Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109

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Posts for: August, 2019

Pain in the rib cage can range from mild tenderness to severe cramps or a burning sensation. Sometimes rib pain stems from a problem in the spine, even if the pain is felt more toward the chest or abdomen.

Here are some potential causes of rib pain that may stem from the mid-spine, also called the thoracic spine.

See Thoracic Spine Anatomy and Upper Back Pain

Fractured or displaced rib

A traumatic injury, such as from a collision, is a common cause of rib fracture and/or displacement where it connects with the thoracic spine. If the rib becomes displaced, it may lead to painful muscle cramps between the ribs, such as in the back or in front. It may also compress the intercostal nerve and send pain, tingling, and/or numbness along the rib and into the chest and less commonly to the abdomen.

See What Causes Back Pain and Shortness of Breath?

Sometimes rib displacement occurs without any type of significant impact or collision. For example, slipping rib syndrome is a condition where the rib becomes hypermobile, such as from a weakened connection at the front of the rib with the cartilage or sternum, and/or at the back of the rib with the vertebra. Many cases of slipping rib syndrome have involved traumatic injury but some have not.

See Thoracic Vertebrae and the Rib Cage

Thoracic herniated disc

While rare, a thoracic herniated disc may lead to inflammatory proteins leaking from the disc and inflaming a thoracic spinal nerve, sending pain along the nerve path. Pain, tingling, and/or numbness may radiate anywhere from the location of the herniation in the upper back along the rib toward the chest or abdomen. Pain may come and go, and may worsen with certain types of activities, such as vigorous exercise or bending in a specific direction.

location of a thoracic herniated disc

See how a herniated disc can cause pain in the upper back. Watch: Thoracic Herniated Disc Video

A thoracic herniated disc can be caused by an injury, or it could be part of the degenerative disc disease process. In many cases, degenerative disc disease and osteoarthritis occur together.

See Upper Back Pain from a Thoracic Herniated Disc

Thoracic osteoarthritis

Thoracic osteoarthritis occurs when protective cartilage starts to break down within the facet joints in the thoracic spine. Osteoarthritic joints become inflamed and bones start to grind together, which can cause bone spurs to grow. Osteoarthritis in the thoracic spine may trigger muscle cramps in the intercostal muscles (between the ribs) and/or contribute to nerve inflammation that causes pain or tingling to travel along a rib and into the chest or abdomen.

See Bone Spurs (Osteophytes) and Back Pain

Osteoarthritic inflammation and bony overgrowth are less common in the thoracic spine compared to the cervical spine and lumbar spine. It is also possible to have osteoarthritis develop in the costovertebral and/or costotransverse joints which connect the ribs to the thoracic spine.

Read more about Osteoarthritis of the Spine

When to see a doctor

When unexplained pain in the rib cage area is severe enough to limit activities or does not alleviate with rest, seek medical attention. In addition, any type of radiating pain, tingling, numbness, or weakness needs an immediate medical evaluation. Treatment is typically more effective the sooner it is started. It is important to get an accurate medical diagnosis rather than trying to ignore the pain.

See Specialists Who Treat Back Pain

Learn more:

Thoracic Disc Herniation Treatment

Osteoarthritis Complete Treatment Guide

If you have sciatica, the burning, tingling, or stabbing pain that radiates from your lower back down through your leg is an uncomfortable annoyance that too often prevents a good night’s sleep.

See What You Need to Know About Sciatica

Image of young woman sleeping with a wedge pillow underneath her back and legs.

Using a two-piece wedge cushion can help to alleviate pressure on the sciatic nerve roots in the lumbar spine.
 Pillow Tips for Sciatica Video

Finding a pillow—and a pillow arrangement—that works best for you can increase your chances of getting sufficient sleep. Interested? Here’s a guide for pillows and sleeping with sciatica pain.

See Pillow Support and Comfort

  1. Find a firm surface. Before considering pillows, take stock of your sleeping surface. While comfort is a matter of personal preference, many people with sciatica opt to sleep on a medium-firm to firm mattress. Some people even prefer sleeping on a yoga mat placed on the floor. A firm surface can provide support and promote spinal alignment.

