Thoracic Intervertebral Joints
Disorders of the thoracic (upper back) intervertebral joints. This may involve damage to the intervertebral disks or facet joints. The joints between the ribs and the spine can also be a cause of pain in this region.

Sternoclavicular Joint
The sternoclavicular joint is another cause of chest pain and is often injured in conjunction with the AC-joint of the shoulder. This joint can be sprained, subluxed and dislocated. Treatment ranges from local soft tissue massage and joint mobilisation to immobilisation, depending upon the severity of the injury.

Referred Pain
The most common cause of chest pain in those under 35, however, is referred pain from the thoracic spine. Treatment is the same as for the thoracic spine.The ribs may be fractured or bruised as a result of a direct blow. X-rays will confirm a fracture. These injuries will be tender for at least three weeks.

Scheuermann's Disease
The most common cause of thoracic pain in adolescents is Scheuermann's Disease, a disorder of the growth plates of the thoracic vertebra- this condition is covered under The Younger Athlete. Pain in this region often presents as pain between or around the shoulder blades. The pain may have commenced suddenly as a result of a sudden movement or may have been of a more gradual onset.

Treatment
Treatment aims to restore full mobility by mobilisation and manipulation of the joints and massage to the spinal muscles. It is important to follow this up with a rehabilitation programme involving stretching and strengthening exercises. Chest pain occurs not infrequently in athletes, usually due to musculoskeletal causes. The possibility of this pain being of cardiac origin must always be considered.

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