Looking for a physiotherapy treatment that can help relieve upper back and rib pain? Evoker may have just the services you need! At Evoker, we know that if you have pain in the upper back and ribs, the culprits are often poor posture, repetitive movements, or muscle imbalances. We can work with you to help determine the root cause of your pain and correct any associated issues.

Evoker is a physiotherapy service that uses gentle, targeted movements to relieve joint pain. Our experienced physiotherapists will work with you to create a treatment plan that is tailored to your individual needs. Our treatments include but are not limited to accurate hands on manual therapy, home exercise plans, along with pilates informed small group classes. Our pilates trained physiotherapists are extremely passionate about this field, so you can rest assured that you’ll receive the highest-quality strategies and results.

At Evoker, we don’t just take a one-size-fits-all solution. On the contrary, we monitor your progress to see what’s working for you. By finding the root cause of the pain, we are in a powerful position to prescribe a solution that will fit your unique situation.

If you are suffering from upper back and rib pain, don’t wait any longer to seek treatment. Evoker can help you get on the road to recovery.

a. Thoracic Spine

i. Costovertebral & Costotransverse Joint Pain

Costotransverse and costovertebral joint disorders are associated with localised tenderness and reduced joint mobility.  These symptoms are pronounced on active movements of the thoracic spine in one or more direction, and may be aggravated with deep inspiration.  Symptoms may present in either acute or chronic settings depending on the individual and the mechanism of injury.  One or more thoracic vertebrae or ribs may be involved.

You can expect to feel restriction in your range of motion, pain on movement or deep inspiration, and associated muscle guarding.

We initially manage this condition with hands on manual therapy, including joint mobilisation to facilitate normal joint movement. Heat, activity modification and bakball may be recommend to manage symptoms.

Longer term we look to addressing any underling dysfunctions or technique correction to reduce future aggravation.


ii. T4 syndrome

T4 syndrome is an uncommon condition that presents with arm pain, headache, sensory changes in hands (paraesthesia) and mid-scapular tightness resulting from upper thoracic joint dysfunction.  The combination of spread symptoms has been referred to as T4 syndrome, however is not currently verified clinically.  The condition is thought to develop from the sympathetic nervous system.

On examination, a combination of thoracic hypomobility and shoulder protraction is present.  Management is directed towards improving thoracic mobility and scapular positioning.  Longer term we look to return to activity and sport pathways.

iii. Scheuermann’s disease

Scheuermann’s disease is a common cause of thoracic pain in adolescents.  The condition is marked by multiple vertebral end-plate irregularities.  The condition is characterised by a low thoracic kyphosis seen in adolescents.  The severity of the condition may range from mild to severe depending on the deformity. In adolescents training in static positions for prolonged periods such as cycling, may need to be modified to avoid aggravation in long term management of symptoms. An inability to participate in physical activity may also be experienced, leading to increased sedentary behaviour.

You can expect to feel muscle tightness and fatigue, intermittent back pain, upper back and rib pain and reduced flexibility on assessment.

We initially look for this in the initial assessment: postural abnormalities, thoracic kyphosis, positive Adam’s test – structural or functional scoliosis, muscle length discrepancies, reduced range of motion, and muscular strength of trunk and gluteal.

Initially we manage the condition with bracing and exercise in mild cases.  Moderate to severe cases may require surgical intervention to manage.


iv. Disc

Thoracic disc pathologies are classified by the severity of the disc injury and subsequent symptoms.  In general, thoracic disc will present with mid back pain around the site of the issue.  In instances where the nerve root is compressed, pain and/ or altered sensation may be present at the rib cage from the back to the front of the chest.  Often a patient will report pain with cough, sneeze or deep inspiration.

We initially look at the thoracic range of motion, strength, sensation, neural mobility and joint mobility.  We may refer for imaging depending on the severity of the symptoms and the presence of other sensations such as upper back and rib pain.

Initially we manage the condition with education, hands on manual therapy, taping, heat and NSAIDs if required. Longer term we look to include exercises to improve strength and movement, before commencing return to activity and sport.

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