Thoracic pain - or a backstabbing colleague?
Introduction
The unfortunate consequences of excessive sitting abound. So too, the joys of any sort of work or hobby that sees you bending forward over a workbench, a desk, another person, a bar, or any other project, for big chunks of time. As soon as we tip our head and shoulders forward even slightly, there is a lot of extra load placed on the joints and muscles of the upper back. This leads to stiffness, aching, and sometimes back stabbing pains!
Anatomy
The section of spine from the base of your neck to your waist is called your thoracic spine. Pairs of joints all the way along our back join the series of vertebra that make up the spine. Strips of muscle run the length of our spines either side of the central column.
When we stand tall and side on, there is a slight outwards curve over our shoulder blades. This curve increases when we bend forwards, and decreases when we bend backwards. This ability to move depends on the joints and the ligaments that stabilize the joints being mobile.
What goes wrong?
Our head is heavy. One could argue that some heads are heavier than others if egos play a role, but the fact of the matter is, whether your brain is gainfully utilized or not, it is heavy. “Ten pound of dead meat” one of my Physio Instructors used to say.
The ‘dead meat’ on our shoulders is no issue if the head sits right on top of the rest of our body, but as soon as our head is even an inch or two forward from our central, straight position, a chain reaction of overload occurs. It begins with gravity.
Gravity plus a forward head (looking down, peering forward at a screen, honing in on a tricky bit of electrical wiring or ‘Angry Birds’) creates a force that pulls forward on our thoracic spine. The thoracic spine curls forward, and quite often stays there for great chunks of time. This puts stress on the joints. The muscles along our thoracic spine have to work consistently hard to hold us up and stop gravity leading us to face plant the desk. (“ ‘Gravity’ is not a good excuse to tell your boss as to why your head is on the desk snoozing, despite it being largely true.”)
After a while (weeks, months or years) the joints in our thoracic spine get so used to slumping forward that they lose their ability to bend back the other way. The ligaments around the joints get tight, and the muscles along the spine get so used to having to work hard, that they forget what relaxing is like. More joint stiffness leads to more muscle tightness, which creates more joint stiffness, which results in more muscle tightness…and so it goes on.
First, your posture suffers as you develop a permanent slump. Then you can develop an aching between your shoulder blades, which has you wriggling around. Sometimes you might move a certain way and get a sudden sharp pain in your back. It feels like someone is jabbing a knife inside your shoulder blade, and it ‘kills’ when you move. The sharp pain is created when a joint becomes irritated, by being made to move in a way that it is now too stiff to accommodate.
You may blame that shifty colleague for stabbing you in the back, but in reality, it’s your own bad posture that is to blame!
What can be done to prevent this?
If my advice was to avoid jobs that involve prolonged postures, we would all be out of work (good for the social life, but terrible for the bank balance.)
My advice, therefore, revolves around minimizing the effects of our activities on our thoracic spines.
Workstation set up comes in to play. The ultimate goal is to set things up so that your head stays back on top of your shoulders, rather than sneaking out forward of your body. This encourages your thoracic spine to stay upright rather than slumped forward. This could mean a higher computer screen, an inclined drafting board for drawing, or simply sitting in closer to the action.
Workstation setup is only part of the deal though – the rest of the correction has to come from you and your habits! Even with the best ergonomic set up in the world, your head will still travel forwards if you let it. Also, breaking up your prolonged positions with other jobs and postures is one of the best ways of minimizing the cumulative trauma on your back.
Finally, arching the upper back over the backrest of your chair, and twisting your upper body around in the chair, are great ways to keep mobility in your thoracic spine.
For more information, or any questions, email enquiries@physios-online.com.
Karen Finnin
Musculoskeletal Physiotherapist
BAppSc(Physio), MMuscPhys
karen@physios-online.com