Thoracic osteochondrosis: details about symptoms and treatment regimens

Author: Zemereva N.Yu., physiotherapist. March, 2021.

Synonyms: thoracodynia, thoracalgia - chest pain.

ICD-10 code: M42, M54.6.

Thoracic osteochondrosis is a degenerative lesion of the spine (depletion and destruction of the bone structure of the vertebra). It begins with damage to posture, the appearance of vegetative symptoms (shortness of breath, weakness, sweating, malaise) and the development of severe pain. Thoracic osteochondrosis imitates cardiovascular diseases, and therefore requires accurate differential diagnosis. Therapy involves a wide range of interventions: medications, physical therapy, physiotherapy and massage.

Thoracic osteochondrosis is less common than cervical or lumbar osteochondrosis. This is due to the specifics of the anatomical structure. The vertebral discs in the thoracic region occupy two-thirds of the entire spine, and they are also larger in diameter, but inferior in size to the lumbar region. This area is strong and has low mobility, and is also protected by the rib cage and ribs. The physiological curvature is directed towards the back. This leads to increased stress on the front of the spinal column. Next, the formation and growth of pathological bone structures on the vertebral bodies (osteophytes) occurs. Peripheral nerve endings are located among ligaments and muscle tissue, their tension leads to compression with the development of pain.

There are also polysegmental lesions of the spine due to osteochondrosis. This combines degeneration of the cervical, thoracic and lumbar spine with corresponding clinical symptoms. The clinical symptoms of thoracic osteochondrosis among women and men are approximately the same and do not have significant differences.

Classification

Thoracic pain syndrome is characterized by severe pain in the chest of an intense nature. The syndrome is associated with damage to peripheral nerves. The damage is due to compression of the nerves by muscles and ligaments.

Degrees of thoracic osteochondrosis:

The first degree is characterized by the absence of pronounced clinical manifestations. There is a loss of elasticity in the intervertebral discs, and their protrusions form.
The second degree is marked by a further loss of elasticity of the intervertebral discs and a decrease in their height. The likelihood of a hernia increases. Pain syndrome appears, and concomitant pain symptoms are possible.
In the third degree, the pain syndrome intensifies. A herniated disc located between the vertebrae may occur. The severity of symptoms depends on the location of the hernia.
Fourth degree with complete disruption of elasticity and loss of function of the intervertebral discs, destruction of the bone structure of the vertebrae. Neurological disorders are most pronounced.

According to the types of pain symptoms:

Vertebrogenic thoracalgia is based on spinal pathology.
Nonvertebrogenic thoracalgia is caused by the formation of pathologies of internal organs: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory lesions of the musculoskeletal system.
Psychogenic thoracalgia is caused by panic attacks and damage to organs of neural origin.

Causes and risk factors

Osteochondrosis does not form without damage factors. A number of reasons or a combination of them lead to the development of disease in the thoracic region.

Sedentary lifestyle. Lack of physical activity leads to weakness of the back muscles and intervertebral segment. Sedentary work and improper organization of the workplace are additional factors for thoracic osteochondrosis.
Improper lifting of weights and various injuries. Excessive loads that disrupt the functioning of the spine. In this situation, the muscles and intervertebral discs cannot withstand the load.
Acquired lesions and curvatures of the spine. Against the background of these pathologies, the functioning of the spinal column is disrupted and the likelihood of developing osteochondrosis increases. Destruction increases if the doctor’s recommendations are not followed.
Lack of required minerals and vitamins. With insufficient calcium concentration in bone tissue, bones become less strong and the likelihood of damage to the musculoskeletal system increases.
Pregnancy as a combination of main factors: increased load on the spine and lack of minerals and vitamins.

Important! Hereditary predisposition plays a significant role. If there are lesions of the musculoskeletal system in a family line, then you should be attentive to your health and the prevention of lesions. A competent system of preventive measures can prevent massive destruction of bone tissue.

