​What is it? 
 
The thoracic region refers to the part of the spine that is surrounded by the rib cage. It consists of 12 vertebrae with discs that sit between each of them. The thoracic spine isn’t an area that you might associate much with movement, however, this area can account for a surprising amount of flexibility, particularly in rotation.
 
With joint attachments both between each side of the 12 vertebrae and a rib on either side, the thoracic spine has almost more individual joints than you can count. If each of these joints is not regularly moved through their full range they can tighten up and lose flexibility. This stiffness can become quite significant over time. 
 
Why is it important?
 
Many people may not even notice this lack of movement, primarily because the neck and lower back provide much more range and can usually compensate for any loss of thoracic flexibility to complete everyday tasks. 
 
When there is no movement occurring in the thoracic region, this means that the structures of the joints in other regions are pushed closer to their limits of range, particularly during rotation. This results in more compression and stress on these joints and the structures surrounding them, such as nerves, blood vessels and muscles. 
 
Thoracic stiffness can be a significant risk factor for neck and lower back pain. This can also reduce the mobility of the chest wall, which can result in less efficient breathing mechanics and, in extreme cases, even reduced exercise tolerance. Thoracic spine movement is aslo important for normal shoulder function, as well as maintaining good posture.
 
How can physiotherapy help?
 
Your physiotherapist is able to assess your thoracic mobility and help you with treatments to improve your range, both with manual therapy and home exercises. They may even help improve your thoracic flexibility as part of a treatment plan for neck and lower back pain.

Muscle Weakness

Muscle stiffness can be a sign that strength is lacking. Our body will prioritise stability over flexibility if our muscles don't have the ability to provide both. This means that your muscles will be a bit tighter and stiffer to compensate for any weakness. If you are feeling a tight and sore, your physiotherapist can help to identify any muscles that maybe need targeted strengthening to help.

Delayed Onset Muscle Soreness (DOMS)

Many of us are familiar with post-exercise pain and stiffness. This is a somewhat protective mechanism to help you recover from a bout of increased exercise. This kind of stiffness will be present in muscles that have been used recently and usually lasts for just a day or two. DOMS usually goes away on its own, although it can be quite uncomfortable, it is usually nothing to be too concerned with. Your physiotherapist can help you with tips to avoid DOMS in your regular workouts.

Lack of movement

Along with muscle weakness, inactivity can lead to joint stiffness. Joints need to move through their full range regularly to maintain their flexibility, as anyone who has kept a joint immobilised in a plaster cast will know! Lack of movement can lead to a reduction of blood flow and nutrients, also impacting joint health. Your physiotherapist can help you to identify any joints that are not moving well and advise you on how to restore joint flexibility. Activities such as Pilates aim to help you move all of your joints through their full range safely and maintain flexibility.

Arthritis

Stiffness is the hallmark of arthritis, often noticeable as increased stiffness on waking that progresses gradually over time. Pain and stiffness caused by arthritis can often be helped by a targeted muscle strengthening program to help support the joints.
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Speak to your physio about any tightness or inflexibility and see how they can help you feel your best. ​

For most of us, screen time and sitting go hand in hand and both are only increasing as our lives move more online. While short periods in any posture aren't harmful, a lack of movement combined with long periods spent in hunched positions can lead to spinal pain, headaches, shoulder pain and more. If you're needing to spend more time in front of a screen, here are a few tips that can help you to keep flexible and avoid pain. 

Set movement breaks
 
Posture in itself isn't always a problem. Spending long periods of time in these postures without taking breaks is the problem. When your body is so used to one position, muscles may become shorter and joints stiffer, making it harder to move out of this posture without pain and discomfort.
 
You can break up your day by setting a timer to move and take a break every 20-30 minutes. Using these short breaks for movement is a great way to both help focus at work and keep your body more flexible.
 
Setup your work and home environment properly
 
Adjusting your work station or setting up a place to relax at home where to you can avoid a hunched posture can help you to reduce time in the same posture. Your physiotherapist can give you tips for how to setup your home and office environment correctly.
 
Take stock of your time spent sitting
 
Time in the car, time on your computer and time on the couch can all quickly add up without you realising. By accounting for the amount of time you spend sitting, you can find more ways to move. For example, if you notice that you're sitting down as soon as you get home, try swapping out watching an episode on TV to going for a walk while listening to a podcast.
 
