380 | Overcoming Chronic or Consistent Mid-Back Pain

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:29] Okay, I just have to say that I am so excited to see everyone getting in Posture Redefined.

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[00:01:03] it's so much better to have that accountability and be in a group actually doing it together.

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[00:02:45] Okay. So today we're going to be talking about consistent or chronic mid-back or thoracic spine pain.

[00:02:53] And chronic doesn't necessarily mean it's something that you have to have all the time or something that is constant.

[00:02:59] Chronic can mean it comes and goes. You have it for a week, it goes away, it comes back a month later.

[00:03:05] And this is an area of the body. I mean, just the whole spine, neck, mid-back, low-back pains in general is one of the most, if not the top for taking account for the most disability in our country or the most pain episodes in our entire country.

[00:03:22] So back pain, neck pain in general is just a huge topic. And we're going to try and cover it in about 20 minutes.

[00:03:29] Well, I mean, that's the thing though, that neck and low back pain is so highly talked about, but thoracic and mid-back is not quite as classified, you know?

[00:03:39] And so we don't have like the same guidelines as we necessarily do sometimes for the neck and low back.

[00:03:46] And sometimes we don't have as much studies or specific exercises as to what you can really do to help with this mid-back pain.

[00:03:54] And so we want to go through, particularly a study we found that had what, you know, what can help with this thoracic spine pain.

[00:04:04] And they gave specific exercises that they outlined. So we want to talk about those and then what they found, you know, ultimately within the study that helped in so many pain markers.

[00:04:17] Taking a quick pause from the episode to talk about Needed.

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[00:05:35] All right, let's get back into the podcast.

[00:05:37] The thing that I love about this study that we found is that it really highlights something that we talk about all the time.

[00:05:43] Like what place does manual therapy or manual techniques have in our rehabilitation from pain or have as a part of our pain protocol to get rid of pains?

[00:05:55] Because this study had two groups in it.

[00:05:57] One group that had manual therapy combined with four exercises and the other group just did the four exercises.

[00:06:05] They did these for eight weeks and they had follow-up 12 weeks after that.

[00:06:11] And they did different questionnaires with this, with these two groups, visual analog scale, which is just your pain rating on one to 10.

[00:06:18] And then a questionnaire that basically had all these questions to gauge quality of life.

[00:06:24] So we could see that as essentially how is this pain affecting my life?

[00:06:28] How is this pain affecting my function, my ability to interact socially, spiritually, how I want and how it makes me fulfilled?

[00:06:35] And the findings, to no surprise of ours, showed that at eight weeks, the manual therapy and exercise group combined had significantly better results.

[00:06:49] However, at the 12-week follow-up after that eight-week program that they went through, at the 12-week follow-up, there was no significant difference between groups.

[00:06:59] And this, again, mirrors exactly what we talk about where manual therapy can be great at helping us get better results faster.

[00:07:09] However, it doesn't have a lasting effect once we stop using those manual techniques.

[00:07:15] Yeah, meaning that exercise alone can be super beneficial in the long run if you don't have access to getting that manual treatment.

[00:07:25] And I think that's what's so important to continue to remember.

[00:07:29] It's like, you know, we always have to outweigh, like, how much do I want to spend on this treatment?

[00:07:34] How much doesn't...

[00:07:35] You don't always know what your insurance covers or you might get a bill afterwards.

[00:07:39] The mystery bill.

[00:07:40] Right.

[00:07:41] Or you might be recommended to this person who doesn't take insurance.

[00:07:44] And that's all great.

[00:07:45] I don't knock going to see someone.

[00:07:48] I think it's really highly beneficial because it gives you an eye into something that you're not trained in.

[00:07:53] Right.

[00:07:54] However, if they're just using manual therapy alone, it's not enough.

[00:08:00] Like, it's going to give us those short-term benefits.

[00:08:02] And this one is specifically only talking about with exercise.

[00:08:06] And that's where you get to see those really bigger effects.

[00:08:10] Because alone, you know, this demonstrates...

[00:08:14] So what this showed was that there's several potentially positive effects of manual therapy

[00:08:19] for a variety of reasons, including placebo.

[00:08:22] So they did talk about the placebo effect in manual therapy.

[00:08:26] The belief that if this is going to get me better, this is going to help.

