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Dr. Mark J. Kirk &
Dr. James McNally
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Thoracic Spine Facet Irritation


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 chiropractor can provide effective care for thoracic facet irritation, and will probably use an adjustment, also known as spinal manipulative therapy, to restore movement to irritated joints, promote healing and relax tight muscles.

The impasse ends, however, when chronic poor posture gives the chest muscles the advantage. The chest muscles then become tight and short, tugging or pulling the shoulders forward. Chronically tight chest muscles cause the muscles behind the shoulders to become relatively weak. At this point, the stronger muscles pull the spine out of its normal alignment, causing postural changes. Now the shoulders are slouched forward and the head, because of its connection, must follow. In an effort to hold the head up to compensate, the muscles in the back of the neck then become tight, ending the other tug-of-war and causing the head to jut forward.

If you have postural syndrome or just poor posture, it's important that you see your chiropractor as soon as possible. Postural awareness and chiropractic care can help restore muscle balance and joint health, but since it may have been many years since you started ignoring your parents' advice, it may take some time for you and your chiropractor to fix the problems.