Mid & Upper Back

What It Is

The vertebrae (bones of the spine) are joined to each other by the discs between them and by small paired joints at the back of the spine called facet joints (Cleveland Clinic, 2022). This sheet is about sprains of the joints in the thoracic (upper and middle back) spine, which are often called facet joint sprains. A sprain is a stretching or tearing of a ligament, and in the thoracic spine it can be caused by a sudden twisting movement (Cleveland Clinic, 2022). Injury can also follow a forced movement backward or forward.

Pain is usually felt in the upper or middle back close to the spine, and it often increases with bending backward or forward. Facet joints are thought to be a source of pain in many people with long-lasting upper back pain (Manchikanti et al., 2004). Pain that spreads to the chest should always be checked by a doctor, as other causes need to be ruled out (see When to Get Help).

What Causes an Intervertebral Joint Sprain?

Repeated forward bending – places load on the discs and stress through the facet joints.
Poor posture and prolonged sitting (Cleveland Clinic, 2022).
Sudden twisting movements, especially if the spine is stiff (Cleveland Clinic, 2022).

Thoracic Intervertebral Joint Sprain Anatomy

The spine is composed of a number of small bones, called vertebrae, stacked one on top of the other. Ligaments, nerves, muscles and intervertebral discs (soft cushions between the vertebrae) are all additional parts of the spine. In the thoracic spine there are twelve vertebrae, labelled T1 to T12 (Cleveland Clinic, 2022).

The stacked vertebrae form a canal that shields and protects the spinal cord. Neighbouring vertebrae are linked by the discs and by small joints at the back called facet joints, which let you twist and turn (Cleveland Clinic, 2022). The spine has three sections that create natural curves in your back: the neck (cervical), the chest area (thoracic) and the lower back (lumbar). At the bottom, the spine ends in the tailbone, which is part of the pelvis (Cleveland Clinic, 2022).

The ribs attach to the thoracic vertebrae (Cleveland Clinic, 2022).

Spinal nerves carry messages between the brain and the body. They branch out from the spinal cord through openings between the vertebrae (Cleveland Clinic, 2022).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Thoracic Intervertebral Joint Sprain

Physiotherapists commonly use exercise, advice, joint mobilisation and soft tissue therapy for upper back pain (Risetti et al., 2023), and the NHS (2026) lists manual therapy as a treatment for back pain. I can help with hands-on work to ease muscle spasm, gentle joint mobilisation and exercises to get your back moving and strong again. See the My Approach tab for how I work.

1. Stay Active

If certain activities clearly make the pain worse, ease off them for a while, but try to stay active and continue with your daily activities, and do not stay in bed for long periods (NHS, 2026). Gentle mobility exercises can usually be started fairly soon.

2. Ice or Heat

Use an ice pack (or bag of frozen peas) wrapped in a tea towel to reduce pain and swelling, or a heat pack or hot water bottle wrapped in a tea towel to relieve stiffness or muscle spasms (NHS, 2026). Never put ice directly on the skin.

3. Maintain Good Posture

Posture and long periods of bending forward are linked with upper back pain (Briggs et al., 2009). Try to keep a comfortable upright posture and take breaks from forward bending. Extension exercises may also help, and I can show you some.

4. Stretching

Make sure to go slow and gentle when first stretching, and only stretch to the first point of tension. You don't want any discomfort or excessive tension during the stretching routine. Stop if your pain gets worse (NHS, 2026). I can give you a stretching plan with specific instructions.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Spinal manipulation: some osteopaths and chiropractors use spinal manipulation (quick thrusts to a joint); there is little research on how well it works for upper back pain (Risetti et al., 2023).
Prescription painkillers: if the pain is severe or not getting better, a doctor may prescribe painkillers (NHS, 2026).

How I can help (see the My Approach tab)

Gentle, low-velocity joint mobilisation, with no quick thrusts
Hands-on work to ease muscle spasm
Stretching, posture and strengthening exercises
Advice on staying active and getting back to your usual activities

Tips

Keep a comfortable posture and change position regularly, especially if you sit for long periods.
Staying active is important; activities like walking, swimming, yoga and pilates may help ease back pain (NHS, 2026).
Tightness and weakness in the muscles may contribute to back problems.
Exercising and building a strong core can help maintain strength and flexibility in your back and spine.