Who's at risk

Often, factors in the formation of degenerative changes in the spine are combined.

Decreased immune status associated with greater susceptibility to infections that can enhance the clinical manifestations of osteochondrosis due to muscle inflammation.
Stressful influences that can cause psychogenic thoracalgia. This occurs due to a large release of catecholamines, which provoke increased pain.
Damage to the nervous system of non-infectious and infectious etiology.
Physical overload.
Failure to comply with ergonomic principles (carrying heavy objects).
Spinal injuries of various origins.
Muscle spasms.
Osteoporotic degeneration of the musculoskeletal system.

Symptoms

Leading symptoms of thoracic osteochondrosis

A burning sensation that occurs in the intercostal spaces.
Paroxysmal and constant pain in the chest, predominantly stabbing in nature.
With thoracalgia, the pain syndrome is stabbing, squeezing and aching in nature.
Surrounding nature of the pain.
Pain in one half of the body.
During movement there is a crunching of the vertebrae.
Painful symptoms increase significantly with movement, deep breathing, coughing and sneezing, which is the main difference between thoracic osteochondrosis and angina pectoris.
The affected areas are palpable, that is, they can be felt, and are located along the affected nerves.
Numbness of the skin along the intercostal spaces.
The patient's condition worsens when exposed to low temperatures or prolonged exposure to an uncomfortable position.

Types of pain syndromes in osteochondrosis of the thoracic spine:

Damage to the lower neck. There is pain in the upper chest, which can radiate to the neck, arms, and the left half of the body.
Damage to the upper thoracic spine. The pain is aching in nature and affects the central part of the chest. Frequent combination with pain in the shoulder blades.
Damage to the scapular-costal zone. Painful symptoms are cutting, aching and stabbing in nature. It has the form of attacks, both long and short. It occupies the lateral area and is also concentrated in the area of the shoulder blades.
The appearance of pain in the anterior chest wall, varying in duration. Occur between the perithoracic and frontal axillary lines.

In addition to the leading signs, there are two types of pain syndromes for osteochondrosis of the thoracic region:

Dorsago - intense but short-term pain at the location of the affected intervertebral discs. Disturbance of normal breathing.
Dorsalgia is mild but prolonged pain in the area of the affected intervertebral discs.

Spondylogenic thoracalgia , associated with damage to the musculoskeletal system, is often accompanied by severe pain and instability of the vertebrae in the thoracic spine (their increased mobility). The lesion is expressed in impaired mobility of the thoracic spine, stabbing and cutting pain in the intercostal spaces.

Vertebrogenic thoracalgia can provoke the following symptoms:

radicular (pain symptoms);
disturbance of the innervation of the thoracic zone (visceral manifestations: a number of patients have pain symptoms of a stabbing nature in the gastrointestinal tract or cardiovascular system.);
radicular syndrome with vegetative signs (pain in the intercostal spaces).

When diagnosing a problem, it is necessary to distinguish symptoms from cardiovascular diseases and myalgia. Heart damage of ischemic etiology is distinguished by the regularity of its appearance during physical or psycho-emotional stress and the relief of the attack by taking nitroglycerin.

A psychogenic attack of thoracalgia is accompanied by the appearance of panic, anxiety, suffocation and mental state disorder. It turns out that the disease is a consequence of problems with psychological stability.

Clinical signs of osteochondrosis are divided into two main parts:

1. Neuralgic symptoms:

With thoracic osteochondrosis, numbness and tingling can occur both in the upper extremities and along the intercostal spaces, spreading to the anterior surface of the chest.
The latissimus dorsi and chest muscles are constantly tense.
There is high emotional lability, attacks of tearfulness and irritability.
In rare situations, the disease manifests itself as severe intercostal neuralgia.

