Upper Back

At Walker and Hall we know through personal experience how any condition affecting the upper back can have an enormous effect on every aspect of your life e.g., from caring for yourself and family, to work, to sports and leisure activities and even just on your concentration.

The most common types of upper back pain we treat are

Thoracic Spine Postural Syndrome
Thoracic Spine Joint Sprain – 1. Thoracic Spine Facet joint Sprain
2. Thoracic Spine Costo-vertebral Joint Sprain
Thoracic Spine Muscle Strains – 1. Intercostal Muscle Strain
2. Internal Oblique muscle Strain
Stiff and Painful Thoracic Spine
T4 Syndrome
Thoracic Spine Disc Prolapse
Thoracic Spine Fracture
Fractured Rib
Scheuermann’s Disease

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below:

• Thoracic Spine Postural Syndrome
• Thoracic Spine Joint Sprain – 1. Thoracic Spine Facet joint Sprain
• Thoracic Spine Costo-vertebral Joint Sprain
• Thoracic Spine Muscle Strains – 1. Intercostal Muscle Strain
• Internal Oblique muscle Strain
• Stiff and Painful Thoracic Spine
• T4 Syndrome
• Thoracic Spine Disc Prolapse
• Thoracic Spine Fracture
• Fractured Rib
• Scheuermann’s Disease

Thoracic postural syndrome (also known as postural dysfunction)

Thoracic postural syndrome is a common condition that causes pain in the upper back without there being significant damage or trauma to the soft tissues. It occurs as a result of a sustained stretch of the joints and muscles of the upper back which if held for too long becomes painful.

We know at Walker and Hall how this type of condition can affect all aspects of your lifestyle from commuting, to working at a computer to leisure activities.

Fortunately thoracic postural syndrome responds well to physiotherapy treatment.

Causes of thoracic postural syndrome

• Poor posture over a prolonged period of time. This may occur in any position such as standing or lying, but in our experience is particularly common when sitting e.g., at a computer or when driving. The adoption of poor posture places a stretching force on the joints and muscles of your upper back and neck and with time will gradually cause an ache and or pain. This is known as thoracic postural syndrome.

Thoracic postural syndrome is common during everyday activities that encourage the arms to move forward in front of the body such as cooking, cleaning or ironing. In sport, thoracic postural syndrome is often seen in athletes whose activity involves prolonged bending forward such as cycling, in hockey players and in wicket keepers in cricket.

Signs and symptoms of thoracic postural syndrome

In our experience the symptoms are only experienced when poor posture is maintained for prolonged periods and include

• Pain – this is typically experienced as a dull ache or burning sensation over the upper back and may with time spread to the neck, lower back or shoulders.

Usually the pain will quickly ease on moving or changing positions, thereby taking the strain off the affected structures.

• Full range pain free movement. With this syndrome the joints of the upper back and neck do not become stiff or painful so you would not expect to suffer any loss of movement.

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which structure(s) in the upper back are causing the postural syndrome, although most people will experience little or no pain once their posture is corrected.

This is essential if the optimum recovery is to be achieved and it is important that your posture is corrected during provocative activities in order to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a thoracic postural syndrome include

• postural education including the use of a lumbar roll for sitting
• a home exercise programme to improve posture, flexibility and strength
• joint mobilization techniques to improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• the use of an appropriate pillow for sleeping
• activity modification advice
• anti-inflammatory advice

Thoracic Spine Joint Sprain 1 – Facet Joint Sprain (also known as Thoracic Facet Joint Sprain, Zygapophyseal Joint Sprain, Sprained Facet Joint, Facet Joint Dysfunction, Facet Joint Pain, Apophyseal Joint Sprain)

At Walker and Hall we know through personal experience how painful a joint sprain of the thoracic spine can be. It can affect all aspects of your life from sitting and working, to activities at home to leisure activities. It can even affect breathing, coughing and sneezing!