Treatment

My Approach

A sprain in the upper or middle back is a stretched or irritated joint and the ligaments around it, often after a sudden twist or a long spell bent forward. My aim is to ease the pain and muscle spasm, get the stiff joints moving again, and keep you active while it heals.

I start by assessing how your back, ribs, neck and shoulders move and finding the movement that brings on your pain. I also screen your nerves (sensation, reflexes and strength) and ask how it started. That tells us which path you're on.

If It's a Mild Sprain

Pain and stiffness close to the spine, with no numbness, weakness or warning signs, is something I can treat directly.

Gentle hands-on work for the muscles in spasm, building up as they settle
Warm or cool applications in the clinic, and I'll show you how to use ice or heat at home
Gentle, low-velocity mobilisation of stiff joints and ribs, never quick thrusts
Contract-relax work for the larger back muscles, with a version you can do at home
Breathing and relaxation to ease guarding
A slow seated bend-and-twist stretch, testing the painful movement before and after
Posture breaks, desk set-up, extension exercises, and strength work for your back, trunk and shoulder blades, building to gym-based lifting when you're ready

If It's More Severe

Pain after a serious accident, pain spreading to your chest, or numbness, tingling or weakness need a doctor's check first (see When to Get Help). Please bring any scan reports and notes from your medical team. Once serious causes have been ruled out, I can support your recovery with gentle hands-on work, comfortable positions and gentle movement, building up as your care team allows.

Every treatment we try should ease your symptoms, not increase them.

What to Expect

Typical Course

Typical course: For a mild sprain, most people come once or twice a week at first, then weekly, then every few weeks as you manage more on your own, with a reassessment at about 4 to 6 weeks; it usually eases within a few weeks. For a more severe injury, visits and the timeline follow your medical team's plan, and recovery can take longer.

What I Focus On

Assessment & Nerve Screening

Spasm Release

Gentle Joint Mobilisation

Posture & Movement

Return to Activity

Please read

When to See a Doctor First

When to Get Help

See your family doctor or nurse practitioner if your back pain is coming from the top of your back (between your shoulders), does not improve after a few weeks, is worse at night, or you have lost weight without trying (NHS, 2026). Get an urgent appointment with your family doctor or nurse practitioner if you feel hot, shivery or unwell, or the pain is severe and starts suddenly (NHS, 2026).

Call 911 or go to the emergency room at your nearest hospital if you have back pain with chest pain, with numbness, tingling or weakness in both legs, with loss of feeling around your genitals or bottom, or with changes in your bladder or bowels, or if the pain started after a serious accident (NHS, 2026).

Sources

References

Cleveland Clinic (2022) Thoracic spine: what it is, function & anatomy. Available at: https://my.clevelandclinic.org/health/body/22460-thoracic-spine (Accessed: 7 October 2026).
Manchikanti, L., Boswell, M.V., Singh, V. et al. (2004) 'Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions', BMC Musculoskeletal Disorders, 5, 15. doi: 10.1186/1471-2474-5-15
Briggs, A.M., Smith, A.J., Straker, L.M. and Bragge, P. (2009) 'Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review', BMC Musculoskeletal Disorders, 10, 77. doi: 10.1186/1471-2474-10-77
Risetti, M., Gambugini, R., Testa, M. and Battista, S. (2023) 'Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists', BMC Musculoskeletal Disorders, 24, 398. doi: 10.1186/s12891-023-06505-8
NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooThoracic Intervertebral Joint Sprain

What It Is

What Causes an Intervertebral Joint Sprain?

Thoracic Intervertebral Joint Sprain Anatomy

Self-Care & Treatment

How to Treat a Thoracic Intervertebral Joint Sprain

1. Stay Active

2. Ice or Heat

3. Maintain Good Posture

4. Stretching

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's a Mild Sprain

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooThoracic Intervertebral Joint Sprain

What It Is

What Causes an Intervertebral Joint Sprain?

Thoracic Intervertebral Joint Sprain Anatomy

Self-Care & Treatment

How to Treat a Thoracic Intervertebral Joint Sprain

1. Stay Active

2. Ice or Heat

3. Maintain Good Posture

4. Stretching

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's a Mild Sprain

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Thoracic Spine Pain

Costovertebral Joint Sprain

Intercostal Muscle Strain

Cervical Kyphosis

Book a session