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What is it?

The thoracic spine is comprised of 12 spinal segments separated by a disc. Each segment articulates with the level above and below through facet joints. Our ribs, which are very important for protection of vital organs and breathing, attach from the breastbone (sternum) at the front to the thoracic joints at the back. The rib articulates with its corresponding thoracic segment at the vertebral body and the transverse process. Irritation or aggravation to the costovertebral joint is a musculoskeletal condition that presents commonly to physiotherapy clinics around the world.


A costovertebral sprain is usually caused by sudden or repetitive twisting, lifting or bending movement, resulting in an injury to the costovertebral joint. This can cause surrounding muscles to spasm and a feeling of stiffness, pain or tightness at the mid back, around the shoulder blade or along the ribs.

Signs and symptoms:

Patients will usually report a sudden pain at the mid back usually either side of the spine. This may be preceded by a sudden movement, or repetitive actions. Patients will usually report twisting, extending or bending movements to be aggravating. Often they will describe breathing, especially deep breathing to be difficult, as well as sneezing, coughing or laughing.


Diagnosis can be determined by a physiotherapist who will complete a thorough examination based on your history, what movements are painful or restricted and if there is pain on palpation of the spinal segments and surrounding musculature.


The first step of management is to settle down the painful symptoms by effective load and pain management strategies. This may involve reducing or modifying aggravating movements, e.g heavy lifting and twisting at work. Pain management may involve off the shelf pain relief, a heat pack or discussing with your GP possible prescribed medications.

Physiotherapy can be very helpful in the management of this condition. Initially, your physiotherapist will focus on pain management strategies which may include soft tissue massage, joint mobilisations, taping or dry needling. Restoring full, pain free range of movement is an integral aspect of the rehabilitation process. A tailored exercise program, based on the patients goals will be prescribed that focuses on strength, mobility and capacity of the thoracic region. This program will aim to ensure you can return to all usual work, sport and daily activities.

If you have injured yourself or have any questions call today to secure an appointment.