Neck pain is a common condition that can make everyday activities more difficult. While
discomfort is felt in the neck, its cause may not always be limited to the cervical spine and
associated tissues because the neck does not exist in isolation. It has been theorized that because
the neck and mid-back (thoracic spine) work together during nearly every upper-body
movement, restricted motion in the thoracic spine may increase mechanical stress on the tissues
of the neck, elevating the risk of pain or injury.
Common conditions that affect the mid-back include restricted or dysfunctional thoracic
facet joints, loss of normal thoracic mobility, excessive rounding of the upper back (thoracic
kyphosis), rib joint dysfunction, muscle tightness and trigger points in the upper back and
shoulder girdle, and weakness of the muscles that stabilize the shoulder blades. Because these
problems can alter posture and reduce normal thoracic motion, they may also alter biomechanics
and place added strain on the muscles and joints of the neck. Over time, these mechanical
changes may contribute to neck pain, stiffness, and reduced range of motion.
Based on this proposed mechanical relationship, researchers have investigated whether
improving thoracic mobility can also improve neck pain and function. In one study, the authors
reviewed 17 randomized clinical trials and found that spinal manipulative therapy applied to the
thoracic spine showed evidence of reducing pain, improving function, and decreasing disability
in individuals with neck pain.
A second study reached a similar conclusion using a different therapeutic approach. The
research team found that combining manual therapy to improve thoracic mobility with exercises
to improve posture reduced neck pain and disability while increasing neck range of motion in
patients with mechanical neck pain. Together, the available evidence suggests that improving
thoracic mobility and posture may help reduce mechanical stress on the neck, decrease pain and
disability, and improve function during everyday activities.
This body of research highlights the importance of evaluating the whole person rather
than focusing only on where pain is felt. Neck pain often has multiple contributing factors, and
restrictions in nearby joints or muscles may represent one piece of the puzzle. A thorough
evaluation can help identify the factors most likely responsible for an individual’s symptoms.
Based on these findings, the chiropractor can develop a treatment plan that addresses the
potential underlying causes with the goal of reducing pain and disability, restoring function, and
potentially lowering the risk of future episodes.
Brent Binder, D.C.
4909 Louise Dr. Suite 102
Mechanicsburg, PA 17055
Pain Relief Chiropractic 
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