*Disclaimer: This post does not in any shape or form substitute a consultation with a healthcare professional. Please seek a health professional if you are experiencing thoracic pain*

The thoracic spine, referred to as the middle back and upper back, connects the cervical spine (neck) and the lumbar spine (low back). It is the spinal region that the rib cage is attached to. Neck pain and low back pain have been in the spotlight and subjects for research, however thoracic back pain is less talked about. The thoracic spine anchors the rib cage which protects our vital organs, that is one of many reasons the thoracic spine is important.

Thoracic pain and red flags
Like many pain conditions, there are a series of “red flags”, clinical indicators of serious pathology, that are associated with thoracic pain that could warrant immediate medical attention. There are red flags for serious spinal pathology such as recent trauma from a motor vehicle accident or lifting injury, recent bacterial infection and structural deformity etc… There are also red flags that would indicate possible pathology in other organ systems such as sudden upper back pain unrelieved with rest, epigastric area to the middle thoracic spine and aggravated by meals etc.. The conclusion is, thoracic pain should not be taken lightly and a thorough assessment should be conducted by a health care professional.
Thoracic pain and musculoskeletal pain
Thoracic pain may also be manifested from less sinister causes. For instance, strain and sprains, poor posture sitting in front of the computer, postural changes from wearing a backpack and even pain from the cervical spine joints can refer to the upper thoracic spine. There are many exercises that could manage and treat thoracic pain; and your exercise program should be tailored to your specific condition. Below are a few ways to help thoracic pain.

Strategies and tips to improve thoracic pain
(1) Increase awareness the way you breathe:Previously we have spoken about diaphragmatic breathing; and breathing of course also involve your ribs and thoracic spine. Respiratory movements and mechanics allow thoracic expansion, which is your ribcage expanding when you inhale. The main respiratory movements happening in the ribs, influenced by the thoracic spine, are the pump handle movement and bucket handle movement. In brief, the lower ribs move in a bucket handle movement and as we move up the ribcage, the pump handle movement dominates.

When breathing, we must also be conscious about rib movements as well and therefore lateral coastal breathing should also be practiced. This breathing exercise may also help with improving stiffness in the thoracic spine and rib cage.

Lateral expansion breathing exercise (how to)

  • In sitting, ensure that your shoulders are relaxed, and ribs are stacked (Imaging your ribs are rings and are properly stacked one on top of the other)
  • Inhale and feel your ribs moving outwards as you fill your lungs. Focus on opening your thorax laterally. You may also place your hands on your lower ribs to feel the movement.
  • Exhale and relax.

(2) Improve your posture and your work station:
A few important factors that could contribute to thoracic spine pain that should be considered:
Sitting weight distribution – Sit with your weight evenly distributed on both of your sitting bones. If you are favoring one side more than the other, this can shift your entire torso and your ribs would not be stacked nicely, like rings on top of each other.
Arm and hand placement – if your keyboard or mouse are too far from you and you find yourself reaching forward, this could also shift your torso.
Monitor height – if you need to look down to your monitor, this may cause a muscular pulling sensation behind your neck and upper back and increases the curvature of your cervical spine and secondarily your thoracic spine. We want to create less stress on your joints, muscles and nerves therefore your monitor should be at eye level.
Taking breaks and moving – It is important to take breaks, move and change postures because again, we would like to minimize prolonged loading and stress in your joints and muscles.


Briggs, A. M., Smith, A. J., Straker, L. M., & Bragge, P. (2009). Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC musculoskeletal disorders, 10, 77. https://doi.org/10.1186/1471-2474-10-77

Heneghan, N. R., Lokhaug, S. M., Tyros, I., Longvastøl, S., & Rushton, A. (2020). Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ open sport & exercise medicine, 6(1), e000713. https://doi.org/10.1136/bmjsem-2019-000713

Louw, A., & Schmidt, S. G. (2015). Chronic pain and the thoracic spine. The Journal of manual & manipulative therapy, 23(3), 162–168. https://doi.org/10.1179/2042618615Y.0000000006

Tidy, C. (2020, April 2). Thoracic Back Pain: Symptoms, Causes and Treatment. Patient.info. https://patient.info/bones-joints-muscles/back-and-spine-pain/thoracic-back-pain#.