Upper backŞişli, Istanbul
Thoracic disc herniation treatment
A thoracic disc herniation is inner disc material pushing through the outer ring in the upper back. It is far rarer than lumbar or cervical herniations, because the ribs stabilise this region and limit its movement.
Also known as: Thoracic disc herniation, upper back disc prolapse
What is it?
The thoracic spine joins the ribs to form the chest cavity, a structure that gives the region marked stability and limits its range of motion. As a result the bending load on thoracic discs is lower and herniations here account for only a very small proportion of all disc herniations.
A distinguishing feature is that pain can radiate forward along the rib line in a band-like distribution. That pattern is sometimes confused with pain of cardiac, pulmonary or gastric origin, so ruling out visceral causes is an important part of the assessment.
Because the spinal cord passes directly through this region, large herniations can produce neurological signs affecting the legs. Where there is leg weakness, unsteady walking or any change in bladder or bowel control, physiotherapy is deferred and medical assessment takes priority. In the absence of these signs, conservative treatment is safe and effective.
Symptoms
- Pain in the midline or to one side of the upper back
- Band-like radiation forward along the rib line
- Pain increased by deep breathing, coughing and sneezing
- Symptoms accentuated by twisting the trunk
- Pain worse lying supine and easing on sitting
- In more advanced cases, numbness or weakness in the legs
- Unsteady walking (a sign of cord compression)
Causes and risk factors
- Age-related disc degeneration
- Repetitive twisting and bending movements
- Sudden heavy lifting or trauma
- Increased thoracic kyphosis and postural loading
- Vertebral changes developing on a background of osteoporosis
- Prolonged forward-leaning work positions
The assessment
The first priority is checking neurological status. Leg strength, reflexes and gait are examined; where findings suggest cord compression, medical assessment takes precedence. Cardiac, pulmonary and gastrointestinal causes of pain are also explored.
The thoracic spine is examined segment by segment, rib joint movement is checked and breathing pattern assessed. Which movements increase the pain is recorded, and that information determines how the programme is built.
Course of treatment
Weeks 0–3
Settling the pain
Twisting and bending movements that increase pain are temporarily limited. Gentle soft tissue techniques and breathing work are used. High-velocity manipulation is not applied in this period.
Weeks 3–8
Restoring movement
Controlled thoracic mobilisation gradually opens up range of motion, and rib joint movement is restored. Pain increased by breathing typically reduces markedly in this phase.
Weeks 8–14
Preparing for load
Trunk and scapular strengthening is progressively increased, and twisting and lifting movements are reintroduced in a controlled way.
Maintenance
Protection
A short daily routine preserving thoracic mobility, together with adjusted working positions, reduces the risk of recurrence.
How long does it take?
In cases without neurological signs, clear relief usually begins within four to eight weeks, with a programme of 10–16 sessions. Where there are signs of cord compression, treatment decisions are made together with a physician and surgical assessment is not delayed.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Weakness, numbness in the legs or unsteady walking
- Any change in bladder or bowel control
- Back pain with chest pain, breathlessness or palpitations
- Back pain with fever, weight loss or a history of cancer
- Severe back pain beginning after trauma
- Pain not relieved by rest at night and steadily increasing
Frequently asked questions
Are thoracic herniations common?
No, they are quite rare. The support provided by the ribs protects the discs in this region. Far more common causes of upper back pain are muscle strain, facet joint and rib joint problems, and these are assessed first.
The pain travels to the front of the chest — is this cardiac?
Thoracic pain can radiate forward along the rib line, which causes confusion. The distinguishing feature is that it changes with movement and breathing. Even so, cardiac causes of chest pain must be ruled out by a physician.
Can the upper back be manipulated?
High-velocity manipulation is not used with an active herniation or neurological signs. Gentle, controlled mobilisation is preferred and achieves the same gains in movement more safely.
There is pain on breathing — is this serious?
Back pain that increases with breathing is usually rib joint or muscular in origin and responds well to treatment. If it is accompanied by breathlessness, fever or cough, however, pulmonary causes must be excluded.
Methods used
Related conditions
Articles on this topic
Articles covering the topic in detail: symptoms, treatment, exercise and daily life.
- Diagnosis and symptoms· 6 min readWhat is a thoracic disc herniation and what are its symptoms?
- Treatment course· 6 min readNon-surgical treatment and physiotherapy in thoracic disc herniation
- Exercise· 6 min readExercise in thoracic disc herniation: breathing, mobility and endurance
- Treatment decision· 6 min readWhich upper back pain symptoms require urgent assessment?
- Daily living· 6 min readDaily life with thoracic herniation: lifting, sitting and breathing
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
No referral is required for assessment. Enquiries regarding Thoracic disc herniation treatment may be submitted via WhatsApp; available dates and times will be provided in response.