[00:08:30] This manipulation is going to put something back into place.

[00:08:34] Then I...

[00:08:35] The time spent with the clinician and the practitioner.

[00:08:38] Exactly.

[00:08:38] The rapport that you build with them.

[00:08:39] Which is difficult to account in a study.

[00:08:41] But regardless of the mechanism, it demonstrates that people improve with both exercise and exercise

[00:08:46] plus manual therapy.

[00:08:48] However, manual therapy plus exercise may offer that quicker but not lasting treatment.

[00:08:53] And I think that's what's important to understand.

[00:08:55] Like, you can't just go in and expect to get an adjustment, a manipulation, a massage technique.

[00:09:01] And that's going to be enough alone.

[00:09:03] Like, that's going to help you feel relief in that moment.

[00:09:06] But especially without exercise, it's not going to do anything long-term.

[00:09:10] Yeah.

[00:09:10] Like, oh, this is going to fix me.

[00:09:11] And so many people, that's what you hear for the people who have been convinced that the

[00:09:16] manual treatments are fixing their issue.

[00:09:19] Is that, oh, I feel so great.

[00:09:21] But then if I go on vacation or I can't see them for 10 days, you know, I'm back in pain

[00:09:27] and I have to go back so that they can fix me or put me back into alignment.

[00:09:31] And we talk about that ad nauseum, that that's not the case.

[00:09:36] It helps give you those short-term benefits to make the exercise easier to do and potentially

[00:09:41] more effective.

[00:09:42] And I forgot to mention at the beginning, the exercise group alone also got benefit.

[00:09:47] Right.

[00:09:47] And the exercises that they are doing aren't anything groundbreaking.

[00:09:51] They're fairly basic exercises.

[00:09:53] They have like a horizontal row with scapular or shoulder blade retraction.

[00:09:58] They did a resisted rotation exercise.

[00:10:02] They did a side bending exercise.

[00:10:05] And then prone thoracic extension.

[00:10:07] And prone thoracic extension.

[00:10:08] And so, explain what that means.

[00:10:10] So, you're laying on your stomach and it's essentially like you're just doing the Superman

[00:10:14] with your top half.

[00:10:15] So, you're lifting your chest and arms off the ground and then going back down.

[00:10:20] So, really all I'm seeing here is some active mobility and some strengthening work, you know.

[00:10:28] Around the upper back.

[00:10:30] And they saw benefit from that after doing that for eight weeks.

[00:10:33] I mean, yeah, these four sets of exercises, three sets of 10, they used the classic three

[00:10:37] sets of 10 of each of them showed benefit.

[00:10:40] Jen and I are going to talk a little bit more in depth about other things we should be paying

[00:10:44] attention to when it comes to the thoracic spine region.

[00:10:46] It's right in the middle of the back.

[00:10:49] And like we said at the beginning, low back and neck get all of the glory for being the

[00:10:54] most in pain areas.

[00:10:56] But thoracic spine definitely gets its fair share.

[00:10:59] And what I think is sad is like the most popular videos online, you know, that you're going

[00:11:05] to assume is what I need for my back are going to be those adjustment manipulation videos.

[00:11:10] It is going to be, oh, laying on this ball in this certain way in this certain muscle is

[00:11:16] what's going to help to relieve this upper back pain.

[00:11:19] And this one side stretch or this one movement and rotation of your spine in this one way is

[00:11:27] what's going to help.

[00:11:27] You know, there's always like the one exercise, the one manipulation, the one treatment that's

[00:11:34] going to help.

[00:11:35] And we just want to reiterate and hopefully the study continues to prove there's not one

[00:11:40] treatment.

[00:11:41] There's not one exercise.

[00:11:43] There's not one protocol for any type of pain that you're having because pain is so much

[00:11:47] more complex than that.

[00:11:50] And understanding that exercise and movement can help move you forward and get you out

[00:11:56] of pain, I think is so beneficial.

[00:11:58] And if you have the ability to combine that with manual therapy in the short term, great

[00:12:03] if you want to feel results quicker.

[00:12:05] But again, we're talking long lasting because especially if we're talking chronic and consistent

[00:12:10] mid back pain, so you're talking about pain that continues to pop up over and over and

[00:12:14] over again.

