Upper back and chest Pain

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Upper back and chest Pain

back pain

Your upper and middle back is called your thoracic spine. Although it is not as common as lower back and neck pain, many people still suffer from pain in their upper or middle back. Our modern lifestyles and working environments have resulted in an increase in people experiencing pain in this area. Long periods of sitting, sitting or working in awkward positions, or performing repeated activities can all place stress and pressure on your spine, causing pain and discomfort. The most common causes for pain in your upper and middle back will be discussed in the subsequent sections. Anyone experiencing upper or middle back pain will benefit from coming for physiotherapy treatment.

Your thoracic and chest area contains many of your vital organs including your heart and lungs. Rarely, pain in this area may indicate a more serious underlying issue. Physiotherapists are well trained to be able to identify signs of these more serious issues.

These more severe but very rare causes for pain in the horacic and chest area include infections, cancers, heart problems and gallbladder problems. These issues require medical treatment. During your visit at Just Physio, we ensure to pick up on any of these problems early on. If we suspect any serious problems, we will refer you to a medical specialist.

Postural Pain Syndrome

back pain

Certain postures and living a sedentary lifestyle can cause changes in the posture, position and dynamics of your spine. The typical posture we see nowadays is a more slouched, forward leaning posture. This posture generally comes from sitting for too long, working on our electronic devices, or driving, which are the things we mostly do during our daily lives. Over time, your body adapts to
these positions.

Slouching postures cause tension and thus weakness of the muscles at the back of your neck and spine. These muscles then become deconditioned in keeping you upright. As the tension builds up, you might start to experience pain and discomfort. If you continue to position yourself in this way, further strain and pressure is placed on your muscles, but also on your ligaments, vertebrae, discs and nerves. This may lead to more pain and other complications.

The good news is that upper and middle back pain caused by postural tension can be managed and treated quite successfully. Our treatments at Just Physio may consist of a variety of techniques. We may decide to release muscle and connective tissue tightness or restrictions using massage, fascia release, heat or ice application, electrotherapeutic modalities, dry needling, exercises and stretches and breathwork. Conditioning your back muscles for improved strength and endurance is vital. Your back muscles must be able to keep you upright. Simply by becoming aware of your posture and adopting a better posture will start to condition these muscles. If they are not used to doing this, they may feel tired fairly quickly. However, with time you will realise that the muscles get stronger. Another very effective way to prevent muscular tension is to take frequent breaks from a sitting position. Stand up, move, stretch and take a few deep breaths at least every hour.

The joints of the thoracic spine may be stiff and contribute to the problem. Since your ribs attach to your upper back, you may have pain or discomfort when taking a deep breath or when pushing on your ribs. This might create a sense of fear in some people. However, simply improving the mobility of your spinal joints can relieve all of these symptoms. We can assist in improving your spinal mobility by performing manual spinal mobilisations and/or manipulations, doing muscle and fascia release, applying heat, needling trigger points in surrounding muscles, and providing you with specific exercises and stretches.

We want to ensure that you ultimately become pain free, are able to maintain your health and prevent problems later on. Therefore, we will advise you on ways to adapt your daily activities in such a way to reduce the risk of recurring pain and discomfort. We can provide you with information on handling and lifting techniques, on ergonomics including sitting postures and how to structure your working environment more effectively, as well as on sport or hobby specific practices.

Pinched nerve

Our thoracic spine, which is the middle and upper back, is made up of 12 bony segments called the vertebrae. Each of these vertebrae have small joints on either side through which several nerves pass. These intricate structures work so closely together to allow us to function properly. Our ribcage must be mobile and able to expand for us to breathe, as well as to allow for upper body and arm movement. Sudden movement, trauma, degeneration, or repetitive straining can cause damage to any of these spinal structures.

When the nerves become injured or irritated by other structures pressing or pulling on them, they cause pain and other neurological symptoms. Occasionally, a sudden single movement like lifting something heavy or twisting your spine awkwardly can injure a nerve. Tiny insignificant injuries can also build up little by little to cause pain over time. These tiny injuries can be caused by routine daily activities, postures or habits that place high loads and strain on your spine repeatedly.

Nerve pain is characteristically vague and fairly constant. This pain can be felt in your upper back, chest area, arm or even your neck. Typical nerve injury also causes neurological symptoms which may include pins and needles, numbness, weakness or a feeling of heaviness of your arms. You may feel tightness in your upper back, especially in the mornings. The area in which you experience symptoms will depend on which of the nerves are injured.

