I am seeing so many people with mid-thoracic
back pain in the pain clinic where I work. I think it is because we are spending too much
time in front of computers, smartphones and TVs, and not doing enough physical activity.
A lot of people, including teenagers are coming to me now with pain in this area.
I’m talking about a pain that is diffuse, uncomfortable, it is hard to find position
to alleviate it. The person feels some knots, the muscles are tense like tight ropes, there
is a sense that something is out of place and when they move the parts
they hear a lot of cracking. What is that?
Today we will talk about mid thoracic back pain and I’ll show you my secret weapon that
I use when I have this nagging pain on my back. So, let’s talk about Mid-thoracic back pain The thoracic spine is the composed of the 12
vertebraes between the cervical and lumbar spine. Each one of these vertebraes supports
two ribs, one on each side to form the rib cage around the chest, and protect
important organs like the heart and lungs. Because of the rib cage, the thoracic spine
is not so flexible for flexion and extension, when compared to the cervical and lumbar areas. The main movements of the thoracic spine
are rotation and some lateral flexion. So, it is relatively rare to have disc herniations
and spinal stenosis in the thoracic spine. Those are problems that we
commonly see in the cervical and lumbar spine, because of
all flexibility in those areas. When the patient complains of pain in the thoracic
area, it is VERY important to rule out some serious problems, like fracture, infection,
tumour, or cancer metastasis to the bones. That is why it is important to see your
doctor before you diagnose yourself. Your doctor will ask questions related to
fever, night pain, unexplained weight loss, previous diagnosis of cancer or osteoporosis,
use of corticosteroids or IV drugs. All of these things increase the chances of a
serious cause of pain in the thoracic spine. Also, the physician or your physical therapist
will examine you and do some special tests, like tapping on the bones with the reflex
hammer. When there is an osteoporotic fracture, for example, the patient will
feel pain when we tap on that vertebra. Now, after we exclude any serious cause of
pain in this area, and we palpate the muscles and they hurt, this is a sign that there is
some myofascial trigger points in this area. Check my other video about what is myofascial
pain syndrome. It is basically pain in the muscles caused by tiny areas that are tight
and not receiving enough oxygen. One of the main reasons for myofascial
pain in this area is poor posture, and when the head is protruded forward
like this, we call it hyperkyphosis. Hyperkyphosis has become very common,
and these muscles are then being pulled and stretched all day. They get weaker and weaker,
and then, the trigger points will flare and hurt. So, what is the treatment
for these trigger points? In my other video about myofascial pain, I
explain that to eliminate trigger points you need four types of exercises: SSAR or stretching,
strengthening, aerobics and relaxation exercises. For the mid thoracic trigger
points, I recommend you to add a self-massage before you start the SSAR.
So, we will demonstrate the M-SSAR, where M is for you to remember
the massage before the exercises. I’ll show you some techniques that
I use for my own trigger points, I have a couple in the rhomboids muscles.
This is a picture of the rhomboid muscles. They connect the spine to the
shoulder blades on each side. When we are sitting in front of the computer,
pulling them apart, they become weak and painful. The other muscle commonly affected is the levator
scapula. This muscle connects the upper part of the shoulder blade to the neck, and is also
pulled when we keep our head forward like this. The paraspinals are all of these deep muscles
connecting and stabilizing each vertebrae. They may also have trigger points.
In this video, I’ll demonstrate exercises with some simple equipment today.
You don’t need to have all of these things. I’m showing them so you get some
ideas of what can work for you. I recommend you to talk to a physiotherapist,
so they can individualize a routine that works for you. The exercises that I demonstrate in
my videos are only for educational purposes. I believe that education is therapy. A person
that is informed about all of their options and understands the reasons why they need to do
movement will adhere more to an exercise routine. In this video, I’ll show you 25 exercise. But
you don’t need to do all of these 25 exercises to get better. In fact, if you choose a few and
do them well, you will notice a lot of benefit. Chose 5 exercises and do them
many times during the day. Think of exercise as snacks.
