It often starts as an occasional pain in the upper back area, especially after long periods of sitting or heavy manual work. A few weeks or months later, you notice the pain becoming more intense during/after exertion. Tasks you easily breeze through on automatic mode become chores as stiffness and more pain become a daily struggle.
Thoracic Spondylosis is part of the back pain epidemic, which affects over 80% of people over the age of 60. The good news is that it’s not a life sentence of pain and discomfort at all. There’s always a legitimate chance to live a pain-free and fulfilling life. This article will look at what Thoracic Spondylosis is all about. We’ll start with a quick look at its nature and causes before proceeding to key treatment options, including exercises to do at home.
What’s Thoracic Spondylosis?
How the Thoracic Spine Works
Let’s set the foundation for understanding what Thoracic Spondylosis is all about with a quick look at how the Thoracic Spine works.
This portion of the spine extends from the base of the neck to the mid back area, at the level of the lowest rib.
Each spinal bone/vertebrae of the Thoracic Spine articulates with a pair of ribs, one on each side. The upper and lower surfaces are connected with other vertebrae through tough connective structures known as Intervertebral Discs.
These vertebrae also articulate with each other at the back through small joints, known as facet joints. This is where most of the movement happens whenever you’re moving your Thoracic Spine in different directions.
A range of connective tissue structures hold the spine together and control its movements in various directions. Ligaments provide passive stability, holding the bones together. Muscles initiate, drive and control spinal movement.
So What Happens During Thoracic Spondylosis?
Spondylosis involves degenerative structural changes in these structures, triggered by a range of factors. Classic signs include:
- Thinning of intervertebral discs.
- Formation of tiny bony spurs known as Osteophytes.
- Irritation of facet joints.
What Causes Thoracic Spondylosis?
Thoracic Spondylosis usually shows up as a result of an interplay of various factors. Let’s take a quick look:
Aging
This is probably the most important factor behind Spondylosis. According to recent research estimates, over 90% of individuals in the 65-90yr age-bracket show signs of Spondylosis. This is no surprise, considering natural spinal changes that take place in the spine, starting from the mid decades of life:
- Intervertebral discs lose water content, which leaves them thinner and stiffer.
- Vertebral bones start losing density and go through structural alterations i.e edges become rough and start developing spikes(osteophytes)
- Facet joint cartilages become thinner and become less efficient at lubricating joint surfaces.
All this sets the stage for profound stiffness, irritation, and pain in the affected spinal segment, which is typical of Spondylosis.
Injuries
Thoracic Spondylosis isn’t always a result of gradual wear and tear over time. Significant injuries caused by trauma can set the stage for degenerative conditions in the absence of age-related changes.
- A fractured vertebrae can end up altering normal mechanics and load-bearing capacity of the thoracic spine. In the long run, this may cause chronic inflammation and set the stage for degenerative changes.
- Ruptured spinal ligaments can render the thoracic spine unstable and cause movement problems over time. If healing doesn’t take place properly, it may trigger a series of processes associated with Thoracic Spondylosis.
Occupational Factors
Studies have established a direct association between physically demanding labour and prevalence of Thoracic Spondylosis. Occupations which involve carrying heavy weights, operating vibrating machinery, and maintaining the same posture for long periods are associated with a higher risk of Thoracic Spondylosis.
The reasons are obvious. Prolonged heavy loading of the spine comes with the risk of altered spinal biomechanics and injury in the spine, which lays the foundation for spondylotic changes.
Treatment Overview
Spondylosis treatment may take the conservative or surgical route depending on the extent of damage. However, most people get back to a pain-free and high quality of life with conservative care.
Physiotherapy
Physiotherapy remains a cornerstone treatment of Thoracic Spondylosis. It aims at reducing symptoms, and enhancing movement and overall quality of life. Key treatment methods include:
Manual Therapy
This involves various hands-on techniques to improve symptoms and promoting mobility of the thoracic spine. Vertebral mobilisation and manipulation techniques offer highly effective options for reducing facet joint pain and promoting spinal mobility. Soft tissue manipulation techniques deal with issues like trigger points, spasms, and tightness in muscles and other soft tissue structures.
Exercise
Exercise can be a game-changer for Thoracic Spondylosis if used properly. Key benefits include pain relief, improved flexibility, and improved postural control. Key interventions include:
- Stretches: This the gold standard for promoting flexibility and movement in the spine. It also proves effective for pain relief by helping with inhibiting transmission of pain signals to the nervous system.