See Different Types of Pillows

See Best Pillows for Different Sleeping Positions

  1. Create a supportive reclining position using a two-piece wedge cushion. A two-piece wedge cushion offers a similar position to a reclining chair, but it can be used on the surface of your mattress. The two-piece wedge cushion is designed to prop up your back and elevate your legs, which can take pressure off the nerve roots in your lumbar spine, and may offer you enough relief to fall asleep.
  2. Recline with 2 plump pillows behind your back and 1 to 2 flat pillows under your knees. If a two-piece wedge cushion is out of your budget range, or takes up too much space on your bed, stack two plump, dense pillows behind your shoulders and tuck a flat pillow or two underneath your knees and upper calves to elevate your legs.
  3. Use pillows to keep you from rolling onto your side. For many people with sciatica, sleeping on their side exacerbates the pain. You can use pillows to hedge yourself in while you sleep on your back. This simple trick can prevent you from accidentally rolling over in your sleep.
  4. Side sleepers: place a contoured pillow in between your knees. If you prefer sleeping on your side, there are methods you can try to get a good sleep despite the sciatica pain. You may benefit from using a contoured pillow, shaped to fit snugly and comfortably between your legs at the knee. A contoured pillow can help reduce lumbar spine pressure and keep your body aligned.
  1. Side sleepers: sleep with a larger-sized pillow. A pillow with a large surface area that you can position under your head and against your chest may help bring you comfort while sleeping on your side. You can try a pillow that features customizable thickness levels, allowing you to find a height and density that feels most comfortable to you.
  2. Try sleeping on your stomach with a pillow under your hips. It is generally best to avoid sleeping on your stomach, but if you try sleeping on your stomach, be sure to place a flat pillow underneath your hips to keep your spine aligned. Use a flat pillow—or no pillow at all—underneath your head, in order to prevent neck strain.

Sciatica pain has various underlying causes, and the medical cause of the sciatica pain may influence what sleep position feels more comfortable. If you give one or more of these tips a try, you may find a more restful and restorative night’s sleep.

See Sciatica Causes

Learn more:

Sciatica Treatment

When Sciatica Pain Is a Medical Emergency


The classic symptom of gastroesophageal reflux disease (GERD) is heartburn felt in the chest, but can this condition cause similar symptoms of burning pain in the back? Probably not.

Closeup image of person holding chest with heartburn

While people can experience GERD and back pain at the same time, GERD is more likely caused by something related to existing back pain or its treatment. Read: All About Upper Back Pain

While people can experience GERD and back pain at the same time, it is more likely that the GERD is caused by something related to the existing back pain or its treatment. Here are some possible causes of GERD and acid reflux related to back pain—and how to handle them.

NSAIDs used to treat back pain

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to help alleviate pain and stiffness associated with back pain. Some common NSAIDs include aspirin, ibuprofen, and naproxen. Unfortunately, some evidence suggests that NSAIDs can increase the risk for developing GERD.1 While most people who use NSAIDs do not get GERD as a result, some people do.

See Potential Risks and Complications of NSAIDs

If you suspect that your medications are causing or worsening symptoms of GERD, check with your doctor. There might be another medication or treatment option that can provide adequate back pain relief without worsening GERD symptoms.

See Medications for Back Pain and Neck Pain

Stress from ongoing pain

Stress can cause GERD in some people.2 And dealing with severe back pain, especially when it lingers or becomes chronic, can be stressful. In addition to the discomfort, chronic pain can prevent a person from working or doing activities they enjoy, such as playing a sport or going out with friends. This ongoing stress may increase the risk for developing GERD.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

If you feel as though your back pain is isolating or a challenge to manage, consider talking with people who may be able to offer additional tips. Some ideas include:

  • Join a support group. Discussing with others who are going through similar challenges can help. You may also learn tips that worked for someone else. Numerous support groups for chronic pain are available online. There might also be one or more local groups in your area that meet in person.
  • Attend cognitive behavioral therapy. Talking with a mental health counselor or therapist may help you form new strategies for positive thinking and better pain management.

It can also help to be honest with family members and friends about how your back is feeling. They may be willing to pitch in and help with a chore or run an errand when needed.