2. Various types of pain:.

Dorsago: sharp, acute pain in the thoracic spine, sometimes making breathing difficult. Movement in the cervical and thoracic spine is limited. It appears or worsens when sitting in a twisted position.
Dorsalgia: the formation of pain symptoms takes from two to three weeks, so the first time proceeds without clinical manifestations for the patient. There is mild discomfort in the chest. The pain intensifies when turning the body to the sides and deep breathing. With the final stabilization of the pathological process, a persistent pain syndrome is formed.
Intercostal neuralgia: radiating pain along the intercostal spaces. When taking a sharp breath, a stabbing pain appears in the heart area. As a result, the pathology is often confused with damage to the cardiovascular system.
Cardiac or pseudocoronary syndrome is formed when there is damage at the level of ThI segments with the development of reflex angina. The difference from organ damage to the cardiovascular system is the appearance of pain when tilting or rotating the spine. They intensify with prolonged stay in a forced position. There is pain on palpation of the spinous processes in the thoracic spine.
Radicular syndrome: pain in the intercostal spaces (Erb's points).
Visceral syndrome: dysfunction of the abdominal organs with damage at the level of the V-XII thoracic vertebrae. Expressed in girdle pain, heaviness in the right hypochondrium, heartburn.

Clinical symptoms depending on the level of damage to the thoracic spine:

*Damage to the nerve processes in thoracic osteochondrosis occurs in cases of the appearance of osteophytes - bone outgrowths on the vertebrae. This is due to the rate of destruction. Therefore, the symptoms listed below are not an integral part of the disease.

Deformation of the nerve process at the Th2 and Th3 levels. Damage to the cardiovascular system occurs with the appearance of attacks of arrhythmia and coronary heart disease. Thus, chronic pain symptoms during thoracalgia can provoke organ dysfunction of the cardiovascular system.
Damage at the Th4-Th5 level. Organs with damaged nerve fibers: pleurisy and bronchitis, pneumonia, bronchial asthma.
Th5-Th6: the bile ducts and gallbladder are affected. The absorption of fats in the body is reduced.
Th6-Th7: the liver and solar plexus area are affected. The functioning of the hepatobiliary tract is disrupted.
Th7-Th8: the stomach is affected. Main pathologies: ulcerative lesions of the duodenum and stomach, dyspepsia and gastritis.
Th8-Th9: the functioning of the duodenum and pancreas changes. Manifestations: duodenitis, pancreatitis and loose stools.
Th9-Th10: damage to nerve cells of internal organs (spleen and diaphragm). Hiccups and breathing problems occur.
Th10-Th11: the adrenal glands are affected. The activity of the immune system decreases and allergies appear.
Th11-Th12: kidney function is disrupted, which leads to the formation of pyelonephritis and urolithiasis.
Th12-L1 (level of the first lumbar vertebra). The kidneys and ureters are damaged. This leads to dysuria - problems with urination.

Signs and clinical manifestations

An attack of thoracalgia in many cases has the same clinical manifestations as pain associated with heart disease, so it is important to know the signs and symptoms of the pathology, as well as the basics of emergency care. The main symptom of thoracalgia, complicated by osteochondrosis of the thoracic spine, is intense pain. It can be burning, stabbing, cutting, dagger-shaped. The course of a painful attack is always acute. Painful sensations intensify when trying to change the position of the body, inhaling, respiratory manifestations (coughing and sneezing), pressing on certain areas along the back. The localization of pain is predominantly in the left side of the chest, but often the pain syndrome radiates to the region of the collarbone, shoulder blades, and lumbosacral area.

Attack of thoracalgia

In standard cases, thoracalgia with thoracic osteochondrosis has the following symptoms:

respiratory dysfunction (pain during inhalation);
muscle twitching;
redness of the facial skin;
increased sweating;
tingling in the center of the sternum with a shift to the left side of the chest;
decreased or absent sensitivity at the site of damage to nerve endings.

Pain while inhaling

The appearance of such symptoms requires an urgent electrocardiogram - measuring the electrical fields generated during heart contractions (ECG). This is necessary to exclude heart pathologies, since in many cases the symptoms of thoracalgia and angina are very similar. To make it easier for the patient and his relatives to independently navigate further actions, below is a table with the basics of differential diagnosis when pain occurs in the sternum.