[00:12:15] Well, then manual therapy is not going to necessarily be the answer because we're looking for long

[00:12:22] term results.

[00:12:22] We're not just looking for the quick fix.

[00:12:25] We're not just looking for short term relief here.

[00:12:27] And I think that's what's really important is to get out of this mindset that I need this

[00:12:31] one technique this person did or I need this one person to work on me and do this.

[00:12:35] Let's drop that mindset and let's see what we can do long term.

[00:12:39] And that's what we really want to talk into.

[00:12:41] And especially when it comes to the thoracic spine, there are things that you can do that

[00:12:46] kind of mimic the manual type of techniques that you get.

[00:12:49] I love foam rolling my upper back.

[00:12:52] It feels great.

[00:12:53] I use the IntelliRoll because it has the amazing groove for your spine to fit in.

[00:12:57] And I get on that and do some different extension work.

[00:13:01] I do a couple techniques that can help mimic kind of a thoracic manipulation.

[00:13:05] I get some cracks in my spine.

[00:13:07] But then is when the exercise comes in and the movement comes in.

[00:13:12] And so, some of my favorite things to do when it comes to the mobility side of things is

[00:13:18] the open book.

[00:13:19] It's one that we talk about all the time to get that thoracic rotation in.

[00:13:23] Rotation is something that we see neglected throughout people's days because of this forward

[00:13:30] and back world that we live in, the sitting posture, the driving posture, we're not doing

[00:13:34] a lot of rotation.

[00:13:35] So, getting in that open book to get some thoracic rotation in.

[00:13:40] What's that one called against the wall with the elbows?

[00:13:43] I don't know.

[00:13:44] That one's tough.

[00:13:45] Yeah.

[00:13:45] It's a tough one to do.

[00:13:47] It combines thoracic side bending and rotation similar to the exercise they do in the study.

[00:13:51] It has that side bending in it.

[00:13:53] We'll show a video of it on YouTube, but you're essentially kneeling next to the wall, doing

[00:13:57] these rotations with your hands behind your head and elbows out to get a combined rotation

[00:14:05] and side bending.

[00:14:06] And extension.

[00:14:07] And extension.

[00:14:07] I mean everything.

[00:14:07] It works you through all ranges of motion of the thoracic spine.

[00:14:10] And if that's tough, then you can always sit at the wall and do the side bending like

[00:14:15] they do in the study.

[00:14:16] Just getting the movement.

[00:14:17] Or just rotating, just getting some active rotation.

[00:14:20] You can even sit at your chair taking breaks.

[00:14:23] We've talked about this so often.

[00:14:24] Taking a break every 30 to 60 minutes and sitting up.

[00:14:30] Maybe you place your interlacing hands behind your head and do some opening in that upper

[00:14:34] back and then you rotate from that upper back.

[00:14:37] Like how can I break up my day more often so I'm not in one position all the time?

[00:14:42] And that's where we see it's the repetitive nature of what we do is typically how we end

[00:14:48] up in pain.

[00:14:49] And so how can I mix up what I've been doing so that I'm trying, I'm doing something different

[00:14:55] all throughout the day.

[00:14:56] And this can mean that even getting up and going, this always feels best for me, but

[00:15:02] getting up and going on a walk first thing in the morning.

[00:15:04] What do we get when we do walking?

[00:15:06] We get thoracic rotation.

[00:15:08] We, every step that you take, your arms are working opposite of your legs, right?

[00:15:13] And we get this gentle rotation through the upper back.

[00:15:15] So we're already starting to lubricate and get movement of the upper back.

[00:15:19] We're usually hopefully not looking down at our phones.

[00:15:22] We're looking up at nature, what's in front of us.

[00:15:25] And so we're getting more of this upright posture, breathing, relaxation in nature.

[00:15:29] And you're just, and so it's all like walking is so beneficial.

[00:15:33] That's one of the most beneficial exercises I feel like you can do for your entire brain

[00:15:37] and body.

[00:15:38] And so that alone can help to make improvement if you do, if you're being more mindful of

[00:15:44] how am I taking breaks and can I get a 10 minute walk, you know, a couple of times throughout

[00:15:47] the day.

[00:15:47] Which that adds into, we're talking about an issue that's chronic and persistent.