Anatomy

The thoracic spine comprises 12 bones (vertebrae) numbered 1 to 12 from the top down. Each vertebra connects to the vertebra above and below by two joints at the back (facet joints) and a disc in the middle (intervertebral disc). These joints are designed to support body weight and enable spinal movement. Each facet joint is made of smooth cartilage which lies between the bony joint surfaces and cushions the impact of one bone on another. Strong connective tissue also wraps around the bony ends providing support to the joint.

During certain movements of the spine, stretching or compressive forces impinge on the facet joints. If these forces are excessive and beyond what the joint can withstand, injury to the facet joint may occur. This may involve damage to the cartilage or tearing of the connective tissue surrounding the joint. This condition is known as a facet joint sprain.

Causes of a facet joint sprain

• Excessive bending, lifting, arching or twisting movements
• Trauma – such as a direct blow to the thoracic spine in sport
• Repetitive or prolonged forces including poor posture – such as slouched sitting for prolonged periods of time

Signs and symptoms of a facet joint sprain

• Pain – either a sudden onset of back pain during the aggravating activity or after the activity e.g., on waking the next day. It may be felt on one side of the spine and muscle spasm may be felt around the affected joint. There may be referral of pain to the shoulder blades, ribs, chest and or upper limbs. The pain may be increased with activities that involve twisting, lifting, arching backwards, bending forwards or sideways, sitting for prolonged periods of time (particularly in poor posture), coughing or sneezing.
• Muscle spasm – often felt around the joint that has been sprained
• Stiffness and a loss of movement – this will mainly be in the thoracic spine. However it may also affect other joints such as the lumbar spine and the shoulders, particularly lifting the arms above your head

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which joint(s) in the thoracic spine is involved. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a thoracic facet joint sprain include:

• soft tissue massage to reduce pain and muscle spasm
• joint mobilization techniques to reduce pain and improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Thoracic Spine Joint Sprain 2 – Costovertebral Joint Sprain (also known as Sprained Costovertebral Joint, Costovertebral Joint Dysfunction, Costovertebral Joint Injury, CV Joint Sprain)

At walker and Hall we know through personal experience how painful a costovertebral joint sprain can be. It can affect all aspects of your life from sitting and working, to activities at home to leisure activities. It can even affect breathing, coughing and sneezing!

Anatomy

The thoracic spine comprises 12 bones (vertebrae) numbered 1 to 12 from the top down. Each vertebra connects to the vertebra above and below by two joints at the back (facet joints) and a disc in the middle (intervertebral disc). These joints are designed to support body weight and enable spinal movement. Each vertebra also connects to a rib on either side of the spine via the costovertebral joint. Each costovertebral joint comprises smooth cartilage which lies between the bony joint surfaces cushioning the impact of one bone (the rib) on another (the vertebra). The joint is then supported by strong connective tissue.

During certain movements of the rib cage and spine, stretching and compressive forces are placed on the costovertebral joints. If these forces are excessive and beyond what the joint can withstand, injury to the costovertebral joint may occur. This may involve damage to the cartilage or tearing of the connective tissue surrounding the joint. This condition is known as a costovertebral joint strain.

Causes of a costovertebral joint strain

• Excessive bending, lifting, arching and twisting movements which may occur traumatically or due to repetitive and or prolonged forces.

Signs and symptoms of a costovertebral joint strain

• Pain – this may appear as a sudden onset upper back and rib pain during the aggravating activity. However, occasionally it may be felt after the aggravating activity especially the following morning. It is typically felt on one side of the spine and rib cage, or it may be referred along the length of the rib into the chest, into the shoulder blade and occasionally into the upper limb. It is made worse by coughing, sneezing, deep breathing, twisting, lifting, arching backwards, bending forwards or bending sideways
• Muscle spasm – this will be felt around the affected joint

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which costovertebral joint(s) is involved. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a costovertebral joint strain include:

• soft tissue massage to reduce pain and muscle spasm
• joint mobilization techniques to reduce pain and improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Thoracic Spine Muscle Strain 1 – Intercostal Muscle Strain (also known as an Intercostal Strain, Intercostal Muscle Tear, Torn Intercostal, Muscle strain)

An intercostal muscle strain is a condition that is commonly seen in cricket fast bowlers and is characterized by a tear in one of the muscles located between the ribs – known as the intercostal muscles.

