5-Minute Quick Guide: Low Back Pain and the Thoracolumbar Junction

What is the Thoracolumbar Junction?

Our spine has many defined sections that allow chiropractors and medical doctors alike to pinpoint the specific causes, care, and treatment for our upper, mid, and low back pain and dysfunction.

An Infographic Depicting the Location of the Thoracolumbar Junction on the Human Spine
Thoracolumbar Junction: Spinal Segments

One of those areas is the thoracolumbar junction, which is exactly as it sounds.

Defined

This is the area of the spine where the thoracic spine (mid-back) transitions into the lumbar spine (low back).

Not many people think of this section of the spine when it comes to their mid and low back pain since symptoms are usually felt further down or higher up in relation to the thoracolumbar junction.

However, this area can be significantly affected by traumatic events, poor posture, and weak muscles which can, of course, lead to noticeable pain and discomfort.

To help you understand exactly how that can happen, let’s break down some important anatomy.

Anatomy and Physiology of the Thoracolumbar Junction

The thoracic spine consists of 12 vertebrae, 24 ribs, and the attachment point for many muscles.

Some of the more critical muscles located in the thoracic spine include:

A Close-up of a Woman's Bare Back with Kinesio Tape Overlaying the Erector Spinae and Rotatores Muscles of the Thoracic Spine
The Erector Spinae and Rotatores Muscles

The erector spinae muscles help you stand up straight and the rotatores muscles help you rotate your bones.

A Close Up of the Trapezius Muscles of the Thoracic Spine
The Latissimus Dorsi Muscles

The latissimus dorsi muscles are more commonly known as the “lats”.

A Close Up of the Rhomboid Muscles of the Thoracic Spine
The Rhomboid Muscles

The rhomboids help with shoulder and neck movements.

A Close Up of the Trapezius Muscles of the Throacic Spine
The Trapezius Muscles

The trapezius muscles are more commonly referred to as the “traps”.

As we move down the thoracic spine, the spine will transition into the lumbar spine as we move past the twelfth vertebrae and twelfth set of ribs.

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Did You Know

The lumbar spine has only five (notably larger) vertebrae, unlike the thoracic spine.

In addition, there are no rib-like structures and the pelvis and sacrum both work with the lumbar spine to keep the low back healthy and functioning.

Like the thoracic spine, the lumbar spine also functions as an attachment point for multiple muscles.

These muscle points include 3 of the muscles located in the thoracic spine, and this helps us understand how the different muscles and segments of the spine work together in keeping the body upright and moving.

The thoracolumbar spine serves a very important and foundational purpose.

When we are born, our spine does not have any curves or junctions where the spine is transitioning.

As we grow, we start to lift our heads, creating the first curve in the neck.

The first curve we create is called the cervicothoracic junction, which is, again, exactly what is sounds like.

An Infographic Depicting the Location of the Cevicothoracic Junction of the Human Spine
Spinal Curves: The Cervicothoracic Junction

As we grow, we start to lay on our stomachs and crawl around on our hands and knees.

Gravity takes effect once again and creates the thoracolumbar junction.

Know This

Your spinal curves stabilize and diffuse the forces of gravity on the spine.

Without the physiologically necessary spinal curves, we would certainly experience many more spinal problems as a result of the forces of gravity and related to the physical load and stress of our day-to-day activities.

The curves in the spine allow for more room for muscles to be attached, for extra bounce and cushion for when we walk or run, and our spinal curves enable us to stand upright for long periods and do so relatively comfortably.

The spinal curve in the thoracolumbar region is another reason we do not commonly sustain many injuries in this area.

To better illustrate this point, imagine you have a dull pair of scissors and you’re trying to cut some high-quality ribbon using this same pair of dull scissors.

If you pull the ribbon taut and slice through it, you have a better chance of successfully cutting the ribbon.

However, if you hold the ribbon loosely and try to cut it with that same pair of dull scissors it’s safe to say you’ll probably be unsuccessful in cutting that ribbon for who knows how many times.

A Scene Depicting a Woman Cutting a Ribbon to Demonstrate the Concept of the Curvature of the Spine Contributing to Its Structural Integrity
Spinal Curves

Why? Because the ribbon will simply keep bending as you try to cut it with those dull scissors.

This example is a great way to help us think about exactly how the curves in the spine help protect us from the “dull knives” that attack our backs throughout the day.

Those “dull knives” can include would be injuries sustained as a result of poor posture, running, car accidents, or even tripping over your own feet.

In addition to the protection provided by the curvature of the thoracolumbar junction, this region of the spine has a few other tricks up its sleeve for even more injury protection.

One such “trick” is it’s actual location in the spinal column – it’s situated in the middle of two highly mobile and fortified sections of the body.

Know This

The neck or the hips often take the brunt of any trauma before the midsection is affected.

The thoracolumbar junction is at the same level as the organs in your stomach.

When there is trauma, we are more likely to instinctively and reflexively protect this area.

The purpose of the skeletal muscles that surround and support the spine is a vital one as well.

As explained above, the thoracolumbar area of the spine has many large and small muscles that contribute to it’s structural integrity.

The muscles in this region allow us to stand up and remain upright, twist our bodies from side to side, and lift heavy objects.

An Infographic Depicting the Structure of the Fibers Within a Skeletal Muscle
Skeletal Muscles

And in addition to being designed for strength, the muscles are woven in a pattern that makes it difficult to break through them.

