When is thoracic pain NOT thoracic pain? About 95% of the time, because it’s thoracic pain that is “referred” from your neck. Yes, this is counterintuitive and it still fools many chiropractors, physical therapists and non-spine specialists. But this counterintuitive fact is long and well-established. Pain physicians know this well because the original experiments were performed by injecting various areas of the spine and documenting where patients felt the pain. And all of this data was mapped out into what we now call myofascial pain patterns.
The good news is that instead of chasing thoracic pain, you can usually ignore it, treat the neck effectively, and watch the thoracic pain melt away. And that’s also good because treating thoracic problems is difficult. There is one thoracic region that is a common, real thoracic problem. And that id what we call thoracolumbar problems. This is an area above your low back and below the bottom of your shoulder blades. It is a transitional area of the spine, meaning that this area is not specialed for bending back and forth, like the low back. And it isn’t specialized for twisting or side bending, like the thoracic area. Therefore, it is subject to extra risk because it has to do both kinds of movements, without specializing in either. Hence, it is commonly injured by twisting, such as to reach into the back seat of your vehicle, or twisting and throwing something.
That reminds me that I should define injuries. As you know, most injuries to our bodies are not broken bones, i.e. fractures. Instead, most injuries involve a movement that imparts a pulling or tensile force to soft tissues like muscles, ligaments, tendons, fascia, etc. And as you can imagine, soft tissues can tear. I liken them to rubber bands. Imagine tearing a rubber band in any of three ways: you can pull it too far, so it fails; you can pull it and hold it in a stretched position for too long, until it fails; or you can pull it repeatedly too many times in too short a time frame and make it fail. These processes are analogous to the various postures and activities in which we participate, and it would be constructive to think of our biological tissues as rubber bands in so far as this conceptualization can help us respect our limits and reduce injury risk.
Back to thoracic pain. All spine specialists learn about referred pain patterns in school. But I think the idea is so counterintuitive, that without repetitive training and repetitive clinical demonstration in real patients, it can escape appreciation. I must say that without an effective neck treatment that works dramatically well, clinicians may not witness this connection time and again the way I have. And the reason I have so much confidence in this referred pain pattern is because I use spinal decompression for neck problems, and it works so fast, and so effectively that it cannot escape my attention.
