It is estimated that 20% of the population suffer with persistent or chronic pain - a condition that has been under-recognised and under-treated for many years. As a Physiotherapist, it is the most common condition I see, usually in the form of chronic low back pain. This is my main area of interest and below is an infograph I created, as part of my Masters in the Clinical Management of Pain, to help explain what pain is and why it persists.

See tips for managing persistent pain here.

Information obtained from:

APKARIAN, A. V., BUSHNELL, M. C., TREEDE, R.-D. & ZUBIETA, J.-K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9, 463-463.

BASBAUM, A. I., BAUTISTA, D. M., SCHERRER, G. & JULIUS, D. (2009). Cellular and Molecular Mechanisms of Pain. Cell, 139, 267-284.

JAMES, S. (2013). Human pain and genetics: some basics. British Journal of Pain, 7, 171-178.

NIJS, J., PAUL VAN WILGEN, C., VAN OOSTERWIJCK, J., VAN ITTERSUM, M. & MEEUS, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy, 16, 413-418.

SCHAIBLE, H.-G. (2015). Emerging Concepts of Pain Therapy Based on Neuronal Mechanisms. In: SCHAIBLE, H.-G. (ed.) Pain Control. Berlin, Heidelberg: Springer Berlin Heidelberg.

WOOLF, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.

Chronic pain affects 20% of the population however it has been under-diagnosed and under-managed for years. The International Association for the Study of Pain defines chronic or persistent pain as pain that lasts or recurs for more than three months. A great deal of progress has been made in recent years in regards to chronic pain and it has now been included in the International Classification of Diseases as a condition in its own right.

Chronic pain is an individual experience however there are some commonalities. Most people living with chronic pain report emotional distress or psychological distress of some description.

Lets go through three different exercises you can do at home to:

1. Keep your upper & mid-back mobile
2. Keep your upper & mid-back strong
3. Help prevent issues occurring in these areas.

1. Mobility Exercise (to get the spine moving!)

a) Sit up tall with your legs crossed or knees bent up in front of you hip distance apart.

b) Place the back of your right hand against the outside of your left leg. Place your left hand on the floor behind you.

c) Breathe in as you grow tall through your trunk, breathe out as you twist your body to the left.

d) See can you go further, using your breathing (as above) to help.

e) Do this for 20 seconds and then repeat to the opposite side.

2. Strengthening Exercise (to keep the muscles able to do everyday activities!)

a) Lie face down with your arms by your side and your tailbone tucked underneath you.

b) Gently engage your core like you were ever so slightly tightening a belt.

c) Lift your arms up and reach towards your toes. Hold this for the count of 10. You should feel your arms and the middle of your back working.

d) Lower the arms.

e) Repeat 5 times.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

3. Stretching Exercise (to keep the muscles mobile & flexible!)

a) Start on your hands and knees. Sit your hips back towards your heels.

b) Lift your left hand off the floor and loop it underneath your right armpit, twisting your body as you do so.

c) Lower your left shoulder as close to the floor as you can. Keep reaching with your left arm.

d) Keep breathing as you hold this for 20 seconds. Each time you exhale see can you reach a little further.

e) Repeat going to the opposite side.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

Note: You should not feel any pain doing these exercises. You may feel the area working or stretching but it should not be painful - please stop the exercise immediately if pain occurs.

These simple exercises can be done at home to help you keep your back mobile!

1. Roll Down

a) Stand up tall with your feet about hip distance apart and a soft bend in your knees.

b) Start to walk your eyes down the wall in front of you and along the floor until your chin is close to or at your chest.

c) Start to round you upper back and shoulders as you imagine you are peeling your spine off a velcro wall behind you one piece at a time.

d) Leading with your arms (like they are heavy weights) continue to peel your spine off that imaginary velcro wall behind you. Rounding your upper back, mid-back and eventually your lower back.

e) Lower yourself as close to the floor as you feel comfortable going. Let your body hang heavy (like a Rag Doll).

f) If you feel tension in the back of your legs bring your weight towards the front of your feet.

g) Slowly roll yourself back up into standing.

h) Repeat 3 times.

2. Cat Stretch

a) Starting on your hands and your knees, bring your chin towards your chest.

b) Round your shoulders and your upper back, then round your mid-back, your lower back and lastly tuck your tailbone underneath you.

c) Then start to go the opposite direction - stick your bum up towards the ceiling, drop your stomach, drop your chest and look out in front of you.

d) Repeat this cycle 3 times.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

3. Hip Stretch

a) Lie on your back and hug your right knee towards your left shoulder. You should feel this stretch in the outside/back of your right hip. Hold for 20-30 seconds.

b) Repeat on the opposite side.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

Note: You should not feel any pain doing these exercises. You may feel the area working or stretching but it should not be painful - please stop the exercise immediately if pain occurs.

The upper and mid-back are collectively known as the Thoracic Spine. It spans the area from the base of the neck down to just above where the back starts to arch or hollow.

What is it made up of?

The Thoracic Spine consists of 12 vertebrae (spinal bones) stacked on top of each other and separated by intervertebral discs. These discs absorb shock and provide cushioning between the vertebrae. Each of the 12 vertebrae have attachments to the ribs, of which there are also 12! Many muscles (big and small!) span this area, alongside some nerve fibers too.

What shape is it?

The Thoracic Spine is naturally more rounded (kyphotic) compared to the neck and lower back, which tend to hollow or arch.

*[To visualize it: Think of your spine running from the top of your neck down to your tailbone as being a slight ‘S’ shape.]*

What does the Thoracic Spine do?

1. Protects the spinal cord
2. Acts as an anchor for the rib cage
3. Allows us to move our trunk in different ways

What movements does the Thoracic Spine do?

The Thoracic Spine typically offers more stability than it does mobility, compared to the neck and lower back. It does move in all different directions:

• Bending forwards and backwards
• Leaning to the side
• But most of all: TWISTING movements.

Did you know: The action of lifting your arm overhead requires a certain amount of movement to happen in the upper back. Without this we would be restricted in how high we can lift the arm!

What causes pain in this area?

Most commonly pain arises due to muscle or joint issues. It is extremely rare that a disc causes pain in this area.

Specific causes of pain include:

• Osteoporosis
• Osteoarthritis
• Shingles
• Trauma (e.g. a fall)
• Scoliosis
• Excessive rounding or kyphosis
• Other medical causes

Is it related to neck or low back pain?

It can be, yes. Commonly in clinical practice we see the Thoracic Spine contributing to neck or low back pain. Usually this presents as stiffness or a lack of movement in the Thoracic Spine which places increased demands on the neck and low back. By keeping the upper and mid-back as mobile as we can, helps to reduce the likelihood of this. By also keeping the muscles in the area strong you can reduce excessive curvature of the spine and help prevent shoulder, back and neck issues.

JennyPhysioPilates members click here to see videos on how to keep your upper & mid-back mobile.