Thoracic radiculopathy: causes, symptoms, exercises

Mid-back or rib pain that wraps around your chest can feel alarming — and confusing. Most of the time, it’s caused by something relatively minor, like muscle strain. But in some cases, it may be due to irritation of a nerve in your mid-back, known as thoracic radiculopathy.

Thoracic radiculopathy isn’t as common as other types along the spine, such as the neck or lower back. But when it happens, it can be painful, says Mark Schroeckenstein, PT, DPT, a physical therapist at Hinge Health.

You don’t need to deal with this pain. Thoracic radiculopathy often resolves in a few weeks. Simple treatments such as targeted exercises — especially those recommended by Hinge Health physical therapists — modifying physical activity, and applying heat or cold therapy can all help ease discomfort. 

What is thoracic radiculopathy?

The thoracic spine is the middle section of the spine, located between the neck and lower back. It’s designed to be stable and protective, which is why it doesn’t move as much as other parts of the spine.

Thoracic radiculopathy occurs when a nerve in the mid-back becomes irritated or compressed. This can cause pain that feels like it travels from the back around to the chest, because the nerves in this region wrap around the rib cage.

It’s also different from myelopathy, which involves compression of the spinal cord itself. “Think of your spinal cord as a tree trunk, and nerve roots like branches,” Dr. Schroeckenstein says. “Thoracic radiculopathy affects the branches, not the trunk.”

Symptoms of thoracic radiculopathy

Thoracic radiculopathy can feel different for everyone, but symptoms often follow a distinct pattern, especially around the chest and rib cage. You may notice:

• Sharp, burning, or shooting pain that wraps from your back around to your chest (often on one side)

• A band-like sensation around your ribs

• Numbness or tingling in your chest or upper torso

• Pain that worsens with twisting, bending, or deep breathing

• Aching or tightness in your mid-back

Causes of thoracic radiculopathy

Thoracic radiculopathy happens when a nerve becomes irritated or compressed. This usually isn’t caused by just one factor, but a combination of stressors on your spine. Common contributors include:

• Changes in spinal discs. “The most common cause is when disc material shifts and adds pressure near a nerve as it exits the spine," says Dr. Schroeckenstein. This can trigger pain that travels around your chest or rib cage.

• Age-related changes. As you get older, natural changes in your spine — like narrowing of the spaces where nerves travel (spinal stenosis) or small bone changes — can increase pressure on nearby nerves.

• Sudden injury or trauma. A fall, accident, or sudden twisting movement can irritate discs or surrounding structures, leading to nerve pain.

• Repetitive movements or positions. Frequent bending, twisting, or lifting can gradually irritate the spine and nearby nerves. “Over time, that repeated stress can lead to symptoms,” says Dr. Schroeckenstein.

• Muscle tension. Tight or overworked muscles in your back can add pressure around the nerve as it exits the spine, contributing to discomfort.

How movement can help thoracic radiculopathy

When you’re in any kind of pain, it’s natural to want to rest. But with thoracic radiculopathy, gentle movement is one of the most effective ways to support your recovery.

Movement helps reduce stiffness, improve circulation, and build strength in the muscles that support your spine. “It also helps calm the nervous system and make pain more manageable,” says Dr. Schroeckenstein.

The key is to move in a way that feels tolerable — not push through sharp pain. Think of it as finding your movement sweet spot: enough activity to help your body, without making symptoms worse.

Physical therapy and targeted exercises can help restore mobility and reduce pressure on the irritated nerve over time.

These exercises help relieve thoracic radiculopathy pain by improving mobility and easing tension in the muscles around your spine. Movements like cat cow, open book, and the T-spine opener support better spinal mobility, helping stiff areas move more freely. Stretches like the doorway chest stretch and standing child’s pose open up tight chest and upper back muscles, reducing pressure on the thoracic spine. Diaphragmatic breathing helps expand your rib cage, creating more space around the nerves and supporting more comfortable movement.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for thoracic radiculopathy

“Physical therapy is often the first-line treatment for thoracic radiculopathy,” says Dr. Schroeckenstein. Staying active is also key — even if you need to temporarily modify certain activities to avoid flare-ups. Other strategies include: 

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, help increase mobility and ease tension in your back. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Targeted exercises are designed to help with recovery, but any type of movement — like walking, yoga, biking, or even household chores — can restore mobility, ease muscle tension, and decrease tension on the nerve. 

• Apply heat or cold therapy. “Ice or cold therapy can help ease discomfort and is especially helpful if the pain is new to you or newly irritated,” says Dr. Schroeckenstein. “Heat can help reduce pain by promoting blood flow and increasing muscle mobility. Heat is often more effective for pain that has been there for longer than a few days. Consider alternating between the two or sticking to the option that works best for you.” 

• Consider over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have back pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Modify your activities. If certain movements consistently trigger your pain, adjust how you do them — at least temporarily. “Often, patients tell me that turning to one side is more difficult, or that bending and lifting is uncomfortable,” says Dr. Schroeckenstein. Instead of twisting, try turning your whole body, and squat to lift rather than bending at your back. A physical therapist can help you find movement strategies that reduce strain while keeping you active.

• Consider lifestyle modifications. Factors like sleep position, stress, and daily posture can all play a role in pain from thoracic radiculopathy. At night, you may find it more comfortable to lie on your non-painful side while you hug a pillow, advises Dr. Schroeckenstein. If you notice symptoms worsen when you are stressed, try some deep breathing exercises like diaphragmatic breathing, to both calm you down and open your rib cage. Also pay attention to your posture, both at home and at work. “Oftentimes, with thoracic radiculopathy, sitting up straight or standing is more helpful,” adds Dr. Schroeckenstein. If you need to turn to see something, try to turn your whole body, rather than just twist to your side. 

• Prioritize nutrition. Eating a balanced, nutrient-rich diet supports your body’s natural healing processes. Focus on foods like fruits, vegetables, fatty fish, nuts, seeds, and whole grains. These foods help reduce inflammation and offer nutrients that support tissue repair, such as omega-3 fatty acids and vitamins C and D. For individualized guidance, consider working with a registered dietitian.

• Try complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for back pain relief, such as massage, acupuncture, or chiropractic care.

• Try TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce back pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent thoracic radiculopathy

You can lower your risk of thoracic radiculopathy by keeping your mid-back strong, mobile, and supported during daily activities. Building balanced strength and practicing mindful movement patterns can help reduce unnecessary strain on your spine. Here’s what Hinge Health physical therapists recommend:

• Strengthen your back regularly. Building strength in the muscles that support your spine improves stability and balance, which can help reduce pressure on nearby nerves.

• Practice good posture. If you sit for long periods, keep your feet flat on the floor and your back supported. Let your shoulders relax instead of rounding forward. Small posture adjustments can go a long way in reducing strain on your mid-back.

• Keep moving throughout the day. “Movement is medicine when it comes to thoracic radiculopathy,” says Dr. Schroeckenstein. Avoid staying in one position too long — take regular movement snack breaks to stand, stretch, or walk to keep your spine and muscles from stiffening up.

• Progress gradually. When starting a new activity, build up intensity and duration over time. Sudden increases — especially with twisting movements like golf — can lead to strain on your back.

• Manage stress. Stress doesn’t directly cause thoracic radiculopathy, but it can increase muscle tension and make you more susceptible to developing symptoms. Incorporating relaxation techniques like diaphragmatic breathing can help ease tension and support overall comfort.

When to see a doctor

Thoracic radiculopathy often improves on its own with at-home treatments. But if your mid-back or chest pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. You should also get medical care if you experience any of these red flags for radiculopathy:

• Sudden, severe chest pain (to rule out cardiac issues)

• Progressive weakness in your legs or difficulty walking

• Loss of bowel or bladder control

• Pain that doesn’t improve after several weeks of conservative treatment

• Fever or unexplained weight loss along with back pain

• Symptoms that continue to worsen over time

How long does thoracic radiculopathy last?

Thoracic radiculopathy often improves over time, especially with the right treatment. Recovery can vary depending on the severity of your symptoms. 

“Most people see significant improvement within six to twelve weeks with consistent care like physical therapy,” says Dr. Schroeckenstein. Mild cases may improve within a few weeks, while more severe cases can take a couple of months. Staying consistent with targeted exercises, physical therapy, and regular movement can help speed recovery and reduce the risk of future flare-ups.

PT tip: Take a breath

If you feel a sharp flare of pain, try slow, deep breathing. “It helps calm your nervous system and allows your rib cage to expand, which can reduce pressure on the irritated nerve,” says Dr. Schroeckenstein.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Mostert, K. A., Perera, J., Jennifer Dens Higano, Davis, P. T., Buus, R. J., Gerberi, D., Meiling, J., & Prideaux, C. (2024). The Efficacy of Physical Therapy to Alleviate Symptomatic Thoracic Radiculopathy: A Systematic Review and Meta-Narrative Analysis. Annals of Rehabilitation Medicine. doi:10.5535/arm.23136

3. Abrar, D., Elbayar, J., Kao, D., & Khan, F. (2017). Thoracic Radiculopathy. Musculoskeletal Sports and Spine Disorders, 375–378. doi:10.1007/978-3-319-50512-1_86

4. B Rutkove, S., & Tarulli, A. (2024, July 8). UpToDate. Www.uptodate.com. https://www.uptodate.com/contents/polyradiculopathy-spinal-stenosis-infectious-carcinomatous-and-inflammatory-nerve-root-syndromes

5. Young, I. A., Pozzi, F., Dunning, J., Linkonis, R., & Michener, L. A. (2019). Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy, 49(5), 299–309. doi:10.2519/jospt.2019.8150