Symptoms associated with a pinched nerve can make it difficult to bend and twist your spine, or to sit in one position for a long time. This is a problem for many people who are required to sit for extended periods, drive, or assume awkward positions (like leaning over to one side) during work. If you find yourself in a similar situation, you may find benefit in giving us a visit. We will help you identify potential factors that put you at risk for future injury, and ultimately provide you with advice on how to adapt or change these.

If you already experience pain and other neurological symptoms, please make an appointment with us as soon as possible. Nerve injuries tend to take longer to recover than soft tissue injuries. Therefore, the earlier you seek help, the better your recovery will be. Our treatment will firstly focus on helping you understand your situation, relieving your pain, and getting you to move better. In advanced cases, where you might already have severe neurological symptoms, we may suggest taking things easy for a short period of time. We will help relieve your pain with treatments such as massage, heat and/or ice, electrotherapeutic modalities, light spinal mobilisations, taping, dry needling, stretches, and nerve mobilisations. As your symptoms improve, we will include further exercise therapy to improve your posture and address any muscle weaknesses or tightness.

Rib and sternum injuries (fractures, contusions)

back pain

Rib injuries are usually caused by traumatic events. Vehicle accidents, falling from a height or onto a sharp object, or colliding incidents during sports are typical incidents that cause rib injuries. In older people, people with osteoporosis or medical conditions that cause brittle bones, rib fractures can occur with something as simple as coughing, sneezing or being hugged tightly.

Rib injuries cause sharp, intense pain and generally also bruising and swelling. Pain will be worse when coughing, sneezing, laughing, taking a deep breath, or moving your upper body. Sometimes, you will feel a grating sensation when you breathe as the ends of the ribs move over or against one another. Sleeping can also be uncomfortable.

Severe rib fractures can cause serious internal damage. If your rib damages your lung, you can experience shortness of breath, a feeling of pressure on your chest, or cough. It is vital for rib injuries to be assessed properly to determine if there is any internal damage or complications. Because of the intricate anatomy of your ribcage, rib fractures are very rarely surgically repaired.

If your rib injury is medically cleared and you do not require hospitalisation, physiotherapy treatment is crucial. Firstly, we will help to relieve your pain and ensure that your injury is protected and rested. Taping on the ribcage usually provides immediate relief, and we can show you ways to brace and support your injury as you move, breathe, cough or sneeze. Other pain management strategies we use include ultrasound, ice and/or heat application, and gentle assisted movements. Our treatment will always include breathing exercises to maintain your ribcage mobility and to prevent any lung problems. Pain will make breathing hard, but shallow, fast breathing will result in further lung problems. The gentle movement that occurs with normal breathing is safe for you to do, and will in fact aid in the healing of your injury. Breathing will be easier once we provide you with some external support like taping.

As your injury heals, we will guide you through some exercises and stretches to improve your mobility and regain your strength. Each person’s situation and injury is unique, and therefore we tailor each program according to each patient’s needs.

Your sternum is the flat bone at the front of your chest to which your ribs attach. Injuries to the sternum are rare but can happen with direct trauma such as vehicle accidents where your chest hits the steering wheel, in people with severely brittle bones, or with repeated forceful stresses during work or sporting activities. Sternum fractures will cause severe pain, tenderness, bruising and swelling. Since your sternum serves as an attachment site for your ribs and chest muscles, you will have difficulty breathing, coughing, sneezing, lifting your arms and changing positions. Treatment of sternal injuries will follow the same principles as for rib injuries.

Rib Joint Disorders

Costochondritis

The joints connecting your ribs to your breastbone (sternum) are called costochondral joints. Costochondritis is an inflammation of these joints. Costochondritis is a very painful condition that can significantly interfere with your daily life. Although it can be debilitating, costochondritis is not a serious condition and can be managed successfully with early treatment. 

There is no definite cause for costochondritis but several factors may contribute to its development. It typically starts after doing an activity that you are not used to, such as a DIY home project, excessive exercising, or even after severe bouts of coughing. Anything that repeatedly strains the costochondral joints can ultimately irritate them and cause inflammation. Costochondritis usually resolves over time but since the pain can be quite intense, seeking early treatment is best. Early diagnosis and treatment will also prevent you from becoming anxious about other potentially serious causes for your pain. 

As physiotherapists, our clinical experience, skills and knowledge enable us to hear you out, do a proper examination, and provide a diagnosis. Additional investigations such as chest X-rays, MRI’s or electrocardiograms (ECG) are often unnecessary expenses. Therefore, contact us as soon as you start feeling chest pain. If we suspect a more serious underlying cause, we will refer you to another medical practitioner or specialist. However, you will never leave empty handed, as we will always provide you with information, advice, guidance and safe, symptomatic treatment. Alternatively, we can discuss your symptoms telephonically to advise you on further treatment or whether or not you need to seek immediate medical attention. See our 10-minute no obligation consultation on our online booking page now.

Once we can confirm that you have costochondritis, treatment will be focused on relieving your pain. Pain-relieving and/or anti-inflammatory medication will be required and can be prescribed by your doctor or pharmacist. Our physiotherapy treatment may include ultrasound, electrotherapy modalities, breathing exercises, dry needling, gentle stretching and massage, heat application, taping, and advice on activity modification. Stiffness in your upper back can cause excessive movement at your costochondral joints. Therefore, spinal and ribcage mobilisations also help relieve your pain and help settle your condition. We will develop an active stretching and progressive exercise program specifically for you once your symptoms have settled. This will be beneficial in the long-term management and prevention of this condition.

Tietze Syndrome

Tietze syndrome is a rare condition that causes inflammation of one or more of the rib cartilages where they attach to your breastbone (sternum). The condition was named after the German surgeon, Alexander Tietze, who first defined it in 1921. Tietze syndrome is also sometimes called Costochondral Junction Syndrome. 

Your ribs attach to your sternum at the front of your chest, and to your upper back vertebrae at the back to form your ribcage. These attachments must be moveable to allow for proper function and movement of your thorax and chest area. The cartilage at these joints serve to enhance the flexibility of your ribcage.

The exact cause of Tietze syndrome is unknown. However, some factors that may contribute to the development of Tietze syndrome have been suggested in the medical literature. These include repeated small injuries to the chest over time, acute direct trauma to the chest, excessive coughing, sneezing or vomiting, frequent chest infections, and surgery to the chest or ribcage. Other factors that may predispose someone to the condition include pregnancy, family history of rheumatic conditions, postural abnormalities and radiation therapy to the chest and ribcage. Stress can also aggravate the condition. 

Tietze syndrome affects men and women alike, and is seen most often in adolescents and young adults under the age of 40. Athletes who follow intense training schedules can be at risk for the development of this condition, especially if they perform repeated movements involving their chest/ribcage, shoulders and arms. Symptoms of Tietze syndrome usually develop over time but can occur abruptly. You will experience pain and tenderness in one or more of your upper ribs at the front of your chest. Pain is often described as aching, sharp, dull or stabbing, and the intensity may vary. There will be swelling. Frequently, there will also be redness and the area may feel warm. 

(Tietze syndrome can be distinguished from costochondritis by the presence of swelling that accompanies the pain. When you have costochondritis, you will not have localised swelling in the area that is affected. Costochondritis also seems more common in adults older than 40 years of age.) 

Your pain and discomfort will be exacerbated with coughing, sneezing (and even laughing), strenuous activity including exercise and possibly when you breathe deeply. Your daily tasks may become challenging due to the movement that happens at the rib joints when you move and use your upper body and arms. Try to avoid these aggravating activities, and do not continue with an activity that you feel increases your pain. You might also have some stiffness in your chest, shoulders and neck, especially in the morning. 

Tietze syndrome can resolve by itself within a few weeks or months. However, if left untreated, you may experience significant pain and discomfort, which will affect your daily life. 

Treatment for Tietze syndrome will be focused on symptom relief. At Just Physio, we will offer you an explanation on the condition, and instruct you on postures and ways to move to prevent worsening of your symptoms. We can also provide you with advice on ways to adapt your daily activities accordingly. Your treatment will require relative rest from aggravating activities. Hands-on treatment may include ultrasound, electrotherapy, heat or ice application, gentle massage, gentle spinal and ribcage mobilisations, taping, breathing exercises, gentle chest stretching and exercises to maintain your mobility. You may need anti-inflammatory or pain relieving medication, which can be prescribed by your doctor or pharmacist. Occasionally, people who do not find relief from these methods may go for a corticosteroid/analgesic injection. 