It can be extremely painful but in our experience it does respond very well to the appropriate physiotherapy treatment.

Anatomy

The chest comprises of 12 pairs of ribs. Each rib attaches to the spine at the back of the body and then passes around to the front of the chest. The top 7 ribs attach to the sternum (breastbone), ribs 8 to 10 attach to the ribs above via cartilage and ribs 11 and 12 are called ‘floating’ ribs because they are only attached to the spine at the back.

There are many muscles in the abdomen, shoulder girdle and back that attach to one or more of the ribs. The intercostal muscles are a group of muscles that run between the ribs, attaching from the rib above to the rib below and are mainly responsible for lifting the ribs (when breathing in) and forming the chest wall.
During contraction or stretching of the intercostal muscles, tension is placed through the muscles. When this tension is excessive due to too much repetition or high force, a tear in one or more of the intercostal muscles may occur. This condition is known as an intercostal strain.

Cause of an intercostal muscle strain

• Sudden muscle contraction – this occurs in sports such as cricket following a forceful bowling spell, in athletics and javelin throwing and rowing, where the intercostal muscles contract suddenly whilst been in a stretched position
• Excessive and or repetitive activity – such as over-training and during activities involving excessive side bending and twisting forces
• Trauma – following direct impact to the ribs, forcing the ribs apart such as a collision in contact sports or due to a motor vehicle accident

Signs and symptoms of an intercostal muscle strain

• Pain – a sudden onset, sharp pain or pulling sensation in the side of the chest (often in the region of the lower ribs) during the aggravating activity. Typically it occurs suddenly e.g., in cricket during a forceful bowling spell, but may also occur gradually over time e.g., over the course of a match or training sessionWith a mild strain you may be able to continue the aggravating activity with only an increase in symptoms when cooling down. With a more severe case you may be unable to continue the activity. The pain typically increases with activities that place strain on the intercostal muscles and these may include bowling, throwing, heavy lifting, rowing, side sit ups, twisting, turning or side bending. It is also common to experience pain and or stiffness after these activities with rest, especially on waking the following morning. With the more severe cases deep breathing, laughing, coughing and sneezing may all increase the symptoms.
• Swelling, muscle spasm, weakness and bruising in the side of the chest – these may all be present with an intercostal muscle strain

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the intercostal muscle strain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for an intercostal muscle strain include

• Pain relieving techniques e.g., electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Thoracic spine and thorax mobilizing techniques e.g., stretching and muscle release techniques.
• Home exercise program – it is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your back moving.
• Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Thoracic Spine Muscle Strain 2 – Side Strain (also known as Back Side Strain, Abdominal Side Strain, Internal Oblique Strain, Internal Oblique Tear, Torn Internal Oblique Muscle)

A side strain is a condition that is commonly seen in cricket and athletics and is characterized by a tear in one of the side abdominal muscles where it attaches to the ribs.

It can be extremely painful however in our experience it does respond very well to the appropriate physiotherapy treatment.

Anatomy

The chest comprises 12 pairs of ribs. Each rib attaches to the spine at the back of the body and then passes around to the front of the chest. The top 7 ribs attach to the sternum (breastbone), ribs 8 to 10 attach to the ribs above via cartilage and ribs 11 and 12 are called ‘floating’ ribs because they are only attached to the spine at the back.

There are many muscles in the abdomen, shoulder girdle and back that attach to one or more of the ribs. One such set are the internal oblique muscles which attach above to the ribs and rib cartilages of ribs 8 to 12 and below to the pelvis (iliac crest) and the strong connective tissue of the lower back (thoracolumbar fascia). It acts to side bend the trunk and rotate the trunk to the same side.