So, if you’re one of the many that have ever wondered why they somehow miraculoursly only ended up with a minor muscle strain after some big stunt or other physical exploit, you know the “magic” your body has all too well.

You know that the muscles protect your vital organs and the other structures orf the spine like a defensive wall.

Without those muscles there, your organs and spine would absolutely be exposed and subject to physical harm more often.

Thoracolumbar Junction Injury

Now that we can appreciate how relatively difficult is is to injure the thoracolumbar region of the body, let’s look at those events and situations that can contribute to injury to this area of the spine.

Because, of course, if it exists, it can get injured!

Know This

The thoracolumbar junction, in particular, is prone to some of the same problems we face in our other transition areas like the shoulders, hips, and the cervicothoracic junction.

These types of injuries include:

  • Trauma
  • Poor Posture
  • Lack of Movement
  • Failure of the Diaphragm
  • Genetics
  • Developmental Problems

Trauma to the Thoracolumbar Junction

Trauma is a large umbrella term often included in any diagnostic questioning by a medical doctor or chiropractor.

Many times trauma is sustained when you are hurt in a sudden manner by way of another object.

A common source of trauma chiropractors and medical doctors treat is car accidents, but trauma can also be sustained as a result of a fall, other serious injuries, natural disasters, etc.

One of the most common fractures seen after a car accident or other whiplash / collision accident is a chance fracture – also referred to as a seat belt fracture.

An Infographic Depicting the Physiological Presentation of a Chance Fracture Near the Thoracolumbar Junction of the Spine
Chance Fractures

For instance, the rapid deceleration experienced at the time of impact in a car accident can result in a seat belt triggered fracture.

Upon deceleration, the spine is “forcibly flexed over the lap seat belt, resulting in the distraction or separation of the middle and posterior elements of the spine.” [1].

Seat belt fractures are most known for happening in adult males and are the second most common location for these chance fractures to occur, after the neck.

Chance fractures are typically sustained near the thoracolumbar junction in the last 2-3 vertebrae of the thoracic spine that we looked at earlier in this guide.

Now that we’ve covered more traditional sources of injury, let’s dive into a commonly overlooked source of chronic thoracolumbar and low back pain: posture.

Poor Posture and the Thoracolumbar Junction

Again, we have the potential to injure any area of the spine, and there are multiple ways this can happen, including by way of habitual poor posture.

Know This

Typically, the worst postures that take a more direct toll on the thoraculumbar area of the spine are those we tend to fall into when we’re sitting and sleeping.

When we sit, for example, a majority of us typically round our backs which decreases the degree of curvature in the thoracolumbar region of the spine.

You’ll recall from a few paragraphs ago just how significant this curvature is to our spinal health, so we do not want to flatten it out.

Similarly, when many of us sleep we prefer to do so on our stomach, and this also affects the thoracolumbar curve of the spine in the exact same way.

A Scene Showing a Man Sprawled Out on His Bed and Sleeping on His Stomach
Spinal Heatlh and Posture

When we lay on our stomach, our thoracolumbar curve has no support, which means the muscles pull at it all night long.

And, as most of us know all too well, when we depend on our muscles for long periods, they start to stretch and loosen.

It makes sense thatn that sleeping on our stomach with no support will almost certainly result in muscle straining and pain when waking up.

Now, let’s cover one additional source of thoracolumbar pain that may surprise you.

Failure of the Diaphragm

An interesting and less known reason for low back pain in the thoracolumbar region is the failure of our diaphragm muscle.

A 2-D Anatomical Image Showing the Location of the Diaphragm Muscle within the Ribcage
Diaphragm

The diaphragm is the muscle that stretches to allow air in and then bends to push air out when we breathe.

The diaphragm can fail with misuse or a more neurological problem involving the Vagus nerve that comes from the brain and branches through the spine.

Misuse is the most common cause of diaphragm failure.

Did You Know

Many times people will breathe with their chest muscles instead of with their stomach muscles which can cause a strain of the chest and shoulder muscles and weakness in the stomach muscles.

Many medical doctors and chiropractors will train patients to breathe by pushing out their stomach when they intake air and sucking their stomach in when they push air out.

Many times this small action will help with low back pain and more general spinal pain.

Next, let’s talk treatment.

Treating Thoracolumbar Junction and Low Back Pain

One of the best questions a patient can ask when they have a problem is what they can do to actively and proactively help ease their pain and discomfort moving forward.

In almost all cases, there are multiple ways to manage thoracolumbar and low back pain to help you find relief and stay strong and steady!

Perhaps the most commonly recommended first-line solution for easing thoracolumbar-related pain is to make an appointment for an evaluation with a licensed medical professional like a chiropractor.

Know This

Chiropractors are trained to assess walking, running, breathing patterns, and posture that could affect the condition of the thoracolumbar spine.

Chiropractors will assess the injury by analyzing patterns the body is following.

After the assessment and gathering of data, a doctor of chiropractic will work to treat the area with adjustments to the mid and low back.

In addition to dispensing adjustments, most chiropractors will often recommend and provide soft tissue therapies to help ease the musculature around the area and go so far as to provide exercises to ensure treatment effects last a lifetime!

A Male Chiropractor Discusses Treatment Options for Thoracolumbar Junction-Related Pain for His Female Patient
Thoracolumbar Pain: Chiropractic Care

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We hope the article above has given you some great notes to share with your patients regarding the importance of the thoracolumbar region of the spine to their overall spinal health.

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