Thoracic Pain

“Sitting and the Heavy Shoulder Syndrome”

Thoracic pains have a muscular component with significant postural and mechanical consequences. Thoracic pain will have a myofascial trigger point in the muscles that are affected by the daily activities and repetitive positions we put ourselves into. Today we will concentrate on how one's physical size, conditioning, and positioning can give a real “pain in the back”.

There are five categories of impaired thoracic alignment: kyphosis, post trunk sway, flat back, rotation and scoliosis. Thoracic kyphosis is defined as an increase in the flexion curve in the thoracic region. It usually starts as a postural fault and becomes a structural impairment. Posterior trunk sway of the thoracic spine occurs when the upper back is shifted backwards and hips are swayed forward so that the shoulders are posterior to the hip joints. The flat back posture is one in which the thoracic spine is straight or the degree of flexion is noticeably less than normal. When the thoracic spine is extended, structural changes are more likely. Rotation of the thoracic spine is almost always an acquired problem resulting from repeated movements in one direction which occurs with one-handed sports such as baseball and tennis. This also can occur when one is sitting at a desk and frequently rotates to one side to work on a computer or answer a phone. Scoliosis is present when the thoracic spine and rib cage are rotated. This can be localized to a few vertebrae or can involve the entire thoracic spine. It is most evident from a posterior view and becomes more obvious with forward bending. (1)

Let's take the discussion of thoracic pain to one of the more common mechanical dysfunctions:


The first common sitting dysfunction is where the individual slouches away from the chair back and leans on to one armrest. This will cause a flexion and rotation thoracic impairment. Sitting on your foot or sitting with your legs crossed can cause you to shift to one side and contribute to a postural scoliosis resulting in a rotational movement system impairment syndrome (MSIS). Sitting on the edge your seat can cause two dysfunctions: flat thoracic spine or when you fatigue, a rounded flexion thoracic posture.

The Heavy Shoulder Syndrome

Individuals with heavy chests, wide and muscular shoulders, heavily weight trained arms can develop some of the worst pain between the shoulder blades due to the postural stress that the weight of these structures and gravity will pull everything forward and down. This can occur in both men and women. The Rhomboids, Middle and Lower Trapezius suffer great strains through the stresses. When you add professions such as computer programming, data entry, cooking, construction and surgery where chronic loading occurs, pain will occur and it can be intense.

Here are some of the thoracic myofascial trigger points Janet Travell found and documented. (2). Note the referral patterns below.

Travell showed that the myofascial trigger point when active or latent will cause a loss of range of motion, weakness of the muscle, lack of coordination of the agonist and antagonist muscle movements, joint compression as well as neural compression. (2) These will all result in aberrant peripheral and central neural input resulting in sensitization and pain spreading across the back, neck and shoulders.

So what can be done about this phenomenon that is becoming a normal part of a lot of our patient’s daily lives? First we start with teaching people how to sit correctly, using their workstations properly. Second we retrain muscles to work efficiently through movement impairment exercises and stretch muscles that are tight that contribute to these abnormal positions. Third Kulp Physical Therapy and Massage will evaluate and treat each muscle, eliminating the trigger point and associated joint and motion dysfunction. Fourth Kulp PT will also address resulting postural deficits through postural exercises. The fifth thing we do is the home exercise program which is essential to the patient getting better.

Kulp Physical Therapy and Massage has focused specifically on utilizing manual myofascial trigger point treatment, joint mobilization, movement system impairment exercises and neural tension techniques in the treatment of thoracic pain and has two nationally certified manual therapists to help your patients.

Take a few moments to inquire how Kulp Physical Therapy and Massage can help your patient feel better. Please contact us at 585-742-8270 or if you’re interested.

(1) Schrmann, SA and Associates. Movement Impairment Syndromes of the Extremities, Cervical and Thoracic Spines, Vol. 1. St. Louis. Elsevier and Mosby. 2011.

(2)Travell JG, Simons DG. Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 1. Baltimore. Williams and Wilkins. 1993