During contraction or stretch of the internal oblique muscles, tension is placed through the muscle. When this tension is excessive due to too much repetition or high force, the internal oblique muscles can tear. This is known as a side strain. Side strains typically involve tearing of the internal oblique muscle at its rib or rib cartilage insertion on the side of the body at ribs 9, 10 or 11.

Cause of a side strain

• Sudden muscle contraction – this occurs in sports such as cricket following a forceful bowling spell, in athletics and javelin throwing and rowing, where the internal oblique muscle contracts suddenly whilst in a stretched position
• Excessive and or repetitive activity – such as over training and during activities involving excessive side bending and twisting forces

Signs and symptoms of a side strain

• Pain – this presents as a sudden, sharp pain or pulling sensation in the side of the chest near the lower ribs or abdomen during the aggravating activity. It may occur suddenly e.g., during a forceful bowling spell or gradually over time e.g., over the course of a match or training session. In minor cases you may be able to continue with the activity and only have an increase in symptoms when cooling down. In more severe cases you may be unable to continue the activity at all
• With this type of muscle strain the pain increases with activities that place strain on the internal oblique muscle. This may include bowling, throwing, heavy lifting, rowing, side sit ups, twisting, turning or side bending. It is also common for you to experience pain and or stiffness after the aggravating activities with rest, especially on waking the following morning. With the more severe cases deep breathing, laughing, coughing and sneezing may all increase the symptoms.
• Swelling, muscle spasm, weakness and bruising in the side abdominal region – these may all be present with an internal oblique muscle strain

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the internal oblique muscle strain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for an internal oblique muscle strain include

• Pain relieving techniques e.g., electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
• Thoracic spine and thorax mobilizing techniques e.g., stretching and muscle release techniques.
• Home exercise programme – it is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your back moving.
• Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Stiff and painful Thoracic spine (also known as Osteoarthritis of the Thoracic spine, Thoracic Spondylosis and Arthritis)

A stiff and painful thoracic spine (often given the diagnosis of thoracic spondylosis) is basically ‘wear and tear’ of the bones and discs in the mid upper back. It is a normal part of ageing and does not cause symptoms in everybody.

Anatomy

The mid upper back comprises 12 bones (vertebrae) numbered 1 to 12 from the top down. They are joined to each other with two joints at the back (facet joints) and a disc in the middle at the front (intervertebral disc). Ligaments and muscles pass between adjacent bones and over the mid upper back to provide support and movement. Behind the disc is the spinal cord. This is a large structure that is made of nerves which pass messages from your brain to the whole of the body. At each level between adjacent vertebrae a pair of nerves emerge and pass around the chest. These nerves send messages to the muscles to cause movement and provide sensation to the skin.

Causes of a stiff and painful Thoracic spine

In the case of Thoracic spondylosis the symptoms are caused by age related “wear and tear” in the vertebrae and discs. This is nothing unusual and depending upon your life style, occupation and sporting activities. This “wear and tear” can begin to develop from the age of 30.

As we get older the edges of the vertebrae start to develop small rough areas called osteophytes and the intervertebral discs become thinner. This is known as degeneration. As the degeneration progresses these rough areas of bone begin to press upon the ligaments, muscles and nerves in the mid upper back and you begin to experience pain and stiffness.

Signs and Symptoms of a stiff and painful Thoracic spine

• Stiffness in the mid upper back, particularly on waking, and often getting worse towards the end of the day
• Pain – most commonly felt over the mid upper back but sometimes over the front of the chest as well. It may just be in the mid upper back but may also be referred into the shoulders, shoulder blades and occasionally the arms. It may be one side of the back with the symptoms spreading into one side of the chest or over the mid upper back as a whole and spread all around the chest. It is often made worse with movement. It often “comes and goes”, sometimes being associated with a particular activity following which your mid upper back feels painful. In a few people the pain will become chronic (persistent).
• Pins, needles and numbness in the mid upper back, chest and even the arms, this can be caused by irritation of a nerve as it leaves the spine

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which structure(s) in the mid upper back are causing the stiffness and pain. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a stiff and painful upper back include:

• joint mobilization techniques to improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility, strength and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

T4 Syndrome

At Walker and Hall we know through personal experience how painful T4 Syndrome can be and how it can affect all aspects of your life from lifting to sitting and driving and even coughing or sneezing.