Most people typically associate chest pain with heart problems. However, there are many other conditions that can cause chest pain. Surely ruling out a serious heart problem is essential and hence, an accurate diagnosis is important. Physiotherapists have the skills and knowledge to thoroughly assess your symptoms and provide a diagnosis. 

Contact us as soon as you start feeling chest pain. If we suspect a more serious underlying cause, we will refer you to another medical practitioner or specialist. However, you will never leave empty handed, as we will always provide you with information, advice, guidance and safe, symptomatic treatment. Alternatively, we can discuss your symptoms telephonically to advise you on further treatment or whether or not you need to seek immediate medical attention. See our 10-minute no obligation consultation on our online booking page now.

Disorders of the Vertebrae

Your spine consists of 33 bones known as vertebrae. Twelve of these vertebrae can be found in your upper back, or thoracic spine. These bones are separated by pliable discs. Many muscles, ligaments and other soft tissue attach to and connect the vertebrae and help to maintain your spinal alignment. The main function for your spine is to protect your spinal cord and nerves. 

Our spines can tolerate a lot of stress and strain. However, there are some conditions and injuries that can damage your muscles, ligaments, discs, vertebrae, or nerves. Some common ones will be discussed in the subsequent sections.

Arthritis 

Osteoarthritis (OA) is a chronic degenerative disorder that typically affects joints that have to support our body weight. OA generally occurs as we age, and a diagnosis is usually made from age 50 and older.  

OA is more likely to develop when someone has had pervious spinal injury, have a genetic tendency to it, or has repeated strain on their spine. Occasionally, a cause cannot be identified. As we age, our spines will naturally show degenerative changes. Some people with OA might not have any symptoms, whereas others may have severe pain, discomfort and problems living a normal life.

Any area of your spine can be affected by OA. The thoracic spine (upper back) is not as commonly affected as the neck or lower back. 

Characteristic of ageing and arthritis is the wear and tear of spinal discs, the process which initiates the onset of OA. The discs lose their plumpness, narrowing the spaces between the vertebrae. Over time, these changes put additional strain on the joints, cartilage, and soft tissues. Extra load and friction cause an inflammatory response as the body tries to repair the area. The body naturally forms more bone as part of this process, leading to bony spurs (little outgrowths of bone at the edges of joints). Ultimately, the result is further inflammation, enlarged joints, pain, and stiffness. As the process advances, further narrowing of the joint spaces can place pressure on sensitive nerves and produce symptoms such as burning or stabbing pain, numbness, pins and needles and muscle weakness. Narrowing of the spinal canal will also reduce the mobility of the spine. 

In early OA, symptoms will come and go and may vary in intensity. Back pain may be brought on by being inactive for long periods of time. Some people also report pain when standing or walking a lot. Pain may be accompanied by stiffness, especially in the morning when waking up (since you do not move much when sleeping). 

As the condition progresses, your pain and stiffness may become more frequent. You may also have associated symptoms of muscle weakness, balance problems and nerve irritation. You may start to notice that your posture is changing as your body adapts. Performing daily tasks can become a challenge. 

Osteoarthritis is different for everyone. Not everyone will have symptoms or problems going on with their lives, even in the presence of OA. Those who develop symptoms might only experience it mildly. For some, OA can become a very painful and disabling condition. The good news is that the process of OA can be slowed down and managed well with basic treatment. The earlier you seek treatment, the better. Physiotherapy treatment will help you manage your OA, slow the deterioration thereof, relieve your symptoms and help you live a better life. 

There are various treatment options for osteoarthritis. We will select the most appropriate treatment strategies that will benefit you, based on your unique situation. Exercise therapy has been proven to be the most important and beneficial approach in the management of OA. We will develop an exercise program with you to help you manage your pain, reduce stiffness, improve your mobility and ultimately function better. Exercise programs include low-impact strengthening exercises, stretching, and balance training. 

Additional treatment for symptoms management may include ice/heat application, massage, spinal joint mobilisations, electrotherapy, and dry needling. Taping can provide additional support to your joints and surrounding tissues. At Just Physio, we believe in holistic treatment approaches. Therefore, we aim to provide you with the best treatment that suits you. We will also advise you on other strategies to manage your OA, including how to safely remain active, maintain a healthy weight, and become aware of diet and nutritional influences.

