The Thoracic Spine: The Key to Neck Pain, Upper Back Pain and Shoulder Pain

The thoracic spine is the part of the spine where the ribs attach and makes up one half of our entire spine. It is often overlooked when it comes to treating neck pain, shoulder pain and upper back pain. The thoracic spine is also an important key to proper posture and spinal alignment.


When the spine is in a neutral alignment or proper posture the neck, shoulders and upper back function correctly reducing the risk of injury and reducing stress to the neck, shoulders and upper back.

Proper posture or a neutral spinal alignment is classified by a slight lordotic (inward) curve in the lumbar spine (low back), a slight kyphotic (outward) curve in the thoracic (upper back) and a slight lordotic curve in the cervical spine (neck).


Often times injuries of the shoulder, upper back and neck are treated by trying to stretch, strengthen, massage, poke, needle and electrically stimulate the muscles of the neck, upper back and shoulders. But if the thoracic spine is not in the proper neutral alignment and if the proper alignment cannot be controlled and held stable during movement then it is likely that the neck or shoulder pain will not be resolved.

Improving Thoracic Posture

The first step to improving thoracic posture is to determine if the muscles and joints of the thoracic spine have the proper mobility to achieve the correct postural position. Tight muscles or restrictions of the joints of the thoracic spine may prevent the spine from moving into the proper position. Modalities such as massage, needling, joint mobilizations and stretching/mobility exercises may be used to restore the mobility of the muscles and/or joints so that the spine can be properly aligned.

Next, motor control must be established. Motor control is not the same as strength. You cannot strengthen your way out of bad posture. Motor control starts with the ability to actively get into a proper spinal posture. It is developing an awareness of what proper posture looks and feels like. Motor control is enhanced by the ability to maintain proper posture while moving. Start with less complex movements with little to no resistance and progress to more complex patterns of movement and eventually against greater resistance.

Resolving Shoulder Pain and Neck Pain

Once proper thoracic posture and motor control of the thoracic spine has been achieved then the symptoms of pain in the neck and shoulder can be addressed. Proper thoracic posture will bring the shoulder and neck into proper position which will reduce strain on the joints and soft tissues. By reducing the strain on the joints and soft tissues modalities such as massage, electric stimulation, needling and joint mobilization will be more effective at reducing pain and promoting healing. Proper posture and control of the thoracic spine will also place the muscles of the scapula (shoulder blade), rotator cuff and neck at the correct length to perform movement and exercise more effectively and will respond to exercises more effectively. This proper positioning reduces the mechanical stress to the joints and soft tissue of the shoulder, upper back and neck which resolves pain and improves function and performance.