The thoracic spine is the longest region of the spine, and by some measures it is also the most complex.
Connecting with the cervical spine above and the lumbar spine below, the thoracic spine runs from the base of the neck down to the abdomen. It is the only spinal region attached to the rib cage
The thoracic spine has 12 vertebrae stacked on top of each other, labeled from T1 down to T12.
These vertebrae form the foundation of the thoracic region’s sturdy spinal column that supports the neck above, the rib cage, soft tissues, flexible joints, blood vessels, and nerves.
Some of the thoracic spine’s most important roles include the following:
Protect the spinal cord. The spinal cord is a critical bundle of nerves that sends electrical signals throughout the body. It runs from the base of the brain down through the bony vertebral canal of the cervical spine and thoracic spine before branching into smaller nerve bundles in the lumbar spine
Anchor the rib cage. The rib cage, supported by the thoracic spine in the back, forms a bony structure to surround and protect vital organs, such as the heart and lungs.
While the cervical spine and lumbar spine are built more for mobility, the thoracic spine is built more for stability.
Thoracic spinal joints can become painful in various ways.
For example, cartilage tears and degeneration can develop in the facet joints where adjacent thoracic vertebrae articulate with each other. It is also possible for a rib to become misaligned or displaced from the vertebrae. In many cases, facet joint degeneration (osteoarthritis) and degenerative disc disease can happen at the same time.
When the upper back becomes painful, it is mostly likely due to an injury that has resulted in muscular irritation or joint dysfunction.
Some of the more common causes of upper back pain are:
Poor posture. Living a sedentary lifestyle or routinely sitting for long periods with poor posture can cause structural changes in the back and neck. The muscles can become deconditioned and weak, and thus not hold the spine in neutral alignment as easily as before. As the head and shoulders hunch forward, more pressure is placed on the spine’s bones, discs, muscles, ligaments, and other soft tissues. If a person leans to one side more often, such as while driving or working at a computer, that could also cause an imbalance in the upper back that leads to pain.
Improper lifting technique. Lifting a heavy object without keeping the spine aligned can put undue stress on the upper back. In particular, lifting or holding a heavy object above the head, especially more toward the left or right as opposed to centered, can leave the shoulder and upper back susceptible to injury. Lifting an object that is too heavy can also cause upper back pain.
Overuse. Putting the upper back through more work than usual, such as by spending a day helping a friend move into a new apartment or painting a ceiling (working above the head), could cause muscle strains, ligament sprains, and inflammation in the upper back.
Accident or collision. Trauma from a vehicular accident (car or bike crash), a fall from height (down steps or from a ladder), or sports collision (football, hockey, etc.) can cause upper back pain by injuring spinal bones, discs, muscles, ligaments, nerves, and/or other soft tissues.
Sometimes there can be a combination of causes, such as from both overuse and improper lifting technique.
Some of the less common causes of upper back pain include:
Thoracic herniated disc. While herniated discs in the thoracic spine are not uncommon, it is rare for one to cause pain or other symptoms. In general, natural age-related spinal degeneration is much more likely to cause symptoms in the cervical spine and lumbar spine.
Compression fractures. Most commonly caused by osteoporosis in older adults, a vertebral bone can weaken and not be able to fully support the weight above it. Small fractures develop at the front of the vertebra as it becomes compressed, causing the vertebra to form more of a wedge shape. If the vertebra loses enough height, it can cause postural changes and become painful.
Arthritis. Various types of arthritis can occur in or spread to the thoracic spine, such osteoarthritis (from natural wear and tear) or rheumatoid arthritis (an autoimmune disease).
Fibromyalgia. While this rare condition is known for widespread pain and fatigue throughout the body, the upper back is commonly affected
Severe spinal deformity. If a spinal deformity progresses enough, it can cause painful muscle spasms and even stress discs and joints. A few examples include Scheuermann’s kyphosis and scoliosis.