ECG

Table. Differential diagnosis of thoracalgia with diseases of the heart and stomach.

Clinical symptom	For thoracalgia	For heart diseases	For stomach pathologies
Duration of pain attack	The pain persists for a long period of time and does not go away after changing body position. In the absence of therapy, the duration of a painful attack can be up to 48 hours or more.	From 2 to 15 minutes (after this time, other symptoms of heart failure appear).	Paroxysmal pain that occurs or intensifies after eating (within 1 hour).
Association with nitroglycerin intake	Does not go away after using nitroglycerin.	It goes away within 5-10 minutes after sublingual application of nitroglycerin.	In rare cases, it is possible to reduce the intensity of pain after using nitroglycerin, but in most cases the drug is ineffective.
Increased pain when palpating the chest	The pain intensifies.	The intensity of the pain does not change.	There are no changes in sensations.
Heart rhythm disturbance	Possibly in rare cases.	Severe tachycardia or bradycardia.	Virtually no change.
Decreased or increased blood pressure	Usually doesn't happen.	Severe hypertension or hypotension.	There is usually no connection with arterial and venous pressure.

Diagnosis of thoracic osteochondrosis

If you suspect osteochondrosis, you can contact a therapist or neurologist.

The patient is examined and all clinical data is recorded. During the formation of stages 2-3, the skeleton undergoes significant deformation. A complete medical history of the patient should be collected in order to accurately establish or exclude factors leading to the formation of osteochondrosis of the thoracic spine.

The very first diagnostic method is radiography. Further studies are carried out based on the clinical history and the need for differential diagnosis. Initially, the patient can be examined by any doctor. The main thing is a competent and fully collected clinical history. This will allow you to accurately determine the etiology of the disease and select a treatment regimen. Treatment of thoracic osteochondrosis is carried out by a therapist, neurologist, and rheumatologist. In case of traumatic effects on the spinal region, consultation with a traumatologist is required.

X-ray examination of the chest in two projections. Allows you to determine the presence and size of osteophytes, determine the contours and height of intervertebral discs, and determine changes in the shape of the disc.
Discography makes it possible to examine the structure of the nucleus pulposus through the use of contrast.
Computed tomography is used to visualize nerve fibers, muscles, ligaments and joints.
Electromyography allows for differential diagnosis with neurological diseases.
Endoscopic diagnostic methods can be prescribed to examine the circulatory and digestive organs.
An ECG is performed to determine the etiology of cardiovascular diseases.
Electroencephalography - to identify pathologies of the nervous system.

Differential diagnosis

Thoracic osteochondrosis should be distinguished from a number of diseases.

Anomalies in the formation of the spine, trauma, tumors, inflammation. There are several variants of these pathologies. For example, an additional congenital process, displacement or fusion of vertebrae (spondylolisthesis), osteomyelitis, ankylosing spondylitis and others.
Damage to the musculoskeletal system (different lengths of the lower limbs, muscle spasms, muscle inflammation and others).
Not associated with damage to the musculoskeletal system, but similar in symptoms to diseases of internal organs. In particular, pancreatitis, inflammation of the appendages, stomach ulcers, coronary heart disease, angina pectoris, pleurisy.
Neurosis-like disorders, combined with migrating pain with increased fatigue, irritability, and mood swings.

Thoracic osteochondrosis and ischemic heart disease

It is extremely important to carry out competent differential diagnosis with the most similar pathologies. The pain that occurs with vertebrogenic thoracalgia and coronary heart disease (CHD) has a number of differences, which makes it possible to accurately establish the diagnosis.

Nature of pain:

With ischemic heart disease, they have a burning and squeezing character, accompanied by the fear of death.

