Thoracic Sprain/Strain and Costovertebral Dysfunction

Understanding Thoracic Sprain/Strain and Costovertebral Dysfunction

Also known as: Mid-Back Sprain, Seatbelt Injury, Rib Joint Injury, Upper Back Pain After Car Accident The thoracic spine is built for stability, which means when it gets injured, it usually requires a high-energy event to do it — and the shoulder strap of the seatbelt provides exactly that kind of force during a frontal crash. Thoracic sprain/strain involves injury to the ligaments and muscles of the mid-back. Costovertebral dysfunction refers to a mechanical problem at the small joints where the ribs meet the thoracic vertebrae. Both commonly occur together after an MVA, and together they produce a characteristic pattern of interscapular pain that can easily be mistaken for cardiac symptoms.

Sharp, stabbing pain between the shoulder blades or along the spine, worsened by deep breath, laugh, cough, or sneeze, is the hallmark. Many patients describe it as "a knife in my back" or feeling like "a rib is out. " Pain may refer to the anterior chest wall. The seatbelt concentrates decelerative force diagonally across the thoracic spine while the body is driven forward into the restraint — and side-impact crashes translate lateral force directly through the rib cage.

After ruling out fracture or pulmonary issues and documenting findings, we typically perform thoracic and rib-specific manipulation or mobilization, soft-tissue therapy to the rhomboids, mid-traps, and paraspinals, diaphragmatic breathing retraining, and Class IV laser for residual inflammation. Postural correction and scapular strengthening prevent recurrence. Most patients improve meaningfully within four to six weeks. We coordinate with your PCP if chest pain symptoms need cardiac or pulmonary clearance.

We may recommend: diversified adjustments, Activator, myofascial release, Graston/IASTM, trigger point therapy, Class IV laser, corrective exercise Seek immediate care if: You have shortness of breath, coughing blood, crushing chest pain, pain radiating to the jaw or left arm, or severe midline spinal tenderness — these require emergency cardiac and pulmonary evaluation before chiropractic care begins.