A 51 year old regular patient came in with middle back pain that had crept in over the previous couple of weeks, with no clear cause other than a possible lift about eight weeks earlier. Here is how we worked through an unusual presentation for her and what we did on the day.
Presenting complaint
This patient is a regular at the practice but books on her own rhythm rather than on a fixed schedule. She tends to come in roughly once a month to once every two months, calling or booking online when she feels she needs a check. Her usual complaint is low back pain, so this visit was a change of pattern for her.
The pain was centralised in the middle of her back, in the thoracic spine, and had been building over the last couple of weeks. She could not point to anything specific that set it off. The best guess she offered was a lift about eight weeks earlier, but she was unsure whether that was really the cause given the gap in time. There were no other symptoms travelling with it. No shooting pain, no pins and needles, no change to breathing, bowel or bladder.
What the assessment showed
The thoracic spine was the clear site of restriction. The surrounding movement was tight through the mid back on rotation, with the joints feeling locked rather than inflamed. We screened for anything organic that could refer pain into this region, because the thoracic area sits over several organs that can mimic a musculoskeletal complaint. Nothing in her history, her description or the examination raised a red flag. Her general health was good, there were no systemic symptoms, and the pain pattern was mechanical.
The clinical thinking
Middle back pain in a maintenance patient is worth slowing down on. It is less common than the lower back and neck complaints we see most days, and when it turns up we always want to make sure we are treating a mechanical joint problem and not a visceral one being referred into the mid back. That screening came back clean here, so we were safe to adjust.
The eight week delay from a possible lift sounds like a long time, but a joint that was stiffened by a lift can sit quietly for weeks before the surrounding tissue starts to protest. The lift may well have been the start of it. Either way, with no red flags and a clearly mechanical presentation, the correct next step was to free up the thoracic spine and see how it responded.
Care plan today
We used a couple of thoracic sitting adjustments to release the stiffness through the mid back. The adjustment is delivered with the patient seated upright, arms folded, with a controlled impulse through the restricted segments. Both moves took really well, better than expected given how locked the area had felt on initial assessment.
How she is now
After the adjustments she was moving significantly easier and freer through the mid back. The expectation is that this will clear up over the coming days. I asked her to give us a call within the week if the pain has not changed, so we can review it either at the end of this week or the start of next week while it is still fresh. If anything new turns up, like shooting pain, numbness or any symptom outside of the back itself, that would change the plan and we would re-examine properly.
Rebates at the counter
She is a Bupa Member First member. The standard return visit fee of $71 was partly covered by her fund. Bupa paid $50.05 directly through our TYRO terminal on the day, leaving a $20.95 gap which she paid on her Visa at the counter. No forms, no lodging a claim later, just the gap on the day.
If you are still deciding
Middle back pain is one of those complaints that people put up with for weeks before coming in, usually because it is less sharp than lower back or neck pain and easier to ignore. If something has been bothering you across the thoracic spine, even without an obvious cause, it is worth a check. Call us on (07) 3272 4622 or book an initial consultation online.
Patient details have been changed to protect privacy. Individual results vary. In accordance with AHPRA and the Chiropractic Board of Australia advertising guidelines, this case study is provided for educational purposes and does not represent typical outcomes or constitute a testimonial.
Frequently asked questions
Can middle back pain show up weeks after a lift, or is that too long a gap to be related?
It can. Sometimes a stiffness from a lift sits quietly in the thoracic spine for weeks before it starts to grumble, especially if the person has carried on with their normal day and never fully reset the joint afterward. That said, we never assume. We also check for anything organic that could refer pain into the mid back, because the thoracic region sits over a few organs that can mimic a musculoskeletal ache.
What is a thoracic sitting adjustment and why is it useful for middle back pain?
It is an adjustment delivered while the patient is sitting upright, with their arms folded in front and the chiropractor providing a controlled impulse through the upper or mid back. It is particularly effective for releasing stiffness through the thoracic spine because sitting gives us a clear line of force into the joints that are stuck. Many patients notice they can breathe deeper and rotate more easily straight after.
How much does a chiropractic visit cost with Bupa Member First at Corrective Chiropractic?
For a standard return visit the fee is $71. Bupa Member First covered $50.05 of that for this patient, leaving a $20.95 gap paid at the counter on the day. The rebate is claimed instantly through our TYRO terminal, so you only pay the gap and there is nothing to lodge yourself.
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