Instead of eating a big meal once a day, you may get the same nutrition
if you eat 6 small meals a day. So, when you watch this video, take note of
5 to 10 exercises that you like the best. Then, plan some breaks during your
day and take your “exercise snacks”. So for the exercises today, i'm going
to demonstrate with some equipment. Again, you don't need to buy all of this
equipment, it's just to give you some idea maybe if you buy one of these things is better
than nothing but you can also do this without this equipment so you can have a tennis
ball we need a tennis ball for massage this is a shepherd's hook also
very helpful for self massage then this is also for self massage this is a
foam roller very hard this is my secret weapon also we will need some free
weights and i use this. they have three pounds for or arms exercise
i also have an elastic tube resistance tube i will demonstrate some exercises with this
tube elastic tube i also have this open elastic bands and some ones that are some elastic
bands that are looped they are closed like this and they come in different some that are harder
and this is very hard. the black one is very hard. the green one is very light. so depending on how
much strength you want to put on this resistance bands you can buy different resistance for you we
also need a mat because we will do some exercises on the floor. and then i'll also demonstrate some
exercises with an exercise ball so again you don't need to have all of this but if you do want to
invest on something like even a simple tennis ball you can get a used tennis ball and that would
be excellent for you to do the self massage. so with the tennis ball what we're going to
do is massage the area. so you find a tennis ball put the put a tennis ball in the area that
hurts most and all you have to do is just roll it on the area that is hurting you will see that you
find the point and then you just massage the area. if you do this for 30 seconds. one minute. you
will feel a lot of relief. it's almost like a finger pushing and massaging that tender point.
try to find in the muscle. not in the bones. With this shepherd's hook that you can find in
some stores, big boxes stores there are many different types, but what i like about
it is that i find the trigger points in the muscles especially in the rhomboid
area, and then I massage here oh I find oh i just found one and if you just put your
elbow in front of your body, you open the space, and allow more room for you to find the
muscle, and when you find it you apply pressure going forward ,and then you massage that
muscle and do this for about 30 seconds. so the only thing is that you have to find
a space in your house to store this one. i like the tennis ball better because it is always
small. it does the same thing but you can also keep in your office. you can when you travel. if
you have a lot of pain in that area you can bring the tennis ball. bringing this is a little bit
more cumbersome, but this can have a lot of other utilities for other parts of your body. but today
i am demonstrating for the mid-thoracic back area. so with the foam roller what we're going
to do is you have to lie down the floor and you have to adjust start with the foam
roller in the lower part of your chest the thoracic spine here when you find this position
what you're going to do is raise your pelvis and this is the position that you're going to do keep
your neck stable and you're just going to roll until don't you don't need to go all the way to
the neck or the lumbar spine it's just the area of the thoracic spine where the ribs are and
go back and forth you may you may hear some cracking when you're doing this that's
normal it's just the vertebrae is adjusting and if you put your arms up like this you're
opening the space between the shoulder blades and then you're exposing the muscles even more.
that's better if you do this with your arms up in the air like this so next we need to start moving
those muscles and i usually recommend for aerobic exercises i recommend that you go for a walk, or
for a run, or for a bike ride, or even dancing. i made another video that i talk about dancing has
a type of aerobic exercises. so the first exercise that we'll do is about range of motion exercises,
and what we need to do is move the thoracic spine to gain some range of motion. so let's start with
that the movements of the spine include flexion, extension, lateral bending, and rotation, so a
lot of rotation happens in the cervical spine and the lumbar spine, and we also do rotation in the
thoracic spine, but flexion and extension happens mostly the cervical and lumbar spine, so we're
going to do for all three areas of the spine, so which we start with the cervical spine,
we're going to do flexion and extension, lateral bending, the other sid,e and now rotation.
now we're going to do the same thing with the thoracic and lumbar spine, so flexion, go as far
as you can, then extension, look at the ceiling. lateral bending to the other side, and rotation
bring your arms up, and turn, turn, turn, turn, until you look at the wall behind you.
