"I’m a regular runner and usually do 5-6 miles per session.  1 week ago, about half way into my run I had a sudden and very sharp pain in the right side of my mid back near my shoulder.  Worryingly, I had sharp pain on taking a deep breath, so much so, I went to casualty.  They checked me over, but couldn’t find any problems.  The pain is now not as sharp, but is still a dull ache, aggravated by leaning to the right side. It’s been much the same for the last 2 weeks.  Any idea what this is, and can you help?"

Ms K age 41 Winsford

Most likely this is an irritation to the facet joints of the mid thoracic spine.  Other suspects would be the articulation between the vertebrae and the rib, or possibly a tear to the muscles between the ribs, the intercostals muscles.

The facet or zygopophyseal joint are part of the spinal bones positioned on either side of the vertebrae.  They are similar to the joints on the end of your finger and are an essential component of the movement and stability of the spine.  In the lumbar vertebrae the joint angle is horizontal and provides stability by preventing excessive side to side movement.  In the mid back it is positioned at 45 degrees.  If you open a book with both hands and hold it in front of you, the angle of the pages is the same as that in the facet joint.  As these thoracic facets have no side locking mechanism they can sprain the fibrous nerve filled capsule around the joint.  The irritation fires the nerves and gives a very point specific, sharp, stabbing pain.  Compressing the joint by leaning to the right will aggravate it. Many describe facet pain as a needle or knife in the back. It can feel as if it comes through to the chest wall.  Your case is right sided and casualty gave you the ok, so nothing serious.  Often it is difficult to find the exact point of tenderness yourself as it can be quite small, until you move enough to trigger the nerves.  A deep breath is often enough, especially running.  I wouldn't be surprised if there was a history of injury to that area in your past.  There often is.

 If left alone the pain should begin to ease within a week. If it's uncomfortable enough at two weeks, I would recommend treatment. (Well I would, wouldn't I!)

Once the facet joint in question has been identified, a chiropractic adjustment will mobilise the joint and calm down any associated muscle spasm and/or nerve pressure.  One to two treatments usually clears the problem within a few days, relief often is immediate.  A check in a month to ensure all has settled well is advisable.

Julien Barker

South Street Chiropractic