The thoracic spine is located in the posterior part of the back and has a slight base kyphosis, that is, a backward curvature (concave forward and convex backward) that is continuous with the ribs on the side. The sternum is the anterior closure where the ribs meet to form the rib cage.
The rib cage contains important viscera such as the heart and lungs, which are essential for life. They are the only vertebrae that articulate with the ribs, and therefore they are vertebrae that have less mobility than the rest of the spine.
This region of the spine is reinforced by a series of muscles that are inserted and that we will describe below, which are responsible for the persistent and diffuse pain typical of back pain. These muscles tend to contract, generating fibrosis and muscle spasm.
The main muscles that generate the painful picture of back pain are those that are deep to the trapezius muscle; they are the rhomboids minor and major and the underlying spinal musculature below it.
The angle of the scapula, although it is closely related to the cervical spine, is also usually a very involved muscle within the picture of back pain. In this image you can see these muscles in a graphic way.
Symptoms of dorsalgia or dorsal pain
The pain of back pain is usually caused by a combination of causes, it is very rare that it is caused by only one and affects almost half of the adult population at some point in life. Back pain or dorsalgia is usually felt on one side of the back or the other, although it can also be bilateral.
The most frequent symptoms of back pain are found in the upper area of the back, between the shoulder blades, which many patients describe colloquially as “shoulder blades“. It is a problem with a great tendency to chronicity, which causes dull pain and more frequent constant at the end of the day even during rest, which can worsen due to some posture, and it is very characteristic that the patient feels relief when pressing the area with force “until noticing a pain that relieves”.
Causes of back pain
The causes of back pain at the dorsal level are varied:
- Back pain can be caused by maintaining poor posture for a long period of time, especially when sitting down, repetitive coughing, sudden turns or exposure to cold.
- Continued stress and emotional somatization are usually a fairly frequent reason for back pain, since as it is a tonic and postural smooth muscle, it is highly anatomically and physiologically influenced by the autonomic vegetative system (sympathetic and parasympathetic), which makes it especially susceptible to emotional influences. These cases of stress that affect the dorsal area must have a special treatment using medicinal plants.
- Existing spinal deformities, people with a kyphotic tendency, scoliosis or an excessively flat back may have a higher susceptibility to back pain although it is not a primary trigger.
Myofascial trigger points at the dorsal level, trigger points represent localized pain areas that radiate to other areas. At the dorsal level there are several that are relevant.
- Autoimmune diseases , such as ankylosing spondylitis or rheumatoid arthritis , attack the spine and therefore can be related to the most severe cases of back pain that are easily diagnosed by the doctor.
- Herniated discs or degenerative disc processes, although it is the area of the spine with the least predisposition to suffer from these disc problems, they also occur and can trigger or aggravate back pain.
Although it is very rare, it is important to see a doctor if the back pain persists over time. Some type of pathology that is not related to the field of action of the physiotherapist must be ruled out, since the symptoms can also be caused by serious illnesses such as cancer or pneumonia.
Diagnosis of back pain
The physiotherapist will always proceed to carry out a physical examination to evaluate the spine in its entirety, the muscles, bones and mobility of the spine, which is usually sufficient if it is a back pain that does not have a serious cause. If there is a deformity at the level of the scapulae, as in the “winged scapula” syndrome, the evaluation should be more exhaustive, in the same way if there is an upper cruciate syndrome.
In general, the palpatory examination will determine in which region the contracted and fibrosed muscles are located.
It is highly recommended to carry out an X-ray to assess the state of the bony components of the spine, possible kyphotic deformities or flat back, scoliosis or to evaluate the intervertebral joints as well as the discs and vertebral bodies, thus ruling out any serious and infrequent problem such as it may be a tumor.
In more severe cases, the following tests may be required: MRI and CT if a herniated disc is suspected, or X-rays for possible fractures or congenital bone abnormalities. It is possible that the patient suffers from non-specific back pain, where diagnostic tests (MRI, CT, etc.) do not show a specific injury or inflammation.
Physiotherapy treatment of back pain
The priority treatment of back pain is normally the relief of the pain that occurs. In general, the doctor will prescribe anti-inflammatory drugs (NSAIDs, corticosteroids, analgesics, etc.) that usually provide little relief and if there is an improvement, it is usually temporary, since they do not act on the cause of the problem. Therefore, the best thing to do would be to go to a physiotherapist to treat the pain, which is usually triggered by more than one cause.
The most used techniques for the treatment of back pain are decontracting massage, stretching, location of trigger points, myofascial therapy, application of heat in the area to cause relaxation of the muscles and spinal manipulation using high speed and short manual techniques. amplitude (osteopathy), which will also be used with special relevance in cases of joint block.
Another relevant technique such as dry needling for the treatment of trigger points is one of the most used today, and the symptoms of back pain can disappear within a few days.
To continue, all patients must improve their posture to avoid bad positions such as ” going stooped “, especially while sitting, so they will be taught postural hygiene as a preventive and treatment measure at the same time.
There are a variety of instrumental treatments, such as laser or tecar therapy within physiotherapy for the acute treatment of back pain, as well as specific applications of neuromuscular bandage or kinesio taping to relax the dorsal muscles.
Recommended videos if you suffer from back pain
We leave you with a series of recommended videos to work on back pain with exercises, stretching and massages, it is important in the case of exercises to take into account the repetitions that the patient can do, remember that all organisms are not the same.
3 exercises for thoracic kyphosis and body posture.
Dorsal kyphosis is one of the most frequent alterations of correct body posture. We teach you 4 exercises for this problem:
Dorsalgia or back pain – Treatment with exercises, stretching and massage
A routine of exercises, stretching and self-massages for the treatment of dorsalgia or dorsal pain is presented:
Summary of dorsalgia or dorsal pain
- Dorsalgia is characterized above all by interscapular pain that can go up to the neck or arms, that is, in the area between the cervical and lumbar spine.
- A differential diagnosis must be made, evaluating the entire spine, because it can be due to visceral, muscular or bone disease.
- The treatment of back pain is mainly based on relieving pain and working on the cause of the pain so that it does not occur again.
- The cervical spine is generally involved in back pain, it results from the connection of the dorsal area with muscles such as the trapezius or levator scapulae that have a high tendency to be tense or contracted.
- The evaluation of myofascial trigger points is essential in cases of back pain.
- Back pain treatments can be carried out with very effective self-massage and self-stretching at home.
- Treatment for back pain will be successful with the help of a physical therapist.
- Postural habits, prolonged sitting, the mattress and other things or activities of daily life that may be generating back pain should be improved.