Doctor Answers to Patient Questions: Thoracic Pain After Car Accident, Back Pain and Breast Size

The following explanations, insights, and advice about upper back problems are provided by Douglas J. Hendricks, MD, a physical medicine and rehabilitation specialist and a contributing author for Spine-health.com.

Patients frequently e-mail us questions about upper back problems, exercises and other treatments, and while we don’t provide individual responses, periodically, Dr. Hendricks and other contributors to Spine-health.com will take time to respond to the themes from more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about upper back problems represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Thoracic pain after a car accident

The Question:
I have a 29 year old son who was recently involved in an accident. Since this, he has been experiencing thoracic pain which radiates to his lumbar region. A recent MRI report states "consider Scheuermann disease." I have researched this disease extensively and as my son has never had childhood or adolescent back pain, this diagnosis makes no sense. Please would you advise me on possible misdiagnosis of this condition or what else could be wrong with my son’s back.

Doctor's Response:
Scheuermann disease is a disease affecting the thoracic spine predominantly in teenagers. Many times there are no symptoms, but sometimes there can be mild pain. It can cause an exaggerated rounding of the midback, and over time it can be harder for the patient to extend (bend backward). There are very characteristic changes on x-rays that, when found, typically lead to mentioning Scheuermann disease in the report. For your son, however, it should be considered likely that he has a musculoligamentous strain of the midback muscles caused by the car accident. This pain is easily treated with analgesics (pain medications such as Tylenol or topical creams), physical therapy or chiropractic. This type of pain usually resolves within weeks to up to three months post-accident.

Back pain caused by breast size

The Question:
I'm having trouble finding specific exercises for preventing back pain caused by breast size. Losing weight won't help with breast size, and I would rather use exercise to handle the problem than breast reduction surgery. Are there any exercises designed specifically for large breasted women?

Doctor's Response:
Good question. There are some things that you can do to help with your pain. First is to stretch the latissimus dorsiflexion (the triangular, flat muscle found along the back of the ribs which covers the back of the lumbar region and the lower half of the thoracic region) and pectoralis (the thick, fan-shaped muscle, found along the upper front of the chest, which lies under the breast in the female) muscles. Second is to do strength training focused on the scapular region (muscles around the shoulder blades). A good place to start would be with a physio ball (also commonly called “swiss”, “stability”, “therapy” or “exercise” ball). While lying on your stomach on the ball, try spinal extensions (bending backwards), hip extensions (lifting a straight leg straight behind you), and raising your arms up in front of you. Third is to be aware of your posture and utilize good posture guidelines while standing, sitting, working, sleeping, etc. (Answered by Jason G. Schomburg, MPT)

What next?

If you have questions about upper back problems, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “Search” box located in the upper left hand corner of each page and type in keywords that represent the topic you are interested in. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with upper back problems, please go to the Spine Forum Message Boards.

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.