The Anatomy of the Thoracic Spine

The thoracic spine is part of your spinal column and is composed of 12 bones that are stacked one upon another. The thoracic spine is located between your cervical and lumbar spines, and it serves as an attachment point for your ribs and for many muscles and bones.

If it seems to you like your neck and low back get all the attention, to the exclusion of the mid and upper back areas, you may well have that right. Here's a run-down of the things you need to know to talk with your healthcare provider, physical therapist, massage therapist and/or chiropractor about the area of your back between your waist and shoulders.

Anatomy of the Thoracic Spine

In technical terms, your spinal column at the mid and upper back levels is called the thoracic spine.

The thoracic spine is comprised of 12 spinal bones connected to and occupying the same level in your body as your 12 ribs. In fact, the thoracic spine works with the ribs to create a protected space—your rib cage—for the lungs, heart, and other organs.

The first 10 ribs also connect to the sternum in front to close most of the cage. The last two ribs, located at the bottom of the cage, are not attached to anything in front and are called floating ribs.

Each area of the spine has a curve, and the thoracic spine is no exception. The directions of the spinal curves alternate per region. This means that when viewing the body in profile, the neck, and low back, respectively called the cervical and lumbar spines, go forward. This type of curve is called a lordosis.  

Located in between the lordotic cervical and lumbar curves is the opposing curve of the thoracic spine. Called a kyphosis, the thoracic curve sweeps backward, and together with the other two curves, helps balance the body in still posture, as well as during movement.

The thoracic spine is made up of 12 vertebrae, each referred to by 'T', with an identifying number appended to it. The number indicates the level of the thoracic spine in which the particular vertebra is located. The thoracic spine as a whole is often called the "T-Spine" for short.

For example, the first rib attaches to the first thoracic vertebra (i.e. T-1); the 12th (last) rib attaches to the last vertebra of the thoracic spine (i.e., T-12).

Function of the Thoracic Spine

The thoracic spine serves many functions. It protects the spinal cord, the bundle of nerves that extend from your brain to the body. It provides an attachment point for your ribs and helps with supporting breathing.

The thoracic spine also serves as an attachment point for many muscles of the body. In the back, your thoracic spine has middle traps, rhomboids, and latissimus muscles. Other muscles that support your shoulders arise from the thoracic spine.

The thoracic spine also functions to help move your body. Thoracic motions include flexion, extension, rotation, and side bending of your spine. These motions are much less than the same motions in your neck or low back; the thoracic spine provides significant stability while sacrificing some mobility.

Associated Conditions

A little bit of kyphosis in the thoracic spine is normal, but when it becomes excessive, as it often does in those of us who sit at a computer for most of our days, it can cause pain and poor posture.

Other, more medical causes of excessive kyphosis exist as well. These tend to be more serious than postural kyphosis due to sitting at a computer. Examples include Scheuermann's kyphosis or Scheuermann's disease, which mainly affects teen boys. Hyperkyphosis following a vertebral compression fracture which affects elderly people and others who sustain this injury is another example.

Although pain in the thoracic spine area is common, it is not as well studied as neck or low back pain. But a 2009 review published in BMC Musculoskeletal Disorders found that between 15.6% and 19.5% of people will experience pain in the upper or mid-back sometime in their lives. The same study found that in one year period the percentage of people affected varies wildly from 3.5% to almost 35%.

Associated with T-spine pain, the study says, are factors such as growth, musculoskeletal pain, lifestyle, use of backpacks, posture, environment, and your psychology. For adolescents, being older or having poor mental health may be risk factors for T-spine pain.

Are Neck and T-Spine Pain Related?

Whether their thoracic spine pain is due to a sedentary lifestyle, and injury or poor day-in and day-out body mechanics, many people turn to their chiropractor for relief. As well, many turn to their chiropractor for neck pain relief.

Are the two related?

In other words, if you have neck pain, should your chiropractor adjust your upper back, too? It certainly seems logical—after all, the neck bones sit on top of those in the thoracic spine; the movements and condition of one probably affect the other in some way. And vice versa. Right?

Maybe, maybe not. While there is some evidence supporting this type of treatment by your chiropractor, according to a 2018 study, the details of how that should be done are not clear. The same study, a randomized controlled trial published in the Journal of Manual and Manipulative Therapy, tested adjustments of the T-spine into two different directions: Into the same direction as the upper back limitation and into the opposite direction. It turns out that both groups got better in terms of pain relief and disability improvement. 

Rehabilitation Considerations

If you have a problem with your thoracic spine, you should visit your healthcare provider right away. He or she can perform an exam and diagnostic tests to help determine the cause of your problem and start on treatment.

Treatment for thoracic spine conditions depends on the problem. In the case of a fracture, immobilization with a brace may be necessary to allow healing to take place. Once the fracture has healed, working on postural control and back strength may be in order.

Scapular stabilization exercises may also be recommended to help you keep your shoulders and thoracic spine in the correct position. These can help you keep good posture and relieve stress through your spine and shoulders.