By duration of pain:

IHD: Short-term attack, lasting a few minutes.
Thoracic osteochondrosis is characterized by fading or prolonged pain, in some cases it does not subside during the day.

Changing body position:

In IHD, the strength and intensity of pain does not vary with physical activity.
With thoracalgia, even relatively gentle movements cause increased pain or the occurrence of a new attack.

Response to physical activity:

With ischemic heart disease, pain appears during physical activity and is relieved at rest.
Thoracalgia, on the contrary, weakens, but does not stop at rest.

Relief on taking medications:

During an ischemic attack, pain is easily relieved by taking nitrates (nitroglycerin).
Thoracalgia is relieved by the use of analgesics.

The influence of physiotherapeutic factors and manual therapy:

In coronary heart disease it gives unstable and insignificant improvement.
With osteochondrosis, there is a significant positive change in the patient's condition.

What is it: definition and pathogenesis

Thoracalgia (intercostal neuralgia) is a neurogenic pain syndrome that occurs as a result of compression or irritation of the nerves located in the intercostal space. Not only the thoracic vertebrae, but also ligaments, muscles, tendons and other tissues located around the intercostal nerves can cause compression of the nerve endings in the area where they exit the spinal column. The main provoking mechanism in the development of thoracalgia is osteochondrosis of the thoracic region: pathology in patients with this diagnosis is detected in 50-60% of cases.

Weak points of the spine

A muscle spasm (an involuntary, convulsive contraction of muscles accompanied by severe pain) can contribute to the occurrence of a painful attack, so the cause of thoracalgia can be working in an uncomfortable position, staying in one position for a long time, or intense physical activity. Experts also include the following factors as factors that increase the risk of developing intercostal neuralgia:

hypothermia;
strong emotional disturbance (including a state of chronic stress);
respiratory infections of the respiratory system;
chest injuries;
endocrine diseases characterized by disturbances in the rate of metabolic reactions and metabolism;
age-related changes in blood vessels (decreased elasticity, changes in the permeability of vascular walls, etc.);
increased tone of the shoulder and back extensor muscles.

Human circulatory system

The causes of thoracalgia in patients of any age can be other diseases of the spine, for example, spondylitis or spinal tumors. It is of great importance to carry out differential diagnosis with diseases of the heart and stomach, since the nature, localization and intensity of the pain syndrome in these pathologies can be similar.

Note! The main group of patients with thoracalgia arising against the background of osteochondrosis of the thoracic spine are people over 40 years of age. In childhood and adolescence, the prevalence of pathology is less than 1.7%.

Vertebrogenic thoracalgia in adults. What causes the disease and the main causes

Orthopedic chair

Treatment of thoracic osteochondrosis

Osteochondrosis is treated by a neurologist.

To organize competent therapy, it is necessary to first establish the etiological prerequisites. Identifying the cause of the pathology allows you to select a competent treatment regimen.

Drugs for bone tissue regeneration are selected taking into account all the functional characteristics of the body. It is advisable to first clarify the concentration of collagen and elastane in the body. When choosing a treatment regimen, the individual characteristics of the body are taken into account.

Standard therapy regimen

Nonsteroidal anti-inflammatory drugs help eliminate chest pain caused by inflammatory reactions. This increases the range of mobility of the chest, as well as the range of motion in the thoracic spine. Medicines:

meloxicam,
nimesulide,
celecoxib,
ibuprofen.

Drugs that affect the production of interleukins. Allows you to stop the inflammatory cascade and normalize the balance of enzymes that cause destruction of the myelin sheath of nerves:

diacerein.

Antispasmodic agents:

no-shpa,
spasmalgon,
unispaz,
mydocalm,
tizanil,
sirdalud.

B vitamins help relieve inflammation of affected nerves:

neurobion,
combilipen,
milgamma,
B-complex.

Preparations that preserve the concentration of collagen and elastane allow fluid to be retained in the intervertebral discs. This increases tissue elasticity and prevents further degeneration:

collagen,
joint formula,
piascledine.