Ask your physio for specific stretches
 
If you can identify the posture you spend the most time in, your physio can help you to develop a specific exercise and stretching program to counteract these positions most directly and keep you strong and flexible.

For most of us, the hours we spend sleeping are simply a time for rest and recovery. However, you might be surprised to learn that your sleeping position can have a significant impact on your body, particularly if you already have an injury. Here are some tips to help to stay pain free overnight.

Back pain tips:
 
For sufferers of back pain, finding a comfortable position at night can be difficult. The natural curves of the spine need to be maintained and supported throughout the night. Ideally, your body should be held in a position of minimal stress while sleeping. This means that all your joints and muscles are resting in a neutral position
 
A mattress that is too soft might feel comfortable to begin with, but over time will let you sink into it too much, meaning the curve of the lower spine will be lost. Waking up with a stiff or sore back could be a sign that you are using the wrong mattress. A mattress that is too firm can also mean your spine is held in a flattened position, which is both uncomfortable during the night and when you wake up.

For many people, sleeping on their side keeps their spine in a more natural alignment than sleeping on their back, especially if they put a pillow between your knees. If you do sleep on your back, placing a pillow under your knees can help to maintain your lumbar spinal curve throughout the night. This can also help to reduce hip and knee pain.
 
Neck pain tips:
 
The neck is often the most vulnerable part of the body if your sleeping setup is not ideal. Side sleepers may let their neck fall excessively to the side with a pillow that is too low or have their neck elevated too much by having their pillows too high.
 
If you find yourself putting your arm under your pillow while you sleep, it is likely that your pillow is too low. Having your shoulder in this position overnight can put unnecessary stress on the structures around the shoulder joint and should be avoided if possible. Stomach sleeping can also put additional pressure on your neck as it is turned to the side for long periods.
 
Hip pain tip:
 
Side sleepers often spend their nights with one leg crossed over their body. This can place extra pressure on the structures on the side of the hip, such as tendons and bursa and can impact the health of these tissues as the compression reduces the blood flow to the area. Placing a pillow under your knee while sleeping on your side in this position can help to maintain a neutral alignment of your hip.
 
Speak to your physiotherapist for more advice on how to improve your sleeping posture and find out if your sleeping setup is right for you.

What is Ankylosing Spondylitis?
 
Ankylosing Spondylitis (AS) is a type of inflammatory, autoimmune arthritis that primarily affects the spine. It is characterised by intermittent pain and progressive stiffness due to the inflammation and eventual hardening of the ligaments that surround the spine. The classic early symptoms of AS are pain and stiffness of the sacroiliac joints, the joints connecting the pelvic bones to the sacrum in the lower back. In the more severe, final stages of the disease, the entire spine can become fused and rigid, often in a flexed, forward posture.
 
As this is an inflammatory disorder, many other systems and joints can also affected. A significant number of people with AS also suffer from irritable bowel syndrome and inflammation of the eye.

What causes it?
 
The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition. Genetics, chronic stress and frequent gastrointestinal infections are among the predisposing factors. Men are affected more often than women and symptoms usually begin between the ages of 17 and 45 years.
 
What are the signs and symptoms?
 
Intermittent back pain and progressive stiffness are the two most common symptoms of Ankylosing Spondylitis. Other tendons and ligaments may be affected, including those in the hands, feet and ribs. Symptoms tend to be worse following periods of rest, particularly first thing in the morning and improve following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.
 
Some people with AS may experience mild discomfort in the spine from time to time, while others may experience severe and debilitating symptoms at frequent intervals with minimal time in remission. Long term issues with AS include breathing difficulties due to thoracic and rib cage stiffness and severe spinal pain and immobility. Medical treatment focuses on reducing inflammation and slowing the disease process.
 
How can physiotherapy help?
 
Physiotherapy treatment aims to manage pain during flare-ups and maintain optimal posture as the disease progresses. Your physiotherapist will assess your spinal movement and posture as well as strength. If your hands, feet, hips or shoulders are affected, they will also provide you with specific exercises to help maintain mobility and strength in those joints. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck.