The thoracic facet joints are located on the back of the spinal segment and are responsible for guiding spinal movements, such as twisting, bending, and extending. When these joints are injured, inflamed, or arthritic, they can cause localised pain and stiffness.

Facet joint pain typically arises from overuse, injury, or degeneration. Common causes include poor posture, repetitive movements, or trauma (such as a car accident). Age-related changes, such as osteoarthritis, can also contribute to facet joint dysfunction in the thoracic region.

1. Symptoms of thoracic facet joint pain can vary, but common signs include:

   • Localised mid back pain: Pain that is felt directly over the middle of the spine, usually between the shoulder blades or at the level of the ribs.
   • Stiffness: Reduced mobility in the mid-back region, especially during rotating or extending movements (arching backwards).
   • Pain with movement: Pain that worsens with certain movements, such as rotating, extending, or arching backwards.
   • Pain at rest: In some cases, discomfort may persist even when at rest, particularly when lying down or sitting for prolonged periods and can be worse in the morning.

1. Diagnosing thoracic facet joint pain involves a thorough clinical evaluation by a skilled physiotherapist. The process includes a detailed history of your symptoms, such as the onset, location, and nature of the pain. A physical assessment that includes provocation movements, such as the thoracic rotation and extension test can provoke discomfort and provide clues as to the painful tissue. Palpation can help identify tenderness or stiffness around the affected joints. In some cases, imaging (e.g., X-rays or MRI) may be recommended to rule out other conditions. A precise diagnosis ensures a tailored, effective treatment plan to alleviate pain and improve your spinal health.

1. Treatment for thoracic facet joint pain should be individualised, addressing the root cause of the discomfort. Evidence-based physiotherapy approaches have been shown to be highly effective in managing and resolving facet joint pain and these include both passive and active interventions. Here are key treatment strategies:

   1. Modalities for pain relief

   Techniques such as heat therapy, ice therapy, ultrasound, and transcutaneous electrical nerve stimulation (TENS) can provide temporary pain relief and reduce inflammation. Hands-on joint and muscle therapy and exercise modalities can also be used to help manage pain.

   2.Manual therapy

   Manual therapy techniques, including spinal mobilisation and manipulation, are commonly used to alleviate pain and restore joint mobility. Research has shown that these hands-on interventions can reduce pain, increase mobility, and improve spinal function by targeting the affected facet joints. This then creates a window of opportunity to use specific movements and exercise to gain further mobility and strength.

   2. Therapeutic exercise

   Exercise is a cornerstone of rehabilitation for thoracic facet joint pain. A tailored exercise program will focus on improving strength of specific muscles surrounding the thoracic spine, and enhance mobility. Specifically, exercises that target the trunk and posterior back muscles and improve spinal movement can reduce the strain on facet joints and prevent further injury.

   Strengthening exercises, such as scapular retraction and thoracic extension exercises, help to support the spine and reduce unnecessary pressure on the facet joints. Dynamic mobility exercises can improve range of motion and ease stiffness in the affected area.

   4. Patient Education and Self-Management

   Educating patients about their condition and teaching them self-management techniques are essential components of successful rehabilitation. Physiotherapists help patients understand the causes of their pain, the importance of maintaining an active lifestyle, and how to prevent future flare-ups.