See? i'm using the whole spine to rotate, so all of those vertebras from the neck,
thoracic, and lumbar, spine they're all rotating, that's good to gain some
range of motion of all spine. so after you warm up, or after you did the
range of motion exercises we're going to start strengthening those muscles and we need to
strengthen the rhomboids, the levator scapulae, infraspinatus, the paraspinals, the trapezius, all
of those muscles, and to do this we may use this tube, elastic tube, and one of the things
that i like to do is the rows, so what you do is you step, this is a light one, and you
can buy some that is harder, more resistance, so you step on them like this, because we're
going to pull this way. if it's too light the less tube you leave here the harder it gets,
right, so then you just turn bend your trunk, remember to keep your lumbar spine straight,
so don't be bending too much your lumbar area and from here, we are going to pull
backwards, so like rowing, row, row, row, okay, and then you can do this eight repetitions. and depending on how tight is your
elastic tube, you're going to do more strengthening, and when we do this we're
strengthening not just the rhomboids but the infraspinatus, the levator scapula, some exercises so you do this eight times, and then you can
increase to 12, 20, if you can repeat this. the other exercise that is also helpful for those
muscles in the back, you step here, and now we're going to pull this forward in front of your
body, and we're going to do this all the way up, if you have any shoulder problem
you can bring up through here, and you can also do this eight times, in
front of your body, and so when you're doing this you have to feel, keep your
spine straight, keep your chin tucked in, keep looking in front of you, don't keep looking
down, just keep looking front you. do this in front of your body, and now you're going to do
this on this side of your body, and for this one it's enough just to bring to the level of your
shoulders, you don't need to bring too high up, and again repeat it eight times, and then
increase to 12, and 20, if you can do it, so you see, you can bring this elastic tubes with
you to your office, or when you're traveling, and this is such a great exercise to strengthen the
muscles of your mid-thoracic area of your spine, so now the next exercise is, we are using either these resistance bands that are open loop
or the closed ones. the open loop ones. the open resistant bands, it's good if you have a good
hand grip because you have you have to hold it, if you don't have a good hand grip then buy one
of those that are closed loop because then you just use around your wrists. what we're going
to do is, first exercise, is just keep your hands around the level of your shoulders like
this, and just pull apart, just do just doing this, so just pulling apart, and when you do this,
try to find if you are moving the back muscles. so don't do this with your shoulder, so don't
use your deltoids to do this. that's not what i want you to do, i want you to feel that
you are moving the muscles in the back in your thoracic spine like pulling backwards.
So, then you can do this about eight repetitions and when you are good with this you can
increase the resistance of the bands, or you can increase the number of repetitions, that you
do that's called endurance exercise, endurance means you're doing more repetitions of the same
exercise, without getting tired, it means that you are, your muscles are now better prepared for
more exercises, it's called endurance, so that's one the other one is still with the resistance
bands. i want you to bring all the way up and now you're going to bring your arms in front
of your head and do this eight times, two, three, four, five, six, seven, and eight, and when you bring in
front of your head, you can also touch your chest here, and now you're going to do the
same thing, but touching the back of your head, so you're going to do this eight repetitions,
here, to bring it behind, you see? So, when i'm doing this, i'm forcing the muscles on my back,
my rhomboids, all of the my trapezius muscle, my latissimus dorsi, all those muscles
they're working because now, i'm bringing this here in the back, and the other exercise that
you can do with this band or with the other one, i'll show you with this one here, just
so you see how it works but you can do it either one. now you're going to hold here
on your back, and you're going to pull it and move touch your butt area, and move away here,
so you're going to do this, touch and move away, you can also do it for this side, and this side
always pulling, always putting some tension here in the band okay? it's not just holding it,
it's putting tension, and you can do this way, and you can also do this excellent exercise
for the back muscles in the thoracic spine. so now, with an exercise ball you can do so many
exercises it's so versatile there are many things you can do with this for your
whole body, basically i'll show you two exercises that you can do with an
exercise ball,, if you have one at home that is excellent for this area of the body the
first one, is what's called the russian twist, and so you sit on the ball, if you have poor
balance please be careful so you don't fall out of the ball. So, you sit on the ball and now you're
going to start sliding on the ball until the ball is touching that area of your body which is the
thoracic spine, okay, once you what you are there, you hold your hands in front of your body, keep
your neck straight ,and it's important that you open ,you hold your hands here, because now you're
opening the space between the shoulder blades there, and they are all exposing those muscles,
and what you're going to do is you go on one side, and on the other side, so here i'm touching
my right shoulder blade is touching the ball. i come to the middle and now my left shoulder
blade is touching the ball, and you do this about eight times for each side, it's important that you
keep your pelvis at the same level of your knees, that you keep here like all straight,
and your neck is also straight ,this is an exercise that is difficult for
some people they don't have a lot of balance, so if this you cannot do this please don't do,
it and when you finish you just go back in the sitting position again, and then you are done so