Fortunately it is a condition that responds well to the appropriate physiotherapy management.

Anatomy

The upper back (the thoracic spine) consists of 12 bones (vertebrae) numbered 1 to 12 from the top down and runs from the base of the neck (the cervical spine) to the top of the lower back (the lumbar spine). Each vertebra connects to the one above and below by two joints viz., a pair of bony joints on either side of the spine (facet joints) and a disc in the middle. These joints are designed to support body weight and enable movement of the spine. Lying close to the joints are nerves and if there is a problem with the joints then the nerves can become damaged or irritated. During certain movements of the spine, stretching and compressive forces are placed on the facet joints and discs at the T4 level. If these forces are excessive and beyond what the joints can withstand, injury to the facet joints and or discs may occur. If this is the case then the nerves lying close to the joints can also be irritated and or damaged and this may cause diffuse arm pain, pins and needles and or numbness in the upper arm. This is known as T4 Syndrome.

Causes of T4 syndrome

• Trauma – any incident that causes injury to the facet joints or disc at T4 level can cause T4 Syndrome
• Repetitive and or prolonged forces – activities such as excessive bending, lifting, arching and twisting movements can cause injury to the facet joints or disc at T4 level and thus cause T4 Syndrome
• Poor posture – in some ways this is a progression of thoracic postural syndrome. If postural advice is not taken initially then as the postural syndrome continues to develop further T4 Syndrome can be the result

Signs and symptoms of T4 syndrome

These symptoms may develop suddenly during the aggravating activity or following the activity e.g., waking the next morning. They may be aggravated by activities that involve twisting, lifting, leaning backwards, bending forwards and or sideways, sitting for prolonged periods, coughing or sneezing, and undertaking activities that involve using the hands in front of the body e.g., driving and ironing. They include

• Pain – often diffuse (widespread and not located in a specific area) and felt in one arm or on one side of the upper back, it may also affect both sides. The pain may radiate into the neck, shoulder blades, ribs and chest.
• Stiffness, restricted spinal movement and muscle spasm – this may be noticeable around the affected joints
• Pins, needles and numbness in the upper arms

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which structure(s) in the thoracic spine are causing the stiffness and pain. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for T4 syndrome include

• joint mobilization techniques to improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility, strength and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Thoracic Disc Prolapse (also known as Thoracic Disc Herniation, Slipped Disc, Thoracic Disc Bulge, Bulging Disc, Herniated Disc, Intervertebral Disc Injury, Sprained Disc)

At Walker and Hall we know how disabling a thoracic disc prolapse can be, affecting all aspects of your life from sitting and driving, to work to your leisure activities. Fortunately a thoracic disc bulge responds well to the appropriate physiotherapy treatment.

Anatomy

The thoracic spine (i.e. the mid and upper back) comprises 12 bones numbered 1 to 12 from the top down. Each bone is separated above and below by a disc which is made of layers of strong connective tissue (the annulus) wrapped around a soft jelly-like substance in the middle (the nucleus) and the nucleus is capable of changing shape. When the nucleus protrudes from the disc due to a tear in the connective tissue it is known as a thoracic disc bulge.

To understand the mechanism of a thoracic disc bulge, think of the disc as a “Jammy” doughnut where the top and bottom of the doughnut attach to the vertebrae above and below, and the jam in the middle represents the jelly-like substance (the nucleus) of the disc. If you pinch the front of the doughnut, you can imagine the jam being squeezed towards the back and if this is done repeatedly, the back of the doughnut (the disc) will become weaker and eventually the doughnut will start to bulge. In the disc, the situation is the same, Repeatedly bending forward squeezes the front of the disc, pushing the jelly-like substance towards the back. Overtime or suddenly this may lead to a thoracic disc bulge.