[00:15:51] And when we're talking about pain, it's not just biomechanical.

[00:15:56] Yes, there are movement things, mobility, strengthening that we can do to help on the biomechanical

[00:16:02] side of things and physiologic side of things.

[00:16:05] But chronic and persistent pain starts to develop these different intricacies on the neurologic

[00:16:11] side, on the social side, on the psychological side that we also need to take into account.

[00:16:15] Yes.

[00:16:16] And just getting outside for a walk or if there's somebody in your neighborhood or a partner

[00:16:19] that you can walk with, it adds that rapport.

[00:16:23] It starts typing in these new messages of, you know, I enjoy doing this.

[00:16:28] We're getting endorphins.

[00:16:29] We're getting sunlight.

[00:16:30] And those things long-term over time can really help rewrite some of those chronic and persistent

[00:16:36] pain patterns that have been typed in.

[00:16:39] Because, you know, we're not idiots.

[00:16:41] We know that chronic and persistent pain is beyond just doing a few exercises a day.

[00:16:46] That's what the research shows.

[00:16:47] That's what, you know, it's shown that having a multi-directional approach that touches and

[00:16:53] takes into account all of our areas of life is most effective.

[00:16:56] Exactly.

[00:16:57] And so we have to address like, are we getting sleep?

[00:17:01] How is our sleep environment set up?

[00:17:03] How can I change my sleep environment?

[00:17:05] Do I need more pillows around me to provide support so that I feel more comfortable?

[00:17:09] Do I need to put my phone in a different room so that I'm not distracted and I can, you

[00:17:13] know, go to bed?

[00:17:14] Like, how can I set up my environment a bit different so that I can set myself up to try

[00:17:19] at least getting better sleep?

[00:17:21] A lot of times, you know, we feel like we fall victim to these things.

[00:17:24] I don't sleep well.

[00:17:25] I don't hydrate.

[00:17:26] I don't do this.

[00:17:27] I don't do that.

[00:17:28] And it's like, okay, what small thing can I change that can create a different impact?

[00:17:33] Because this all plays a role on our nervous system.

[00:17:36] If I'm not sleeping well, if I'm not hydrating, if I'm not getting good nutrients, if I'm not

[00:17:40] talking to friends, if I'm not, if I'm super stressed at work, this is all having an impact

[00:17:45] on my overall nervous system, which is going to increase our sensitivity to pain, period.

[00:17:50] And so, especially when we're talking about chronic and consistent pain, it isn't reiterating

[00:17:55] with dumb sense, not just about the movements, but we have to take into account everything.

[00:17:59] And it's hard when you're already in pain and you already have so much going on in life.

[00:18:04] It's hard.

[00:18:04] Like we're not, you know, saying that this is easy by any means, but we're saying, okay,

[00:18:11] here's some movements that you can try.

[00:18:13] Try open book first thing in the morning and then get up at your desk and try to rotate.

[00:18:17] Do a wall pec stretch, a wall rotation stretch.

[00:18:20] Like there are different things that we can do to break up our day.

[00:18:25] Take a walk during lunch after you eat.

[00:18:29] Take a five to 10 minute walk before you go back into your workday.

[00:18:32] Okay.

[00:18:32] So how can we start to add in little things that can create a larger impact over time?

[00:18:39] Because that's really what we're looking at.

[00:18:40] We're looking at chronic consistent pain.

[00:18:42] So what can we start to change in the short term, little bits at a time that create long

[00:18:48] term impact?

[00:18:49] And then like in the study, the last thing that I would add, I guess there's probably

[00:18:53] more that I would want to add.

[00:18:54] I know.

[00:18:55] There's so much.

[00:18:56] Yeah.

[00:18:56] It's the strength work.

[00:18:57] Yeah.

[00:18:58] The strength work and using resistance.

[00:18:59] And this doesn't necessarily need to mean, you know, getting into the gym and lifting

[00:19:04] heavy dumbbells or heavy barbells.

[00:19:06] In the study, they use resistance bands.

[00:19:08] They do rows with resistance bands.

[00:19:10] They do.

[00:19:11] It's kind of like a, what we would call a paloff press, you know, getting active rotation

[00:19:16] with the resistance with, with the band, the Superman exercise on the ground.