Hormonal (steroid) drugs. They have a powerful anti-inflammatory effect, but are used only for acute thoracalgia, as they negatively affect the body as a whole:

betamethasone (diprospan, triderm),
dexamethasone,
prednisolone.

During the acute period of the disease, diuretics help relieve swelling from the nerve endings. Preference is given to potassium-sparing diuretics. Apply

indap,
veroshpiron,
Spironaloctone.

Ointments and gels with anti-inflammatory effect. When rubbing the affected area of the back, the local inflammatory process is reduced and highly active pain symptoms are eliminated. Use

art traffic,
nimulid,
voltaren,
nize,
finalgon,
long

Massage

The therapeutic effect of massage is to relieve spasm from the muscular corset of the thoracic spine and normalize local blood circulation.

Effects of massage techniques:

relieving muscle hypertonicity;
strengthening the structure of the intervertebral disc bodies.

The use of massage techniques is combined with a visit to a chiropractor in combination with a regular exercise therapy system.

Physiotherapy

Acupuncture. Eliminates or reduces muscle spasms, and also reduces pain symptoms.

Manual therapy. Allows systemic blood circulation in the intercostal space to return to normal. This ensures the supply of tissues with nutrients, improves their trophism and stimulates oxygen saturation in the blood.

Nutrition for osteochondrosis of the thoracic spine

Compliance with certain nutritional principles allows you to achieve maximum therapeutic effect.

Foods rich in vitamins A, B, C and E (greens, nuts, cereals) are recommended.
Omega-3.6 fatty acids found in fish.
Chondroitins in the form of dietary supplements help maintain tissue strength. Glucosamine maintains the elasticity of tissue structures.

Read more about the diet for osteochondrosis in our separate article.

Drug treatment

The treatment regimen for diagnosed thoracalgia against the background of osteochondrosis of the thoracic spine is selected individually, taking into account the severity of degenerative changes in the intervertebral discs, the localization and intensity of the pain syndrome.

Muscle relaxants

These are centrally acting drugs (n-cholinergic blockers), which reduce skeletal muscle tone and help eliminate muscle spasms. The most effective in the treatment of various neuralgia are drugs based on tolperisone hydrochloride. They have no contraindications (with the exception of myasthenia gravis, an autoimmune pathology in which the patient experiences pathologically rapid fatigue of striated muscles) and, if necessary, can be used for children over 3 years of age.

Pharmacological effects of muscle relaxants

The standard dosage of tolperisone for adults and adolescents over 14 years of age is 50 mg 2-3 times a day (after meals), followed by an increase in the daily dosage to 300-450 mg. For children from 3 to 14 years old, the daily dose is 2-5 mg/kg.

Drugs from the group of muscle relaxants based on tolperisone:

Mydocalm;
Tolperisone;
Calmirex;
Tolisor.

Drugs from the group of muscle relaxants

Treatment of thoracalgia can be supplemented with drugs that regulate neuromuscular transmission (Sirdalud, Tizanil, Tizanidine).

Tizanidine

NSAIDs

Drugs in this group are necessary to relieve pain and relieve inflammatory processes. Traditional non-steroidal anti-inflammatory drugs based on ketorolac and ibuprofen are ineffective for severe pain, so in most cases experts recommend the use of nimesulide-based drugs. Nimesulide not only has a pronounced analgesic and anti-inflammatory effect, but also prevents platelet aggregation. The drug is taken in a dosage of 100 mg 2 times a day for no longer than 7-10 days in a row. Nimesulide can be produced under the following trade names:

Nemulex;
Sulaydin;
Nise;
Nimesil;
Mesulide;
Actasulide.

Nise

Children should not use nimesulide. If it is necessary to use NSAIDs in children and adolescents under 12 years of age, it is recommended to use drugs based on ibuprofen or paracetamol.

Important! Nimesulide has many contraindications (severe heart, liver and kidney diseases, bleeding disorders, cerebrovascular bleeding, etc.), so it can only be used after consultation with a doctor.