Osteoporosis

Osteoporosis is a chronic reduction in bone mass and density that occurs over time. Bone loss is a natural process that happens as we age. However, in osteoporosis, this process of bone deterioration is more rapid and more severe. The reduction in bone mass and density makes your bone fragile, and ultimately puts you at risk for getting fractures. Osteoporosis can lead to pain, loss of function and disability if it is not detected and managed early on. 

Osteoporosis is a silent disease that progresses over time. Often, people do not realize that they have osteoporosis until the disease has advanced so much that it starts causing fractures. Osteoporotic fractures can occur with even the slightest movement, bump or fall. Early detection of osteoporosis followed by early management strategies such as starting a physiotherapy program can significantly improve your life and prevent complications associated with this chronic condition. 

The thoracic spine (upper back) is one of the common areas affected by osteoporosis. Compression fractures can occur in the vertebrae that make up our spines as a direct result of reduced bone mass. Some of these spinal fractures go unnoticed, but over time as more fractures occur, they can cause changes in your spinal structure and therefore your posture. These changes will also come with symptoms of pain, stiffness, limited mobility and ultimately disability. 

Our bodies constantly renew our bone by absorbing and replacing bone materials. This is done naturally in response to the stress, load and impact being placed on our bones. In osteoporosis, the amount of bone that is absorbed becomes greater than the amount being produced. Eventually, our bones lose their structure and become weaker.

Bone, as with all our body tissues, will deteriorate as we age. However, some factors can increase the rate at which some tissues break down. Osteoporosis is naturally more prevalent in the elderly population. Other factors that will increase your risk for osteoporosis include being a women, hormone imbalances, living a sedentary lifestyle, eating a nutrient-poor diet, consuming high amounts of alcohol, smoking, taking certain medications and chronic inflammation. There is also a genetic predisposition to getting osteoporosis. 

After menopause, women are especially at risk for bone loss. Oestrogen is a hormone that plays a vital role in bone health. Menopause causes a reduction in oestrogen levels, which in turn results in an increased rate of bone loss. Similarly, young women with amenorrhea (lack of menstruation), late or irregular menstruation, are at an increased risk for developing osteoporosis. Our peak bone mass and density is achieved at approximately age 20. Thereafter, we start losing bone mass at an average of 1% per year. Post-menopausal women lose bone mass up to 8 years after menopause. Any hormone imbalances, whether levels are too high or too low, will hinder your body’s ability to maintain healthy bones. Other hormonal issues that can put you at risk for osteoporosis include problems with your thyroid, parathyroid, adrenal glands and other sex glands. 

Some medications are also associated with an increased risk for developing osteoporosis. These include those used for epilepsy and some mental health disorders (anticonvulsants), steroid-based drugs, thyroid supplements, chemotherapy drugs and insulin.

As with any chronic disease, nutrition is a vital aspect to consider in its management. A poor diet will place you at risk for developing osteoporosis, but will also worsen your condition if you already have the disease. A diet lacking Calcium and Vitamin D, specifically, is a huge risk for developing osteoporosis. Calcium is a building block for bone and cannot be absorbed properly without Vitamin D. Alcohol (and smoking) interferes with your body’s ability to absorb nutrients and should thus be limited or avoided. Poor gut health also affects the absorption of nutrients. If you have inflammation, lack the proper gut bacteria, or inactive, your body will not be able to absorb nutrients. At Just Physio, we can provide you with basic nutritional advice as we help you manage your osteoporosis to ensure overall health and wellbeing. We can also recommend a nutritionist/dietician if you would like further assistance with nutrition. 

Exercise is the most important aspect in the management of osteoporosis. Bone is a living tissue that responds amazingly to the loads applied to it. Therefore, physical activity helps to build strong bones. Weight-bearing exercises are especially beneficial in the prevention and management of osteoporosis. Muscle strengthening exercises are also important. Muscles attach to bone, and the pulling force they create when working will further improve bone strength. Muscles are also important to support and protect our skeletal structure, allowing less severe injury when we fall or get hurt in any other way. 

We live in a modern world that has made us live less active and less healthy lives. However, we do not need to suffer the consequences of living this way. At Just Physio, we want to encourage you to screen for osteoporosis early in your life. We can advise you on screening procedures and develop a personalised exercise program to help prevent the onset of, or manage your osteoporosis effectively. If you have osteoporosis that has started causing fractures, pain, or any other complications, we will also help manage these symptoms. We have various treatment options available and will select the most appropriate treatments for you.

