When it comes to back pain, the thoracic spine does not get a lot of attention. Consisting of 12 vertebrae, this area is located in the middle and upper part of your back. Ten of the 12 vertebrae connect to the sternum in the front of the body to form your ribcage. This bony armor protects our most vulnerable organs: the heart and lungs, to name two. The remaining vertebrae hold two “floating ribs” that do not connect to the sternum but offer some protection across the side of your body.

The result of this rigid cage is superior protection for vital organs, but reduced flexibility. And this is where the trouble may begin. Because the middle and upper back don’t allow for much movement, any injury or pain in this area can be difficult to treat.

As with all other vertebrae, the facet joints enable what little movement there is in this region to be supported. Winding through each joint is a thin web of medial branch nerves that are responsible for pain signals. If the facet joints are inflamed or otherwise irritated, the resulting pain can be debilitating.

What causes this type of facet joint pain? It most often occurs from these conditions:

• Spondylosis
• Spondylolisthesis
• Chronic chest wall pain

Any injury or deterioration in the facet joint can also cause pain, as can chronic middle back pain with no known cause.