(Also known as Mid Back Arthritis, Spinal Arthritis, Degenerative Spine, Osteoarthritis of the Spine, Thoracic Disc Degeneration, Spinal Canal Stenosis, Spinal Stenosis, Vertebral Canal Stenosis)
What is thoracic spinal degeneration?
Spinal degeneration of the thoracic spine (upper back) is a condition characterised by gradual wear and tear to the discs, joints and bones of the spine that typically occurs in older patients.
The thoracic spine comprises of many bones known as vertebrae each of which has a large hole in its centre (figure 1). Because these bones are situated on top of each other, their holes line up, forming the spinal canal. This canal provides protection and space for the spinal cord and nerves to travel from the brain to the rest of the body. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 2). There are also small holes on each side of the spine known as intervertebral foramen. These are located between adjacent vertebrae and allow nerves to exit the spinal canal (figure 2).
Over time, wear and tear to the discs, joints and bones can occur resulting in degenerative changes to the spine. These degenerative changes may include decreased disc height, disc bulging, loss of joint cartilage, bony spurring (osteophytes) and thickening of bone. This condition is known as spinal degeneration. As this condition progress the spinal canal and intervertebral foramen can begin to narrow (leading to spinal canal stenosis) and may eventually place pressure on the spinal cord and nerves resulting in a variety of symptoms.
Figure 1 – Vertebra
Figure 2 – Relevant Anatomy for Spinal Degeneration
Causes of a spinal degeneration
Spinal degeneration of the upper back is a condition that typically occurs over time due to gradual wear and tear associated with overuse or aging. It may be particularly common in patients with a history of upper back pain or trauma to the spine or in those patients with lifestyles that have involved large amounts of lifting, bending, slouching, activities requiring use of the arms in front of the body, twisting or sitting activities.
Signs and symptoms of spinal degeneration
Spinal degeneration is typically seen in older patients. Minor cases of degeneration may cause little or no symptoms. As the condition progresses patients may experience upper back pain, loss of spinal movement and general upper back stiffness and loss of range of movement. In more severe cases involving spinal cord or nerve compression, pain, pins and needles, weakness or numbness may be experienced in the neck, ribs, chest, shoulder blades, arms, or hands. These patients typically display an increased roundedness of the upper back (kyphosis) or a twist in the spine (scoliosis).
Patients who experience pain due to this condition generally experience an increase in symptoms during activities that repetitively or continuously straighten or extend the spine (figure 3). Symptoms may also increase during activities that place weight on the spine (e.g. lifting, prolonged standing or walking etc.). Symptoms tend to ease during activities that bend the spine forwards or take weight off it (e.g. lying down).
Figure 3 – Thoracic Extension Over Chair
Diagnosis of spinal degeneration
A thorough assessment from a physiotherapist combined with appropriate investigations is usually required to diagnose spinal degeneration. An X-ray of the spine will typically demonstrate changes associated with degeneration. Other investigations such as CT scan, bone scan or MRI may also be indicated to assess the severity and to determine the exact structures that are affected.
Treatment for spinal degeneration
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Prognosis of spinal degeneration
Although little can be done to reverse the degenerative changes to the spine associated with this condition, most patients can have a good outcome with appropriate management. Many patients with mild to moderate degenerative changes to the spine can often experience little or no symptoms with appropriate management and remain active with some lifestyle modifications. Patients with more severe degeneration can also demonstrate significant improvements with appropriate management, although typically, they may require more significant lifestyle modifications and often experience more severe symptoms and functional limitations.
Physiotherapy for spinal degeneration
Physiotherapy treatment for patients with this condition is vital to assist with pain relief, improve flexibility and strength and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- electrotherapy (e.g. ultrasound)
- postural bracing or postural taping
- dry needling
- ice or heat treatment
- the use of a lumbar support for sitting
- the use of an appropriate pillow for sleeping
- activity modification advice
- ergonomic advice
- Clinical Pilates
- exercises to improve flexibility, strength, posture and core stability
- a gradual return to activity program
Contributing factors to the development of spinal degeneration
There are several factors that may contribute to the development of spinal degeneration. These factors need to be assessed and corrected with direction from a physiotherapist and may include:
- age (> 40 years)
- a lifestyle that has involved large amounts of lifting, bending, sitting, shoulders forwards activities, slouching or twisting
- history of injury or trauma to the upper back
- being overweight
- excessive or inappropriate activity
- inadequate recovery periods from activity
- poor posture
- poor ergonomic setup
- thoracic spine stiffness
- poor core stability
- muscle weakness or tightness
- muscle imbalances
- inappropriate lifting technique
- biomechanical abnormalities
- a sedentary lifestyle
- use of an inappropriate pillow or pillows during sleep
Other intervention for spinal degeneration
Despite appropriate physiotherapy management, some patients with spinal degeneration may continue to deteriorate and experience ongoing severe pain and disability. When this occurs, other intervention may be required. This may include pharmaceutical intervention, corticosteroid injection, the use of supplements such as fish oil, glucosamine and chondroitin, investigations such as an X-ray, CT scan, bone scan or MRI, or assessment from a specialist. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of spinal degeneration involving spinal canal stenosis or nerve compression, surgery may be required to relieve the pressure on the spinal cord or nerves.
Exercises for spinal degeneration
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back straight (figure 5). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 1-2 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 5 – Shoulder Blade Squeezes
Rotation in Sitting
Begin sitting tall, with your arms across your chest. Keeping your legs still, gently rotate to one side as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 6). Hold for 1 – 2 seconds and repeat 10 times to each side, alternating sides, provided the exercise is pain free.
Figure 6 – Rotation in Sitting (left side)
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Rehabilitation Protocol for spinal degeneration
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Some of the most commonly recommended products by physiotherapists to assist patients with this condition include:
- Posture Supports
- Lumbar Rollsor Car Seat Supportsfor sitting
- Ice Packs or Heat Packs
- Resistance Band (for scapular stability exercises)
- Swiss Balls (for core stability exercises)
- Sports Tape (for postural or protective taping)
- Foam Rollers
- Spikey Massage Balls
- Nutritional Supplements (such as fish oil, glucosamine and chondroitin)
To purchase physiotherapy products for spinal degeneration, click on one of the above links or visit the PhysioAdvisor Shop.
- Upper Back Stretches.
- Upper Back Strengthening Exercises.
- Core Exercises.
- Scapular Stability Exercises.
- Pilates Exercises.
- Cardiovascular Exercise.
- Postural Taping.
- Ergonomic Desk Setup
- Mobile Phone Ergonomics
- Safe Lifting
- Ice or Heat.
- The R.I.C.E. Regime.
- Understanding Pain
- Upper Back & Chest Diagnosis Guide.
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Spinal degeneration of the thoracic spine is a common condition characterised by gradual wear and tear to the discs, joints and bones of the spine of the mid / upper back that typically occurs in older patients. Spinal degeneration usually occurs gradually over time and causes mid or upper back pain, stiffness and loss of range of movement.
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