the next exercise with the ball the exercise ball is if you have one of this and if you have
hand weights, this is also excellent for you to do rows, what you do is you lie down here on
your stomach, make sure that you support on your chest and then grab your free weights and now
you're going to do rows this way, it's good for balance and it's also good for strengthening
those muscles in your back so row, row row. here so this exercise is the corner push-up,
you have to find a corner in your room, and then what you're going to do is put your
arms around the same height of your shoulders, and if you come too close to the corner then you
just be doing some stretching for the pectoralis, which is not exactly what we need to do so, what
we are going to do is push ups on the corner wall .so you have to come backwards maybe two feet or
three feet backwards, and with your hands here, now you're going to do push-ups and put all your
weight around towards the corner, and you see, i am now contracting the back muscles of my
thoracic spine, so when i do this do this, very slow you don't need to do this quick and the
important thing here is that you are contracting and you're also stretching the pectoralis
muscles in front of your chest, which is usually very good for people who have
hyperkyphosis, that they are like this all the time they need to stretch the pecs muscle. so this
is a good exercise to stretch these muscles and you can do this eight repetitions, and increase
to 12, and 20, and that's the corner push up. so this exercise is the wall angel,
and what you need is a flat wall, no pictures on the wall, and you're going
to stay maybe one feet apart from the wall, with your feet apart from each other,
you're going to touch your pelvis, the shoulders, and the back of your head on the
wall. not like thi.s don't look down. your chin tucked in and looking ahead, and
now your fingers on the wall here, and we're going to do the wall angels, so imagine
that you're doing the wings of the angels, here, and that's the wall angels exercise, that's
good for range of motion of the shoulders, but also moving all those muscles the paraspinals,
the trapezius, levator scapula, all the muscles on the back, and this is also good for people who
have hyperkyphosis because sometimes it's even hard when a person has the head too much protruded
ahead of them, they can't even touch the wall with the back of their head, and so in this case they
can put a small towel on the back of their head, and hold it here so this is really good to even
prevent people from developing hyperkyphosis, and those rounding of the shoulders that happens
when we are looking, doing things too much here, in front of us, we need to open up the space so
this is what the wall angel exercise does for us, because then it allows us to recover our
posture, it's excellent for our posture. so the next exercise is the plank. plank is
an exercise that is excellent to maintain the strength, to strengthen all of the part spinal
muscles, the abdominal muscles, the glutes, all of these muscles give stability to
the spine, including the thoracic spine, so the way we do a plank, we need
a mat comfortable for your elbows, and it's important that the
elbow is under the shoulder, and when you find this position we are
going to do raise like this, and straight your body has to be straight and you do this you
hold it for 10, 15 seconds, and if you can you hold for 30 seconds, and the idea is that you will
be able to hold it for 60 seconds or one minute, so the next exercise is the side plank that
is also excellent to strengthen the muscles around your shoulder in the thoracic back area.
there are two ways that you can do the side plank one is easier with your knees bent
and it's important that the elbow is exactly under the shoulder, so don't do
this and here but right under the shoulder, and so now that we are going to do the easy
one first, where you raise on your knees, and you hold this position for about 10, 15
seconds, 30, or even 60 seconds, one minute, and also do for the other side, repeat for the
right in the left side, and the full side plank is when you hold all of your weight on your ankles
so you have to do your body, has to be straight ,and again the elbow under your shoulder, and
let's go, and hold up and when you do this count to 10, or you can count to 15, or 30
seconds, or even one minute, i rarely can get to 30 seconds, so it's a harder exercise, but
the more you practice the longer you can hold. so this exercise is the cow-cat, and we're going
to do a modified version we're going to cross our hands in front of us because we want to
open and stretch more the rhomboids muscle, so first we're going to do the cow, so you lower
your spine your lumbar curve, your lumbar spine, and look up all the way up try to it's almost
like if your navel is touching the ground, you want to touch the ground with your navel,
now we're going to do the opposite now you're going to go up, this is the cat, so we look
down, down, down, down, our head goes down, and our trunk goes up and we push down the
floor like if we wanted to push the floor down, and then we come up, and you do this eight repetitions, for
each side and that's the cow cat exercise. so the next exercise is the superman. this
exercise is excellent to strengthen the paraspinal muscles, and what you're going to
do is, on a mat you're going to raise your head and your legs at the same time and
you're going to hold on this position for you can start with 10
seconds, increase to 15, 20, 30, and 60 seconds, so when you hold in this
position all of the muscles on the back of your spine, they are contracting, holding there,
and you are strengthening all of those muscles, so now this exercise is stretching we're going
to start now stretching all the muscles on the back of our thoracic spine and to stretch all the
muscles down from the neck and thoracic and lumbar spine i love doing this stretch on the chair so
you put your hands around the back of your neck at the back of your head like this and just we're
going to go down a chair when you're sitting on a chair we're just going let the weight of your arms
pull down and you can open a little bit the legs here and just go down you don't need to push too
much just the weight of your arms is pulling down and if you can touch if the elbows can touch
the knee, that's good here and stay there. and come back slowly.