Compression Syndromes

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a form of spinal arthritis where the spinal joints become inflamed. The joints at the base of the spine, where it connects to the pelvis, is predominantly affected. The cause for this inflammatory process is not known, but it has been suggested that genetics and other factors, such as infection and abnormalities in immune and hormone function, play a role in its development. 

Ankylosing Spondylitis causes a gradual onset of pain and discomfort at the base of the spine (lower back and buttock area). Pain is typically described as dull and aching. Over time, as the disease progresses, you will feel stiff in your back, hips and possibly other joints like your neck, shoulders and knees. Stiffness will be worse in the morning and evening, and will increase more when you remain inactive. Taking a warm shower or doing light exercise will lessen your symptoms.  

In the early stages of AS, you may have a light fever, loss of appetite and feel tired. Your body requires extra energy to deal with the inflammation, making you feel tired and generally unwell. Over time, the inflammation damages the spinal bones and joints. As your body tries to repair these damaged areas, it produces more bone. As more bone is formed around your spinal joints, they start losing their mobility and fuse together, changing your spinal structure. This is known as “ankylosing”. AS is often referred to as “bamboo spine”. The fusion of bone that occurs gives your spine the appearance of bamboo when seen on X-ray. As the condition advances, it can cause severe pain, stiffness, and postural rigidity, which will impair your ability to perform functional activities.

Generally, the onset of AS occurs in older adolescents and young adults. It is typically diagnosed by a rheumatologist. The onset, course and severity of AS varies a lot from person to person. Some people will only have intermittent pain and discomfort, some may not advance to spinal fusion. Others may have severe disease with debilitating pain and disabling rigidity. 

Although there is no known cure for Ankylosing Spondylitis, there are many treatments available that will manage your symptoms, help slow the disease progression, and help you live a better life. Medical treatment is important and your doctor will prescribe anti-inflammatory and pain-relieving medication. However, physiotherapy is integral in the management of Ankylosing Spondylitis. Our aims of treatment are to ease your pain and discomfort, reduce stiffness, improve your spinal mobility, help correct or improve your posture and ultimately allow you to live a fully functional and enjoyable life. We are here to provide you with information and guidance throughout your journey. We will develop a personalised exercise program for and with you that you can enjoy. 

Scheuermann’s Disease

Scheuermann’s disease is a condition affecting the development of someone’s spine. Since it is a developmental disorder, it is typically found in adolescents. The thoracic spine (upper back) is most commonly affected. Scheuermann’s disease causes the vertebrae (bony segments) of the upper back to develop abnormally, with the front part of the vertebra growing at a slower rate than the back part. This abnormal growth results in a wedge-shaped vertebra, which is characteristic to this condition. This wedging results in an exaggerated forward bend in the shape of the spine, called a kyphosis. Aesthetically, this looks like someone is slouching or hunching forward.

The exact cause of Scheuermann’s disease is not known, but many factors are thought to increase the risk for its development. There is a strong hereditary component to it, meaning that it occurs commonly among members of the same family. Other factors that may contribute to the development of Scheuermann’s disease include endocrine disorders, poor nutrient absorption, infection, trauma to the spine, and abnormalities in body structure or movement. 

To be diagnosed with Scheuermann’s disease, a plain X-ray can be used, in which the classic wedging of vertebrae will be identified. Otherwise, a physical evaluation can also be sufficient. 

Many people with Scheuermann’s disease do not have any symptoms other than the curved spine. Other people may experience pain and stiffness associated with their altered posture and load on their spine. 

Pain is usually in and around the upper back area. Pain may be aggravated with activities involving backward bending or twisting of the spine. Rest will ease the pain. Stiffness in the thoracic spine, especially into extension (back bending) is very common and will restrict movements of the upper body. Tightness in the hamstring muscles is also a common finding. In severe cases, pain and restrictions in your mobility will make it difficult to perform certain activities. 

People without symptoms of pain and stiffness, who do not feel that their curved spine limit them in any way in their daily life will not seek treatment. Treatment for symptomatic Scheuermann’s disease will depend on how bad the symptoms are, the location of the symptoms and spinal abnormality, what the person’s main concerns are, as well as their age. 

Pain will eventually resolve when the person reaches skeletal maturity. Most people carry on living pain-free lives. However, the structural effects of this disease puts them at risk for chronic back pain. 