Causes of a thoracic disc bulge

• Forceful, repetitive and or prolonged strain – there are several activities undertaken on a daily basis that can cause a thoracic disc bulges such as bending forward, slouching, activities using your arms in front of the body e.g. washing dishes and driving, and lifting (especially in combination with twisting).
• Trivial movements – occasionally a thoracic disc bulges occurs following a trivial movement such as bending forward e.g., picking up a small object or sneezing. For such a trivial movement or activity to cause a thoracic disc bulge, the disc has normally already been weakened by repetitive and prolonged bending, slouching or lifting

Signs and symptoms of a thoracic disc bulge

• Pain – often sudden in onset and felt at the time of the incident or activity, however occasionally it may occur after the activity such as on waking the following morning. The pain tends to be in the mid back and or around the shoulder blades, and may be central, on one side or on both sides of the spine. Occasionally it may radiate around the ribs into the chest and even down the arms. It tends to increase with activities involving rotation, side bending, activities using your arms in front of your body, lifting, bending forwards and prolonged sitting (especially if slouched). Breathing, coughing and sneezing may also aggravate the pain.
• Muscle spasm, pins and needles, numbness or weakness – these may also be present with a thoracic disc bulge
• Deformity – in some cases you will notice that you are not standing straight when you stand up. This is because the pain from the disc bulge makes you stand with your spine noticeably out of alignment

How can Walker and Hall help you

A thorough musculoskeletal examination is required to determine which level of the thoracic spine is causing the pain. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a thoracic disc prolapse include:

• joint mobilization techniques to improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility, strength and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Thoracic Spine Fracture (also known as Thoracic Spine Compression Fracture, Thoracic Spine Wedge Fracture and Fracture of the Thoracic spine)

At Walker and Hall we know through personal experience how disabling a Thoracic Spine fracture can be, affecting all aspects of your life from sitting and driving, to work to your leisure activities. Fortunately with the appropriate medical and physiotherapy treatment these fractures make a good recovery.

Anatomy

The thoracic spine (i.e. the mid and upper back) comprises 12 bones (vertebrae) numbered 1 to 12 from the top down. Each individual vertebra consists of a large round structure at the front which is called the body (vertebral body) and a bony ring at the back.

During certain activities and with certain conditions such as osteoporosis, stretching and compressive forces are placed on the thoracic vertebrae and in particular the vertebral body. If these forces are excessive and beyond what the vertebral body can withstand, a fracture to the vertebra body may occur. This is known as a Thoracic Spine Fracture.

Causes of a Thoracic Spine Fracture

• Trauma – a forceful impact such as a fall onto the bottom or a blow to the top of the head such as hitting your head against the windscreen in a motor vehicle accident, can cause a fracture to the vertebral body. This type of injury tends to crack the back (posterior) part of the vertebral body.
• Disease – conditions that weaken the bone structure such as osteoporosis can cause weakness of the vertebral bodies which in turn can cause a fracture. Fractures from osteoporosis usually occur in the front (anterior) part of the vertebral body. Sometimes disease can weaken the bone to the point where even a mild force can lead to a fracture e.g., reaching down to pull on a pair of socks.

Signs and Symptoms of a Thoracic Spine Fracture

• Pain – if occurring as the result of a fracture due to osteoporosis, there may actually be little or no pain initially and when it does appear it often settles down completely after a few weeks. However if it is due to trauma, the pain can be sudden, sharp and intense, and it tends to be felt in the vertebra that has been fractured and may spread into the lower back and legs
• Loss of movement – this occurs in association with the pain and the fact that the facet joints are unable to move through their normal range of movement
• Muscle spasm – this occurs in association with the pain
• Deformity – with the collapse of the vertebrae the front of the vertebral body crumbles and causes it to become wedge-shaped. This change in shape angles the spine forward producing a hunch-backed appearance which is called a called kyphosis.