come back slowly so then you don't get dizzy. the other exercise is to stretch the levator
scapula, which is more in the diagonal, you're going to hold here on the back of
this chair and you're going to pull in this direction here, so the elbow towards the knee.
the right elbow right knee. come back slowly. Now, hold on the other side and the left elbow
towards the left knee, and do this stretch. So, the other stretching exercise is what
i call the scarf, and this is excellent for the infraspinatus muscle. So, you're going
to bring your elbow in front of your body, and with the other hand you just pull
here, you can turn your body, if you want and hold it and feel all the muscles stretching
there in the back, and do the same thing for the other side, so bring this arm all the way like
a scarf, and the other one pull and you can turn your body towards that side. So, you stretch
a little bit more hold it you can hold for 10 seconds, and release and you can repeat
these exercises three times for each side. Now, the other stretching exercise is
for the rhomboids and infraspinatus as well. you just hold your hands in front of
you, at about the height of your shoulder, the same level of your shoulder ,here so hold them
in front of you, and what you're going to do is, you're going to pull forward, almost like
if i want to come and touch the other wall, here, where you are and but without bending my
trunk ,so my trunk is stable here, it's almost like if i'm attached here to this chair, but
i'm pulling, now i'm going to start pulling my hands in front of me, if i want to touch
that wall and pull pull,pull, pull, and relax so pull in front of you ,and relax. you can do
this three times. pull you can hold there for 10 seconds. and relax. so when you do this you feel
all of those muscles being stretched, and behind where your thoracic spine is., so, don't forget,
also during those periods that you take a break that you are doing your exercise snack, it's
also important to relax those muscles, and instead of being the whole time in the computer,
or on your desk like this, remember to do some exercise. and you can do a breathing exercise,
and what i recommend is on your chair just your arms relax around your body, like this and then
you close your eyes, and then you just ground yourself on your breathing, so take a couple
of deep breaths and relax here and breathe out. breathe in and breathe out ,and when you're
doing this remember to relax your muscles, and pay attention to the air coming into your
lungs, and out through your nose and your mouth. and you do this 10 times, you can also do some
shoulder rotations to relax your shoulders, but there are so many different
options for relaxation exercises, this is just one of them. deep breathing,
relaxation ,and you can schedule maybe every hour you put a little reminder on your phone
saying remember to do the relaxation exercise, and you do this a couple of times. you will see
that at the end of the day you're not so tense, and you're not so tight, and those
trigger points are not hurting that much In summary
Take breaks during your day and choose 5 to 10 of the exercises that I mentioned above.
You don’t need to do all 25 exercises at once. I usually take breaks every
2 hours, especially when I’m working in front of the computer, and then I
do 5 of these exercises that I enjoy the most. It doesn’t take more than 10 minutes.
Remember the exercises snacks. Use the comments below to write
your suggestions, ask questions, or suggest topics for future videos.
If you go to “see more” below this video, there is a description of all
products that I mentioned in this video if you are interested in purchasing them.
I added time stamps to this video, so you can watch the parts that are useful
to you, like the summary of these exercises. Also, if you go to the description of this video
below, there is a link to a document that you can download and it summarizes all the content
of this video, including the M-SSAR exercises. Please, don’t forget that this video
is for educational purpose only. If you have a condition that needs medical
advice, please talk to your doctor. If you have any question about the exercises,
please talk to your physiotherapist. And if there is an emergency, go to
the nearest emergency department. If you like this video, give a thumbs up here, turn on the notifications and don’t
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Good bye