- Strength training: This is about improving muscle performance around the thoracic region and the spine as a whole. Muscular inefficiencies are a key issue in affected individuals, and this leads to faulty movement patterns and impaired ability to handle spinal loads. The result is more dysfunction and pain in the long run. A properly designed strength training program can improve the spine’s ability to handle loads and move properly.
Education
Physiotherapy empowers you to take matters into your own hands. In fact, this is often the key to ensuring sustainable improvements and minimal risk of symptom flareups. Teaching postural management strategies/techniques and home exercise programs is always integral to successful physiotherapy treatment.
This isn’t hearsay by any means. Thoracic Spondylosis contributes a substantial part of our workload at Healthy Movements Physiotherapy. Dylan’s case demonstrates the value of a properly executed physiotherapy program:
Dylan, a 52 year old, walked in complaining of persistent pain between his shoulder blades for over 3 months. He kept brushing it off as a passing inconvenience. Later on, he accepted the pain as an inevitable part of being a productive CEO of his accounting firm. However, it progressed to constant pain in the upper back area which didn’t care whether he was working or not. By the time he walked into the clinic, he could barely sit for 10 minutes without needing to lie down for a while.
Our physical exam and images(x-rays, MRI scan) showed typical features of Thoracic Spondylosis. We took the conservative management route: Physiotherapy, and referral to a doctor to consider appropriate analgesics/painkillers for intense episodes of pain.
The first session focused on hands-on techniques and exercises aimed at reducing symptoms and optimizing movement. We managed to reduce the pain by about 70 percent.
The subsequent 3 sessions saw further improvements in terms of function: he could sit for more than 15 minutes and was able to take a 20 minute walk without significant pain. By the end of 7 sessions, the pain was reduced to short-lived episodes of minimal pain that typically set in after prolonged sitting. We tweaked the approach to include more core and strength training to improve his postural awareness, strength, and endurance.
He is now back at work: happier, healthier and more productive than ever.
Surgery
Surgery is almost always the last resort for Thoracic Spondylosis. It’s often reserved for significant structural derangements causing severe symptoms. Common procedures include:
- Spinal Fusion: Two or more vertebrae are joined to improve stability.
- Discectomy: Part or whole discs are removed to deal with nerve compression issues and pain.
- Laminectomy: Part of a vertebrae is removed to ease pressure on the spinal cord and nerves.
Medication
Over-the-counter painkillers and NSAIDs complement physiotherapy, especially in acute cases. When these fail to effect any significant changes, epidural steroid injections may be used to deal with inflammation in the short term.
Effective Exercises for Thoracic Spondylosis
A word of caution: These exercises aren’t meant to replace professional advice and management. Spondylosis is a condition that needs you to work with a qualified Physiotherapist or any other capable health care professional. Consult our physiotherapists here if you’re experiencing any signs of Spondylosis. If you already have a home exercise program for spondylosis, these exercises can help you factor in some variability to build on the gains you’ve already made so far. Let’s get started:
1. Lying Rotational Stretches
Aim: Improve rotational thoracic flexibility through a gentle rotational stretch.
How to do it
- Lie down on your side, bend your legs(knees should be bent at 90 degrees)
- Extend your arms straight forward at shoulder level.
- Keep your back straight, chest slightly drawn forwards.
- Raise the top arm in a backward circular motion while rotating your head and shoulder in the same direction.
- At the end position of the stretch, your head should be completely turned to the opposite side as the moving arm rests on the floor. Hold the end position for 2-3 seconds.
- With control, return to the starting position.
- Repeat the movement, 3-4 times.
Safety Tips
- Stop the exercise if you experience severe pain possibly radiating to surrounding areas.
- You don’t have to go all the way to the end position. Stay within the pain free range and gradually work your way up to full range.
2. Roller Extensions
Aim: Optimising flexion(forward bending) and extension. Like the rotational stretch, it helps with stretching facet joints in the extension/flexion directions, which are critical movements for proper spinal mobility.
How to do it
Starting Position
- You’ll need a soft, firm roller to get this done.
- Lie down: upper back resting on the roller, feet flat on the floor, and hands clasped at the back of the head.
- Extend your back over the roller while rolling your upper body over the roller.
- Return to the starting position.
- Repeat the movement 10-15 times, 2-3 sets.
Safety
- Stop the move if the roller proves too uncomfortable or painful, you may end up just irritating inflamed tissue.
3. Cat Cow
Aim: Improving thoracic flexion and extension, which translates to better flexibility.
How to do it
- Get into a quadruped/all-fours position. Wrists should be directly below your shoulders, and knees below your hips.
- Draw your chest in and curve your upper back upwards, as far as you can. Hold for 2-3 seconds.
- Reverse the movement: Draw your chest out and curve your back downwards, as much as you can . Hold for 2-3 seconds.
- Alternate the movements till you hit 10-15 reps. Rest. Repeat 3-4 times.
Safety
- Pay attention to how your thoracic spine is responding. Skip the exercise if you experience severe aggravation of pain or emergence of additional symptoms.
4. Plank
Aim: Building strength in key stabilisers of the spine(core muscles).
How to do it
- Lie down on a mat, face down.
- Prop up on your elbows and knees.
- Lift your whole body and get into a straight, plank position.
- Hold for 20-30 seconds.
- Return to the starting position.
- Repeat 3-4 times.
Safety
- No need to force things if you can hardly hold the position, the plank can be quite a heavy exercise. Switch to an easier variation if you find it too difficult:
- Use your palms instead of propping up on your elbows, it makes the load easier for a start.
5. Bird Dog
Aim: Build core strength, which translates to better spinal stability and control over time.
How to do it
- Get into a quadruped position.
- Raise your left leg and right arm to shoulder level.
- Hold for 1-2 seconds.
- Return to the starting position.
- Repeat movement on the other side: right leg and left arm. Aim for 10-12 reps for each side.
Safety
- Watch out for poor positioning and posture. Your back should be held in a neutral position throughout the movement to achieve proper loading.
6. Bent-over Dumbbell Fly
Aim: This is a dynamic exercise, aimed at improving strength in the upper back muscles and the core.
How to do it
- Hold a dumbbell in each hand, stand tall with feet placed at shoulder width apart.
- Bend your knees slightly and lean forward to get your upper body at a relatively 45-degree angle from the vertical. Your arms should be extending downwards at this point, palms facing each other at knee level.
- Raise your arms sideways to shoulder level.
- With control, return to the starting position.
- Repeat the movement 10-15 times. Aim for 3-4 sets.
Safety
- Keep your back in a neutral position throughout the movement. Curling your back can easily cause injuries in the lumbar and thoracic spine.
When to see a Physiotherapist
Most people can do with a solid home exercise program without issues. However, watchout for these red flags and seek for physiotherapy attention as soon as possible:
- Intense pain in the mid-upper back pain area hours/days after an exercise session.
- Numbness, burning sensations, or any other weird sensations in the thoracic and lower body areas.
- Muscle weakness: Progressive loss of muscle strength in the lower body areas i.e legs.
- Bowel and bladder problems:
Get in Touch: We're Just Around the Corner..in Western Sydney Area
Is Thoracic Spondylosis or upper back pain holding you back? don’t hesitate, seek professional help. We’re a team of physiotherapists in the Western Sydney area, specialised in assessing and treating musculoskeletal conditions like yours. We bring years of expertise to get you back to living the pain-free, productive life you deserve. Book an appointment: Hit the “book an appointment” button up top and talk to us today. We’re looking forward to being part of your incredible recovery journey.
Frequently Asked Questions
There isn’t any defined time frame for Spondylosis recovery. Individuals recover from severe symptoms at varying rates and time frames. The reason is that Spondylosis is a product of a wide range of factors which interact differently in different individuals.
The best treatment for Spondylosis is the one that best addresses the primary factors associated with the condition in the affected individual. For instance, if occupational stress is the primary factor, the best treatment puts appropriate and effective strategies in place to manage loads which are consistently placed on the spine.
Physiotherapy reduces symptoms, promotes movement, and enhances overall physical function. This is possible through a thorough assessment, coupled with evidence-based treatment methods i.e:
- Manual techniques.
- Exercise therapy.
- Electrophysical modalities: Heat therapy, nerve stimulation procedures.
Typical exercise programs for Thoracic Spondylosis combine stretches and strength training. Stretches aim at restoring optimal flexibility in and around the thoracic spine while strength training focuses on building control and muscle strength around the spine. Key exercises include:
- Roller extensions.
- Active/assisted spinal rotations.
- Cat cow stretches.
- Bird-dogs.
- Planks.
- Bent-over flys.
For details, refer to the exercise descriptions section above.