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which vertebral bodies are damaged and to what extent. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a thoracic spine fracture include

• advice with regards to achieving comfortable sitting, standing and sleeping postures
• pain relieving and anti-inflammatory advice. The appropriate pain relief is essential for comfort and anti-inflammatory medication may also significantly hasten the healing process. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
• joint mobilization techniques to improve the range of movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• a home exercise programme to improve flexibility, strength and posture

Fractured Rib (also known as a Broken Rib, Rib Fracture)

This is a relatively common injury and involves a break (fracture) in one or more of the rib bones that form the chest (thorax) and upper back. It will possibly be the only time in your life when you realise that you breathe up to 18 times per minute because with a fractured rib, every breath can be agony.

Anatomy

The chest (thorax) comprises of 12 pairs of rib bones, one on each side of the body. Each rib attaches to the spine (thoracic spine) at the back of the body and then travels around to the front of the chest. The top 7 ribs attach to the sternum, ribs 8 to 10 attach via cartilage to the ribs above and ribs 11 and 12 are known as ‘floating’ ribs as they are only attached at the back.

Following a direct blow to the front or side of the chest, or upper back, stress is placed on the ribs. If this stress is mild it can result in a bruised rib. However if the stress is more than the bones can withstand, then a fractured (broken) rib or ribs results. Occasionally if the fracture is severe and displaced it may result in damage to other organs of the body such as the lungs (e.g. a pneumothorax), liver, spleen or kidney.

Causes of a Fractured Rib

• Trauma – this is the main cause of a fractured rib and is often the result of a direct blow to the rib from an object or person. This is normally occurs due to a collision with another player during contact sports such as football or rugby, or from impact from a ball in sports such as hockey or cricket. A rib fracture(s) may also occur during other activities such as a motor vehicle accident or fall from a height.

Signs and symptoms of a Fractured Rib

• Pain – a sudden onset of sharp severe pain over the chest or in the side of the ribs at the time of injury which may occasionally radiate into the back, shoulder and neck. Activities such as lying on the affected side, touching the broken rib, deep breathing, coughing, laughing and sneezing may increase the pain. You may also experience pain during movements of the upper back such as bending and twisting and sometimes during certain activities involving the use of the arms such as overhead activities, heavy pushing, pulling and lifting.

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which ribs have been fractured. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a fractured rib include

• advice regarding comfortable sitting, standing and sleeping postures
• pain relieving and anti-inflammatory advice. The appropriate pain relief is essential for comfort and anti-inflammatory medication may also significantly hasten the healing process. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
• joint mobilization techniques to improve the range of movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• a home exercise programme to improve flexibility, strength and posture

Scheuermann’s Disease (also known as Osteochondrosis of the Thoracic spine)

This is a condition that presents as a postural abnormality characterized by an excessive curvature of the upper back (thoracic spine). It is osteochondrosis of the thoracic spine, which means it affects the bony growth and development of the thoracic spine at the growth plates.

Cause of Scheuermann’s disease

The causes of Scheuermann’s disease are not known.

Signs and symptoms of Scheuermann’s disease

This condition most often occurs during adolescence at a time of rapid growth and whilst it most frequently presents as acute back pain, occasionally it may be symptom free and not picked up until later in life. It tends to affect boys more often than girls. The common symptoms are

• Pain and stiffness – often felt in the upper back and more commonly experienced after a period of rapid growth. It is often mild to moderate in severity and may increase with physical activity
• Postural abnormalities – such as an excessive curvature of the upper back (thoracic kyphosis), and possibly a secondary compensatory excessive lumbar lordosis (increased arch in the lower back) may also be present

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine which level of the thoracic spine is affected. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for Scheuermann’s disease include

• joint mobilization techniques to improve the range of movements
• joint manipulation techniques to improve the range of joint movements
• soft tissue massage to reduce pain and muscle spasm
• electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
• postural education including the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• a home exercise programme to improve flexibility, strength and posture
• activity modification advice
• anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist