Thoracic pain refers to discomfort or stiffness in the mid-back region, between the base of the neck and the lower ribs.
Although less common than neck or low back pain, it affects up to 15–20% of the population at some point, and can arise from mechanical strain, postural overload, or referred pain from other regions.
The thoracic spine is unique — it connects to the rib cage, providing both stability and protection for the heart, lungs, and major vessels. Because of this structure, pain here may have musculoskeletal, respiratory, or visceral origins.
Most thoracic pain is mechanical, meaning it results from tension, restricted movement, or overload of joints, muscles, or fascia.
However, it’s important to differentiate these benign causes from more serious sources such as cardiac, pulmonary, or gastrointestinal conditions.
Dull, aching, or sharp pain between the shoulder blades or along the mid-back.
Stiffness or restriction during rotation, deep breathing, or bending.
Pain radiating around the ribs or chest wall.
Discomfort aggravated by posture (sitting, computer work, or lifting).
Occasionally, referred symptoms from the neck or lower back.
Functional impact:
Thoracic pain can limit breathing depth, posture, and upper limb mobility, often leading to fatigue or discomfort during daily tasks and exercise.
Red flags:
Chest pain associated with shortness of breath, sweating, dizziness, or radiating to the left arm/jaw may indicate cardiac involvement.
Pain with fever, coughing, or weight loss should be medically evaluated for infection, inflammation, or visceral pathology.
Thoracic pain is often multifactorial, influenced by lifestyle, posture, and mechanical imbalance:
Postural strain: prolonged sitting, forward head posture, or rounded shoulders.
Muscle imbalance: tight pectoral and upper trapezius muscles, weak scapular stabilizers.
Joint restriction: reduced mobility of thoracic vertebrae, costovertebral or costotransverse joints.
Breathing mechanics: shallow or upper-chest breathing reducing diaphragm motion.
Overuse or lifting strain.
Viscerosomatic reflexes: referred pain from the lungs, heart, or digestive organs.
Emotional stress: sustained tension in the thoracic and diaphragmatic region.
A key osteopathic insight is that thoracic dysfunction often coexists with neck, shoulder, or lumbar issues, forming part of a larger compensatory pattern.
Osteopathic management focuses on restoring thoracic mobility, improving breathing mechanics, and reducing mechanical strain on the surrounding structures.
An osteopathic assessment may include:
Evaluation of thoracic spine, ribs, diaphragm, and postural alignment.
Gentle joint mobilisation, soft-tissue, and myofascial techniques to improve flexibility and circulation.
Rib and costovertebral articulation to facilitate deep breathing and rib expansion.
Addressing related regions such as the cervical and lumbar spine for compensatory tension.
Breathing and posture education to support self-regulation and prevent recurrence.
The goal is to restore mobility and comfort, promote efficient respiration, and improve overall body mechanics — supporting both musculoskeletal and autonomic balance.
Recent research supports manual therapy and exercise for thoracic pain and mobility disorders, particularly when integrated with postural and respiratory retraining.
Osteopathic and spinal mobilisation techniques have been shown to improve pain, motion, and breathing function, with a strong safety profile.
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Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for thoracic and musculoskeletal pain: systematic review and meta-analysis. Pain Physician. 2021;24(3):305–318. Link
Cerritelli F, Esteves JE, Martelli M, et al. The effect of osteopathic manipulative treatment on respiratory function and autonomic balance: a randomized controlled trial. Complement Ther Med. 2022;66:102812. Link
Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for thoracic spine dysfunction: a network meta-analysis. Front Med. 2024;15:1507267. Link
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