Pain in the mid back and chest wall is often overlooked but can have a significant impact on breathing mechanics, posture, core stability, and athletic performance. These regions include the thoracic spine, rib articulations, intercostal muscles, and supporting soft tissues. Dysfunction here may arise from poor posture, lifting injuries, sports impact, or repetitive motion and can mimic cardiac or pulmonary conditions.
At the Performance Medicine Institute, we take a detailed and integrative approach to mid back and chest wall pain. Our clinicians evaluate posture, spinal mobility, rib motion, breathing mechanics, and muscular coordination. We offer evidence-based treatments including manual therapy, rib mobilization, dry needling, neurodynamic techniques, and functional strength programming. Common conditions we treat include:
Thoracic Facet Joint Dysfunction
Facet joints in the thoracic spine can become stiff, inflamed, or irritated due to poor posture, rotational strain, or degenerative changes. This leads to localized pain between the shoulder blades, often worsened by twisting or deep breathing. Treatment includes spinal mobilization, postural correction, and segmental stabilization exercises.
Rib Dysfunction / Subluxation
Rib joints (costovertebral and costotransverse) can become misaligned or restricted, causing sharp pain with breathing, rotation, or coughing. Patients may describe a “catch” or stabbing sensation. Manual rib mobilization, thoracic manipulation, and breathing retraining are often effective.
Intercostal Muscle Strain
Intercostal muscles, which run between the ribs, can be strained by twisting, coughing, or sudden movements. This causes localized, sharp pain with breathing or torso movement. We treat this with soft tissue release, graded mobility, laser therapy, and progressive loading as symptoms resolve.
Scheuermann’s Kyphosis
A structural spinal condition seen in adolescents and young adults, Scheuermann’s kyphosis causes an exaggerated forward curvature of the thoracic spine. It may lead to stiffness, fatigue, or back pain during prolonged activity. Care focuses on spinal mobility, core strengthening, postural re-education, and bracing when indicated.
Postural Syndrome / Rounded Upper Back
Slouched posture, forward head position, and prolonged sitting can lead to thoracic stiffness and muscular imbalance. Patients often report aching between the shoulder blades or tightness across the chest. We correct these imbalances with targeted stretching, scapular stabilization, and ergonomic coaching.
T4 Syndrome
T4 syndrome is a neurovascular condition involving upper thoracic spinal segments. It presents as vague upper back discomfort with referred pain, numbness, or tingling into the arms or hands—often without a clear nerve root pattern. Treatment includes spinal mobilization, nerve glides, and postural interventions.
Musculoskeletal Chest Wall Pain
Chest pain that’s reproducible with movement or by pressing on the area is often musculoskeletal in origin. This includes costochondritis, myofascial trigger points, or referred pain from the thoracic spine. Care focuses on differentiating from cardiac causes, followed by soft tissue therapy, breathing mechanics training, and strength restoration.
Post Thoracotomy Pain
Patients that have underwent thoracotomy procedures often develop significant chest pain after they are discharged from the hospital. The tiny nerves which run between the ribs can get caught up in scar tissue, and can be very painful. We offer an integrated treatment approach, including laser therapy and nerve mobilization, that helps to free up the nerve to rapidly relieve pain and restore function.