September is Menopause Awareness Month – so in this post, I wanted to take a look at the effects of Menopause on the Thoracic Spine – what do we need to know and what’s the good news?

Often, when we think of back pain and menopause, we may wonder about lumbar spine degeneration, we may think about the cervical spine, cervicogenic headaches or TMJ dysfunction (more blogs on those topics coming in the future!) The thoracic spine, in my opinion, doesn’t always get the attention it deserves but it becomes increasingly important at midlife, particularly when we consider trunk mobility through the lens of bone health, respiratory function, mood, cardiovascular health and even as a moderator of menopausal symptoms and healthy self image. Intrigued? Read on!
The thoracic spine is the longest part of the spine, made up of twelve vertebrae and is the only part of the spine attached to the ribcage. The upper part of the thoracic spine’s main movement capacity is for axial rotation but as we move to the lower part of the thoracic region, the vertebrae change shape to resemble the lumbar spine and have more ability to flex, extend and side bend and less capacity to rotate.
At menopause, there are several thoracic considerations we might consider:
Breast Health: In Spencer’s 2013 paper ‘‘Breast size, thoracic kyphosis & thoracic spine pain – association & relevance of bra fitting in post-menopausal women: a correlational study’, the author found that ‘…‘.. larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post-menopause women present with a spectrum of anthropometrical changes that have the potential to contribute to altered biomechanics and affect pain states in the thoracic spine.’ I’d also say that we should consider how this may affect exercise participation – if the breasts aren’t well supported, how comfortable will exercise be? (or how likely are you to participate?) How might running form be affected for example if thoracic rotation is reduced because we’re trying to support the breasts? The good news? A well fitted bra with enough support can make all the difference in body confidence when exercising! (When was the last time you got measured? How old are your sport bras? Several high street shops offer a free bra fitting service but here are some handy tips from Marks and Spencer:

from: marksandspencer.ie

Bone Health: Osteoporosis is estimated to affect 200 million women worldwide – approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90. Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50 and one of the most common areas for these fractures to occur is in the thoracic spine. Osteoporotic changes in the spine can affect Breathing, Cardiac function, Digestion, Mobility, Pain, Continence and Mental Health. The characteristic slumped posture of thoracic kyphosis can play a role in mood as well – there’s a documented positive correlation between “optimal” posture and a person’s self-efficacy, confidence (Briñol et al 2009) and body image (Pop 2016) The good news? Although there are some risk factors we can’t control (being a woman, having a small frame, getting older) there are lots of things that we DO have control over: eating well (dark green leafy veg, dairy if you can digest it, oily fish), getting good sleep (decreased sleep is associated with decreased BMD) and of course…EXERCISE!! The right type of exercise can not only halt bone loss, but potentially reverse it! We have research showing that spinal extension exercises, low load high repetition resistance exercises, increasing your squat strength, and High-Intensity Resistance and Impact Training ALL have the capacity to improve bone health – as long as they are taught by an appropriately qualified instructor, ideally a women’s health physio or a Holistic Core Restore® coach.

And of course, one of my favourite topics to talk about:

Heart Health: It is incredibly important for women to pay attention to their heart health at midlife – when oestrogen levels decline during and after peri-menopause, women’s risk of having a cardiac event becomes significantly elevated. It is also worth remembering that women don’t have what many regard as ‘typical’ symptoms of a heart attack – women may or may not have chest pain, but they can also have breathlessness, nausea or indigestion type symptoms, insomnia, anxiety and either jaw or thoracic pain. Thoracic mobility is also important in preventing cardiovascular events – in their 2009 study ‘‘Poor trunk flexibility is associated with arterial stiffening’, Yamamoto et al ‘…suggest that trunk flexibility may be a predictor of arterial stiffening.’. The good news? Exercise is a key component of lifestyle changes (including eating well, sleeping well and having good stress management strategies) that may help prevent a heart attack in the first place and can certainly have a big impact on recovery and preventing recurrence


If you’d like to take a deeper dive into menopausal health, including exercise prescription, pelvic health, hormonal balance, nutrition and much more…
I’ll be teaching a one day live Menopause Masterclass at Live and Breathe Pilates in Dublin on September 30th  and I’ll be teaching a two day live course on An Integrative Approach to Menopause’  in Toronto in October in conjunction with pelvichealthsolutions.ca
Prefer to learn online? I’ve teamed up with Burrell Education on a number of different courses, including ‘Breathe Better’ and ‘Optimal Health After Hysterectomy’
Hope to see you in class, either online or in person
Until next time
Onwards & Upwards