The thoracic spine is comprised of 12 vertebra, which lie between the vertebrae of the neck and the low back. Whether it's driving a golf ball or driving a car, spinal rotation is a needed movement in our daily lives. Poor movement in the thoracic region can result in overuse injuries and chronic injuries that reduce performance. This issue of the eReport discusses this often under treated area of the spine.

Movement

Spinal vertebrae articulate between the vertebral bodies (the interbody joint) and on either side at the facet joints. Due to the orientation of the facet joints, this region of the spine is more suited for rotation than it is for flexion and extension. The thoracic spine is responsible for almost three times more rotation than the lumbar spine (low back). Movement in the thoracic region is also influenced by the articulation of the ribs with the thoracic vertebrae at the costo-transverse joint. The thoracic spine also contributes to shoulder movements, neck movements and breathing.

Stability

Spinal stability is maintained due to contributions from discs, ligaments, bony architecture, the small segmental muscles (rotators, multifidus and semispinalis) and larger muscle groups. At the thoracic spine, a unique factor contributing to stability is the presence of the ribcage. Posteriorly, all of the ribs attach to the vertebra at the transverse process. Anteriorly, the upper 6 ribs (sternal ribs) attach directly to the sternum. Ribs 7 to 10 attach to the sternal ribs by cartilaginous connections while ribs 11 and 12 have no anterior attachments and are known as floating ribs. The anterior and posterior attachments afford an extra level of stability not present in the cervical or lumbar spine.

Muscles

Spinal movement is a necessary part of daily life including sports participation. The rotation that is produced by the large thoracolumbar muscles (abdominals, erector spinae, latissimus dorsi to name a few) allow the endurance required to jog while providing the power required for a hockey slap shot. Breakdowns in spinal movement can be a result of local joint restrictions or due to muscle imbalances developed from previous injury, overuse or faulty training.

Thoracic Pain

Local thoracic pain can be a result of traumatic injuries, such as body contact, resulting in a muscle contusion, dislocated rib or joint sprain. Disc herniations can also occur in this area of the spine, however these are not as common as in the lumbar spine. Compression fractures in the lower thoracic spine can occur with heavy falls.

In addition to traumatic injury, repetitive strain injuries can occur. Compensatory movements may be required because of poor movement at nearby segments or muscle imbalances. Postural alignment is often compromised. This can result in a local joint sprain, muscle fatigue or strain. In order to maintain alignment, more muscle contribution is required from larger segments. Frequently symptoms are felt when positions are held for long periods. However because of its inherent stability and the large number of stabilizing muscles, restrictions in thoracic mobility may not present as thoracic pain. Instead pain can be felt in less stable areas such as the neck, lumbar spine, sacroiliac joints (pelvis), or shoulders.

From the perspective of an active lifestyle, increased reliance on large muscle groups to sustain faulty posture reduces their ability to contribute during sporting events and therefore hinder performance. Abnormal postural alignment can even limit rib movement. This can affect the body's ability to adequately intake oxygen during activities leading to headaches, nausea or early onset of fatigue.

Treatment

Rehabilitation of the thoracic spine requires proper assessment of the spine and neighbouring joints. Treatment may consist of improving the mobility of stiff segments and strengthening segments with too much mobility. This may involve training the local muscles as well as strengthening and stretching the larger muscle groups. The health care professionals at SEMI are trained in both manual therapy assessment and treatment techniques as well as therapeutic exercises to help you achieve your maximum physical potential.