The thoracic spine, known as the middle back, starts below the cervical (neck) spine at around the level of the shoulders. It continues down to the first level of the low back or lumbar spine. There are twelve vertebrae, numbered T1-T12 from top to bottom, and it is these vertebrae that make up the thoracic spine. When viewed from the side, a normal forward curve is visible.
The ribs are attached to the thoracic spine’s vertebrae, making this region of the spine strong and stable. However, this area has less range of motion than the neck region. Because of its location, the thoracic spine sustains fewer injuries than other areas of the spine. But it is the most common site of osteoporotic fractures. Scoliosis and abnormal kyphosis are also thoracic spine disorders.
Getting to know the body’s spine and how it functions can help individuals have a better and more thorough understanding of possible causes of upper and middle back pain, a doctor’s diagnosis, and the reasons for how simple lifestyle changes/choices can keep the middle back, as well as the rest of the spine, healthy.
Table of Contents
Thoracic Support
The thoracic spine supports the torso and chest and provides an attachment point for each of the rib bones, minus the two at the bottom. The vertebral bodies are rounded with bony arches that project from the back of each and form a hollow protective space for the spinal cord. Facet joints are paired at the back of each vertebra and allow for limited movement.
Intervertebral Discs
There is a fibrous pad called an intervertebral disc that is held in place by the endplates between each level’s upper and lower vertebral bodies. Each disc acts as a spacer, creating disc height (space) between the upper and lower vertebrae. This space opens nerve passageways, called foramina or neural foramina, on both sides. Nerve roots branch off the spinal cord and exit the canal through the neural foramina.
Soft Support Structures Limited Movement/s
The entire spinal column consists of:
- Ligaments
- Tendons
- Muscles
These soft tissues attach to the bones and discs and work together to stabilize the midback at rest and in motion. Ligaments are the strong bands of tissue that connect/protect the vertebrae and discs, provide stability, and help with excessive movement. Muscles hold the body upright and allow spinal flexion (bending forward), extension (bending backward), and rotation (twisting from side to side). And the tendons are fibrous tissues that attach the muscle/s to the bone.
Nerves’ Role
The twelve pairs of nerve rootlets that branch off the cord through the neural foramina are to supply and generate sensation/feeling along with function/movement to the body. These nerves provide nutrients to the midback and chest area and relay signals between the brain and major organs, including the following:
- Lungs
- Heart
- Liver
- Small intestine
Spinal Disorders
- Osteoporosis raises the chances of a thoracic fracture. A vertebral compression fracture can cause one or more vertebral bodies to flatten or become wedge-shaped, leading to spinal cord/nerve compression. Sudden and severe back pain can be associated with vertebral compression fractures.
- Scoliosis is an abnormal side-to-side curvature of the spine that is well known to develop in the thoracic spine, causing deformity.
- Abnormal kyphosis means the forward curvature has become extreme. A kyphotic deformity may appear as a hump.
Types of kyphosis:
- Congenital or appearing at birth
- Posture related
- Scheuermann’s disease
- Metastatic cancer, where it travels from the chest or lung, causing spinal tumor/s that can develop and potentially lead to structural deterioration
- Thoracic disc herniations are not common because of the middle back’s strength and stability created by the rib cage.
Spine Maintenance
Talk with your doctor, chiropractor, or spine specialist about stretches and exercises that will work for your specific situation to strengthen the core and middle-back musculature. This will help significantly with injury prevention during flexion, extension, and rotation.
- Pay attention to posture
- Learn to use proper body mechanics
- Quit smoking/vaping
- Healthy diet
- Learn about the risks for osteoporosis and talk with your doctor about a preventive bone maintenance plan.
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The information herein on "Thoracic Spine - Middle Back Basics" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
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Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
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|---|---|---|---|
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| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
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