Thoracic Spine Facet Irritation

About

People with thoracic facet irritation often complain of a sharp, stabbing, well-localized pain in the mid back. In most cases the pain gets worse after long periods of inactivity, like in the morning after a long night's sleep. Fortunately, this severe discomfort tends to dissipate as the day goes on and muscles and tissues see more activity.

Beyond prolonged periods of inactivity, specific movements and bodily functions can also accentuate the pain, such as when patients bend over to one side, cough, sneeze or even breathe deeply.

With thoracic facet irritation, people also commonly feel soreness in the ribs. That's because the thoracic spine, found in the mid back, is attached to the rib cage. The rib cage wraps all the way around the middle portion of the body, helping to make the spine much more stable and less prone to injury. When the joints in the spine get irritated, the area where the ribs attach to the thoracic spine can become tender.

Thoracic facet irritation develops when there's inflammation of the facet joints, which are the joints that connect the vertebrae (spinal bones). Awkward neck and back movements, subluxations (stuck or misaligned joints), acute injuries, poor posture and tight muscles can place stress on the facet joints or limit their motion, which leads to irritation and ultimately the pain associated with this condition.

Subluxations are a major contributor to thoracic facet irritation, because they limit the joints' ability to move through their normal range of motion, preventing them from functioning properly. When joints are aligned and able to move through their normal range of motion, they lubricate themselves and remain healthy. When subluxated, however, they no longer lubricate themselves and begin to stick, like an unused door hinge. This stickiness causes irritation.

Physical activities, including heavy lifting, reaching overhead to put something away, carrying heavy objects on the shoulders or pulling a weighted object for a long period of time can lead to thoracic facet irritation. These activities may stretch the joint capsules (which protect and support the joints) or jam the facet joints, causing subluxations in the spine and painful swelling and inflammation.

Fortunately, your healthcare practitioner can provide effective care for thoracic facet irritation to relieve irritated joints, relax tight muscles, promote overall healing.

Anatomy

When you think about the spine, imagine a pyramid with three distinct levels. The lumbar spine makes up the base because it's the strongest and biggest, the thoracic spine makes up the middle section and the cervical spine, found in your neck, has the smallest spinal bones and sits at the very top.

Thoracic facet irritation occurs in the thoracic spine, which is the longest part of the spine and comprises 12 spinal bones called vertebrae. The thoracic facet joints link these vertebrae from behind, allowing each vertebra to work in sync with the one above and below and linking the spinal bones closely together to provide the back with stability. As a result of these close links, the facet joints' movement is limited.

Each facet joint is lined with cartilage, a soft spongy substance that insulates and cushions, and is surrounded by a capsule, which provides lubrication and support. When your thoracic spine is healthy and moving through its normal range of motion, the joints and capsules allow the vertebrae to glide smoothly, keeping you healthy and pain free.

Problems begin when the facet joints become swollen and irritated, as a result of subluxations. Subluxations are disruptions to the spine that often cause facet joints to become stuck. They commonly develop as a result of poor posture, everyday wear-and-tear and trauma, such as the trauma associated with car accidents, heavy sneezing and coughing. Subluxations then prevent joints from functioning normally, decreasing their mobility and irritating surrounding nerves and soft tissues.

To avoid the pain this causes, people with thoracic facet irritation often sit in a forward slouched position. While this will reduce symptoms initially, it forces muscles in the mid back to work harder than they normally do. This can cause a muscle spasm and eventually make movements of the back more painful and difficult than before.

While the mechanisms underlying thoracic facet irritation are similar for everyone, factors unique to each patient will determine which management techniques will work best to alleviate the condition. If you have thoracic facet irritation, your chiropractor will perform a thorough assessment to determine which factors contributed to your condition, and then develop a suitable plan to address them.

Chiropractic Care

People with thoracic facet irritation respond particularly well to chiropractic care. Spinal manipulative therapy (SMT), trigger point therapy, muscular release technique and physiotherapeutic devices are all types of care that your chiropractor may use. These methods of care not only address pain, but also ensure that the spine and the surrounding muscles are healthy and functioning properly.

SMT, also called an adjustment, can correct subluxations in your spinal joints, enabling them to function properly. To perform this technique, your chiropractor will use his or her hands or a device called an activator to restore joints to their normal position and keep them moving within their normal range of motion. This will ease pain, relax muscles, decrease inflammation and improve function and movement.

If your chiropractor feels that tight muscles are impairing the facet joints' function, he or she may also use trigger point therapy. Trigger point therapy works by returning tight muscles to their natural state. If your chiropractor uses this type of care, he or she will target muscle tissue that is in contracture, which is a state of excessive shortening that makes parts of muscles feel like taut bands or nodules. By applying pressure to these areas for about 10 seconds, your chiropractor can return the muscle tissue to its appropriate length and remove irritating waste products, which helps decrease pain and relieve tension.

To further promote muscle health, your chiropractor may use muscular release technique to facilitate the growth of healthy tissue. Patients with thoracic facet irritation often have weak, strained muscles. To compensate, the body lays down new tissue to help them remain functional. This new tissue is scar tissue, however, and usually doesn't have the same properties as healthy muscle tissue. Over time, the presence of scar tissue can weaken muscles, which can lead to pain and dysfunction. By sliding his or her hands along the surface of weak muscles, your chiropractor can strip away scar tissue, allowing healthy tissue to grow in its place.

To further promote muscle health and relieve any muscle strain in your upper and middle back, your chiropractor may also care for you with physiotherapeutic tools like ultrasound and interferential current (IFC). Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing.

IFC works in a similar way, but instead of sound waves, it sends an electrical current through the body. IFC machines work by sending these painless waves through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the thoracic spine, your chiropractor can cause endorphins to interrupt the flow of pain signals from affected tissues to the brain, decrease inflammation and facilitate healing.

Your chiropractor may also recommend you make changes in your postural and sleeping habits. Postural habits, such as the way you sit, can affect the curve of your thoracic spine. If you sit at a desk all day, certain positions can put strain on your back and other positions can promote your back's health. Keeping your chin tucked in and holding your shoulders back, for example, will help ensure your spine is strong and healthy. In addition, supporting your shoulders with a high-back chair and keeping your feet flat on the floor will help decrease your risk of thoracic facet irritation.

Good sleeping habits, such as sleeping on your back or your side, can also make a difference. Poor sleeping habits can irritate the cervical or lumbar spine, which can lead to secondary irritations in the thoracic spine. Try to avoid sleeping on your stomach and instead sleep on your side with a pillow between your knees, or on your back with a pillow under your knees. The pillow forces your body into a position that maintains the proper curvature of your spine.

To ensure your thoracic facet irritation doesn't return, your chiropractor may also suggest a number of strengthening, stretching and postural exercises. By strengthening weak muscles in your mid back, you can eliminate muscle imbalances that can cause one muscle group to tug on the facet joints and cause a misalignment. Stretching and postural exercises also help to maintain maximum muscle efficiency in the thoracic region, which promotes proper joint function and movement.

If the symptoms of thoracic irritation flare up, your chiropractor may also recommend that you use a cold application. During the first 24 to 72 hours of the condition's development, a cold application, like an ice pack, can reduce swelling and pain in the irritated joint. Cold applications work by constricting blood vessels, numbing pain receptors in the skin and decreasing blood flow to the affected area. By constricting blood vessels and decreasing blood flow, they help reduce the release of painful inflammatory chemicals.

While all these methods of care can help, you should still avoid any activity that can exacerbate symptoms. Even when you don't feel pain, a slight twisting of the mid back can trigger irritation all over again. So before attempting any activity involving your back, be sure to speak with your chiropractor.