Physiotherapy treatment is very effective in the management of pain and stiffness, and can help you maintain or improve your spinal mobility. Initially, treatment will focus on pain reduction and preventing further problems. Your doctor might prescribe anti-inflammatory and pain-relieving medication as well. To manage your pain, we can use a variety of techniques including ice/heat application, electrotherapy, massage, dry needling, breathing exercises, and gentle stretches. We also use taping techniques to off-load sensitive structures and encourage better postures. From your first visit to Just Physio, we will guide you through the process, provide you with helpful information and guidance where you may need it. 

As your symptoms settle, our focus will move to regaining movement and mobility in your spine. We will work especially on extension movements. Your exercises will be specific to your body and needs. Once you achieve sufficient mobility in your spine, we may progress your exercise program to include strengthening and further conditioning to prepare you for sport/work specific activities. 

It is vital for you to continue with a conditioning program to prevent problems of pain, stiffness and postural issues in future. We will work with you to develop such a program and will be here to encourage you to commit to it.

Scoliosis & Kyphosis

upper back

The thoracic spine (upper back) naturally curves slightly forward. This gentle curvature, called a kyphosis, is normal and very necessary. It allows our spines to carry and distribute our body weight, it helps absorb impact forces to our spines, and allows us to move properly. When the curve is or becomes exaggerated, causing hyperkyphosis, it can cause problems such as pain, stiffness, and movement restrictions which can affect your daily life.

Everyone is different, and people have varying degrees of natural curvature in their spine. Not everyone with an increased spinal curve will have problems or symptoms. 

The most common cause for a hyperkyphosis is poor posture, typically with your head and neck pushing forward, and rounding your shoulders and back. Frequently adopting these poor postures, especially when they are maintained for a long period of time, causes gradual changes in the structure and function of your spine and surrounding tissues. The muscles at the back of your spine become weak and deconditioned in holding you upright. Your spinal joints and ligaments also take more strain. As your body adapts to these habitual poor postures, the more you will slouch forward. 

As we age, our spinal curvature will also increase gradually as a result of age-related muscle weakness, reductions in bone density and lifelong loading. People with osteoporosis have an increased risk of developing abnormal spinal curves. 

Hyperkyphosis can also be caused by fixed structural defects in someone’s spine. Certain medical conditions can cause permanent changes in the structure of your spine, such as arthritis, Scheuermann’s disease, osteoporosis, spinal fractures, and spina bifida, amongst others. Fixed kyphosis is more challenging to treat, and some people may require surgery. Rarely, a baby is born with an exaggerated spinal curve. 

The risk for developing a hyperkyphosis is increased by many things. Women tend to develop kyphotic postures more rapidly than men, and people with muscle or nerve impairments are also at a greater risk for its development. Daily activities performed in poor postures, or being in occupations where your spine takes high loads will also increase your risk. Psychological factors also play a role. People with depression, anxiety, and reduced self-confidence tend to adopt a more rounded posture. 

Hyperkyphosis can cause back pain and stiffness. Pain often arises from soft tissues that are overloaded, or from joint or nerve compression. Loss of spinal mobility will cause restrictions in your shoulder and possible also your hip movements. Over time, you might have difficulty performing daily activities. In severe cases, people may have breathing difficulties and problems with their balance, which increases their risk of falling. 

Physiotherapy treatment for kyphosis should start as early as possible. Our main goals of treatment will be to manage your pain, decrease stiffness, reduce your spinal curvature or prevent it from worsening, improving your functional capacity and preventing complications. Correction and management of kyphosis will take time. For the best outcomes, you will have to comply with the treatment program. 

Our treatment will be tailored to your specific situation, and will depend on your age, degree of spinal curvature, severity of your symptoms, and your goals. We have various techniques we can use to help you. To reduce muscle pain and stiffness, we may do manual soft tissue releasing and stretches. We will also teach you postural correction techniques and can use taping to help you achieve better posture or reduce loading on sensitive structures. To increase your spinal mobility, we can perform spinal joint mobilisations as well as teach you breathing techniques for better ribcage expansion. Additional pain management strategies could include the use of heat or ice, electrotherapy, dry needling and massage. Strengthening your back muscles is vital, and we will guide you through a strengthening program. Your program might also include core, balance, co-ordination and stretching exercises.

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