[00:19:21] That's like a strength body weight, you know, body weight extension type exercise.

[00:19:26] Even just bent the I's, T's and Y's with body weight.

[00:19:31] So laying prone on your stomach, either on the floor or on a bench and doing T's, I's,

[00:19:38] W's.

[00:19:38] It helps work all of those retraction muscles and extension type muscles in your back.

[00:19:44] Um, and, and beyond that, this is where we go into the other areas of the body because

[00:19:49] it's not just the mid back.

[00:19:51] Right.

[00:19:51] You know, the mid back is where we feel the symptom.

[00:19:53] What are the other root causes that could be contributing to why our mid back is working

[00:19:58] so much?

[00:19:59] Um, before I get into that, we have a posture course that we're coming out with.

[00:20:04] Yeah.

[00:20:04] It's going to address so many different areas.

[00:20:07] It's going to address so many different things.

[00:20:08] The course, um, we're starting with a huge community next week.

[00:20:12] Right now it's on an early bird sale.

[00:20:14] So if you're interested, or if you're somebody who has mid back pain, low back pain, or just

[00:20:19] interested in how you can optimize your understanding of posture, the thing that I love about this

[00:20:25] course and why I wanted to bring it up when we were talking about the whole body approach

[00:20:29] is it takes a whole body approach when it comes to posture all the way from the feet

[00:20:33] to the top of the head.

[00:20:35] It helps us understand better how all these different areas interact, coexist together,

[00:20:41] posture and are implemented to make up the dynamic posture that we use throughout the

[00:20:46] day.

[00:20:47] And not sure if you have anything else to say about that, but I mean, it all starts with,

[00:20:52] you know, our breath, our foundation, you know, if, if I can get a better expansion through

[00:20:57] my low rib cage, that, that plays a role into my thoracic and upper back, um, in my mid back

[00:21:04] region.

[00:21:04] Right.

[00:21:04] So if I can learn to expand my rib cage better, if I can learn to utilize my diaphragmatic breath

[00:21:11] and calm symptoms down, I'm automatically helping to feel better.

[00:21:14] So that's like a phase one to start, but then we go into core, we go into strengthening, we

[00:21:19] go into mobility work and so much more that can play a role in again, this long-term effect

[00:21:25] that you're feeling within your, in your mid back.

[00:21:27] And I'd highly recommend this course because understanding that posture is dynamic and

[00:21:33] it's personal to you.

[00:21:34] There's no one perfect posture.

[00:21:36] There's no pull your shoulders down and back and stand in this rigid form.

[00:21:39] It is what, it's what you find and discover within your belly, your belly, your body that

[00:21:47] helps you to find balance so that you don't feel like you have these muscles tugging and

[00:21:53] working constantly, which is resulting in that chronic and consistent pain pattern.

[00:21:59] And so, I mean, this would just be a great course to, to help combine all of this together.

[00:22:05] It is a great course to say all the other things that we want to say about chronic and consistent

[00:22:10] mid back pain in a 30 day course that you will have lifetime access to.

[00:22:14] Like you mentioned, the other things we go into for talking more specifically about mid back

[00:22:21] pain now is the rib cage expansion, finding that dynamic core control, dynamic foundation,

[00:22:27] deep core control, figuring out how our hips and core and mid back all are working together.

[00:22:34] You know, often when we start doing exercises that are focused on the low back, we're compensating

[00:22:38] through lower body, we're compensating through the low back and the upper back.

[00:22:43] So it all has interplay.

[00:22:45] There is a place to work on all those and find out where the restrictions are that may

[00:22:51] be contributing to your upper back pain.

[00:22:55] Once again, if you want to check that out, we're going to have that linked up in the show

[00:22:58] notes.

[00:22:59] This is going to be such an exciting course and I cannot wait to get started with a new

[00:23:03] community.

[00:23:04] Of course, when you join the community, you get direct access to me throughout this course

[00:23:09] and you have lifetime access to always be able to refer back to it.

[00:23:13] If you heard something that you feel like can support someone else, please pass this episode

[00:23:17] along.

[00:23:17] This is how we get the information out and help relieve people of those pains and restrictions

[00:23:21] within their bodies.

[00:23:22] We hope to see you back on another episode of the Optimal Body Podcast.