Nimesulide

Chondroprotectors

This is a group of slow-acting drugs, whose pharmacological properties relate to correctors of the metabolism of cartilage and bone tissue. The most effective chondroprotectors include glucosamine, chondroitin and hyaluronic acid. Hyaluronic acid (in the form of sodium salt - sodium hyaluronate) is a synovial fluid prosthesis and provides lubrication and hydration of the articular surfaces and protects them from premature abrasion.

Chondroprotectors

Preparations for strengthening ligaments and joints

For severe pain in the chest area caused by thoracic osteochondrosis, the use of combined medications based on glucosamine and chondroitin (Chondroxide, Teraflex, Dona) is indicated.

Complications

When establishing a diagnosis of thoracic osteochondrosis, one should take into account a possible cascade of probable organ pathologies that develop over time.

Damage to the cardiovascular system: persistent pain leads to destabilization of the ion exchange of the myocardial muscle, which is a prerequisite for the development of coronary heart disease.
Disorders of the functioning of the abdominal organs: stomach, duodenum, pancreas. This is due to the high secretion of adrenaline during persistent pain, which leads to increased secretion of VIP (vasointestinal peptides).
Dyskinesia of the gallbladder is due to an increase in the lithogenicity of bile against the background of a chronic inflammatory process.

With regular adherence to the principles of therapy, the exercise therapy system, maintaining posture and eliminating risk factors, the course of the disease is reduced to regression. The prognosis is considered favorable if the pathology does not develop further and the disease does not actively manifest itself.

Treatment of thoracalgia in Samara includes methods that give the greatest effect:

dosed traction and massage using the Ormed device
manual therapy
kinesio taping
carboxytherapy
ozone therapy (intravenous administration of ozonized saline solution and subcutaneous local administration of ozone)
mesoinjection therapy with vascular drugs
chronomagnetic complex "Multimag"
physiotherapeutic techniques (high-top, ultrasound, electrophoresis)
medical therapeutic blockades

Residents of Samara and Kazakhstan can undergo examination and treatment for thoracalgia at the FIRST NEUROLOGY clinic

Prevention

Elimination of physical inactivity, therapeutic exercises. Exercises for counter-force, perpendicular loads with displacement, and spinal extension are selected.
When driving a car for a long time, select special exercises to relax the muscle frame.
Pumping the muscles of the thoracic spine. There is both a physical therapy complex and the use of myostimulation if independent training is impossible.
Organization of the work place: the back of the work chair should provide support for the spine. To prevent stress on the spine from increasing, you should warm up every 30 minutes by stretching or walking. This is explained by the fact that the sitting position increases the load on the spine.
Correct position of the spine at night: purchasing orthopedic sleep accessories. A completely rigid surface is not rational due to the disruption of the physiological curves of the spine.
Compliance with ergonomic principles: do not lift weights that can injure the spine.
Formation of correct posture.
Optimization of blood circulation and lymph flow through a stretching system or the use of special procedures (pressotherapy).

Sources:

Yuri Kwon. The effect of sitting posture on the loads at cervico-thoracic and lumbosacral joints. — Technology and Health Care, 2021.
Finn L.L. Acute pain in the chest. Differential diagnosis. — Bulletin of Science and Education, 2021.
Osteocondritis of the spine. Clinical recommendations. — Ministry of Health of the Russian Federation, 2021.

Exercise therapy exercises

Physical therapy exercises are very important, but they are ineffective in the acute stage. After all, the thoracic region has limited mobility and muscle spasms can sometimes only be relieved with medications. However, as a means of preventing the recurrence of thoracalgia, exercise therapy exercises come first. In case of illness, sets of exercises are indicated to strengthen the muscle corset, swimming, and cardio exercises in order to reduce excess body weight. It is undesirable to engage in martial arts (risk of injury), weightlifting (overload), basketball (frequent vertical loads).