of the intervertebral discs. This extra pressure can then be amplified as the upper trapezius and levator scapulae muscles are sitting in a shortened position and therefore become tight and taut, putting extra compressive forces through the neck.
Furthermore, the “rounded”/kyphotic thoracic spine encourages the scapulae to protract and downwardly rotate (ie. Rounded shoulders!), putting further tension through the upper/middle trapezius, rhomboids and levator scapulae, and therefore, the neck too! As you can see, this is a bad combination and spells trouble!
Stiffness in the thoracic spine can be caused by a number of factors:
- Prolonged poor/slouched postures (eg. Sitting/driving, general inactivity)
- Tightness of muscles that attach to the thoracic spine (from excessive lifting/carrying, tension/stress, poor sitting postures)
- Medical conditions such as osteoarthritis, rheumatoid arthritis, Scheuermann’s disease can also contribute to thoracic vertebrae stiffening.
The second common contributor to excessive load on the cervical spine from the thorax is the presence of a thoracic scoliosis, or sideways curvature. This can be a structural scoliosis (ie. due to the bony structure and development of the spine) or functional scoliosis (ie due to muscular asymmetries and poor movement patterns.
The presence of a scoliosis, again, has a domino effect up to the cervical spine. Muscle asymmetries develop due to the shorter distance travelled on one side compared to the other, as well as extra compression on the facet joints and disc on the concave side of the curvature. Often a scoliosis causes one shoulder to sit lower than the other which puts abnormal strain on the neck through the muscles which are placed on a greater stretch.
Where to start!?
All patients presenting with cervical problems need proper assessment of the thoracic spine to establish if it could be contributing to their problem. Often if significant stiffness, asymmetries or weakness is found in the thoracic area, treatment to address these issues can often be the solution, rather than needing to address the neck.
The team of physiotherapists at Physio Professionals take pride in always searching for the underlying cause of the problem, rather than just treating the symptoms. Treating a stiff thoracic spine can often help resolve a patient’s cervicogenic headaches, simply because it allows them to assume a better posture with less strain placed on their upper cervical spine. Treatment can involve techniques such as manual therapy, postural strengthening exercises, stretching, relaxation/breathing awareness and dry needling. The techniques chosen to be most effective are chosen by the physiotherapist based on each individual’s presentation.