A patient case from today. A 21 year old woman, slim build, slightly hypermobile. Horse rider. Under our care since September 2024.
Presenting complaint
Normally on maintenance checks, booked in a week earlier than scheduled with an acute left upper back pain that was worse on breathing and sneezing. She had the same pattern a month ago, we adjusted her, and it settled. It has come back the last couple of days.
What the assessment showed
Thoracic spine quite locked, particularly through the left side where the rib attaches. Lower back fine for her today. Upper neck tight on both sides at C1 and C2, consistent with the headaches she has had lately. Soft tissue in the mid back very sensitive to touch.
The clinical thinking
Upper back pain that spikes on breathing and sneezing can look like a lot of things. Before any adjustment, we worked through a differential. Prior imaging has already cleared lung and chest pathology for her. Today we checked a short systems review (digestion, abdomen) to rule out referred pain from organ-based causes. Reflux, indigestion, kidney stones and gallstones all have classic referral patterns that present as musculoskeletal pain in the thoracic area, and they are worth ruling in or out before you treat the symptom. Her pattern was consistent with a mechanical rib and thoracic joint problem, likely with a muscle spasm overlay, and nothing on review suggested otherwise.
Care plan today
Light soft tissue work with the massage gun (gentle because the area was very sensitive). Thoracic adjustments to free up the locked segments. Her usual lower back adjustments. Upper neck adjustments at C1 and C2 on both sides. Advice to come straight back in if the spasm pattern has not started settling within a week, or sooner if it worsens. If it does not resolve, we would refer for further imaging rather than keep repeating the same treatment.
How she is now
Still a little sore immediately after, as expected with a spasm pattern, but moving noticeably better. Booked back in three weeks for her usual maintenance, with instructions to come sooner if symptoms do not settle.
Rebates at the counter
Bupa Member First Provider rebate on today’s visit. $71 adjustment fee, $42.90 rebate through Bupa, $28.10 gap paid on Mastercard.
If you are still deciding
If you have upper back or rib pain that gets worse with breathing or sneezing, that pattern deserves a proper check before anyone adjusts it. We will work through what else it might be before treating what we think it is. Book an initial consultation.
Patient name has been changed. Individual results vary. This case study is shared for educational purposes and does not constitute a clinical recommendation for anyone else.
Frequently asked questions
Can upper back pain come from internal organs?
Yes. Reflux, gallstones, kidney stones and even heart issues can refer pain into the thoracic area. This is why we perform a systems review before adjusting thoracic pain, especially when the pattern is unusual or does not respond as expected.
Is chiropractic suitable for hypermobile patients?
Yes, with technique selection matched to the person. Hypermobile patients often need less forceful adjustments and more focus on joint stability. We adapt the technique to the individual.
Related patient cases
- Patient case: acute neck pain and headache in a 45 year old maintenance patient
A 45 year old regular patient hurt his neck lifting on Monday and came in with headaches by Thursday. Here is how we worked through it. - Patient case: acute lower back and leg pain, Medicare EPC covered
A 69 year old man came back to us with acute lower back pain and pain running down both legs. Here is how we cleared it and what a Medicare EPC visit looked like at the counter. - Patient case: 12 visit progress exam for a tall patient with lower back pain
A 51 year old patient hit his 12 visit progress exam today after starting care in June. Here is what the formal progress check looks like.
Add Comment