See Stress-Related Back Pain

Eating too much or trigger foods

Some people with debilitating back pain may become less active and potentially eat more, which can increase the risk for acid reflux and GERD. Greasy, fatty meals are common triggers for acid reflux. Many other potential trigger foods exist, such as:

  • Caffeine
  • Chocolate
  • Alcohol
  • Onion
  • Citrus fruit
  • Garlic

See Food for Thought: Diet and Nutrition for a Healthy Back

Trigger foods for acid reflux can vary widely from person to person, so it may take some trial and error to find your trigger foods. Eating smaller meals throughout the day, rather than big meals, may also reduce GERD symptoms. In addition, eating shortly before bedtime is not recommended because that can contribute to acid reflux during sleep.

Over time, untreated GERD can lead to worsening problems. If you have acid reflux or any other new symptoms in addition to ongoing back pain, be sure to mention it to your doctor.

Learn more:

Causes of Upper Back Pain

Immunonutrition: Healing Nutrients for Back Pain and Spine Surgery


  1. Ruszniewski P1, Soufflet C, Barthélémy P. Nonsteroidal anti-inflammatory drug use as a risk factor for gastro-oesophageal reflux disease: an observational study. Aliment Pharmacol Ther. 2008 28(9):1134-9. doi: 10.1111/j.1365-2036.2008.03821.x.
  2. Song EM, Jung H-K, Jung JM. The association between reflux esophagitis and psychological stress. Dig Dis Sci. 2013; 58(2):471-7. doi: 10.1007/s10620-012-2377-z.

A warm feeling in the thigh may range from that of spilled warm milk to a hot, burning pain. The warmth may be localized to a specific area or may affect the entire thigh.

Animated video still highlighting the thighs

Depending on the underlying cause, warmth or pain in the thigh may occur in the front, outer and/or inner side, or the back of the thigh.

Several conditions can cause a warm feeling in the thigh, including nerve, muscle, and joint problems. Nerve pain may sometimes be felt as warmth, which may progress into sharp, searing pain in the later stages. Pain from muscles and joints may be felt as a warm sensation due to the inflammatory process of the underlying tissues.

Here are a few examples.


Nerve root irritation or compression near the spine can cause radicular pain or radiculopathy. Radiculopathy from the lumbar nerve roots L1-L4 may cause1:

  • Pain along the outer side of the thigh, typically localized within a 5 to 8 cm wide area
  • Numbness and weakness in the outer and/or inner thigh

See Lumbar Radiculopathy

When radicular pain from the spinal nerve roots radiates from the lower back into the thigh, leg, and/or foot, it is called sciatica. Sciatica usually caused when one or more nerve roots from L4 to S1 are affected.2

See What You Need to Know About Sciatica

Radicular pain typically affects one leg at a time and is caused due to nerve root compression from herniated lumbar disc, degeneration of spinal structures, or tumors.

See Lumbar Degenerative Disc Disease (DDD)

Meralgia paresthetica

When a nerve is compressed, entrapped, or degenerated along its path, is called neuropathy. Meralgia paresthetica is caused due to neuropathy of the lateral femoral cutaneous nerve, which is a superficial sensory nerve in the thigh.3 A few typical characteristics include4:

  • Pain in the side and/or front of one or both thighs
  • Buzzing or vibration felt inside the thigh
  • Muscle ache and numbness in the thigh

See Understanding Neuropathy Symptoms

The pain may increase with prolonged standing and walking and reduce while sitting.4

Meralgia paresthetica is typically caused when a direct compression of the nerve occurs due to tight garments, pressure from seat belts, direct trauma, or muscle spasm in the hip. Other causes include damage to the nerve due to diabetes mellitus, alcoholism, and lead poisoning.4 Severe abdominal fat can also cause meralgia paresthetica.

Watch: Causes of Neuropathic Pain Video

Other types of nerve pain in the thigh include femoral and obturator neuropathy. Obturator nerve pain may produce symptoms in the inner thigh and femoral neuropathy usually causes symptoms from the thigh to travel down into the knee, leg, and/or foot.5

See Treatment Options for Neuropathic Pain

Greater trochanteric pain syndrome (GTPS)

GTPS is defined by a range of problems in the hip and may cause symptoms such as warmth or aches in the side of the thigh and hip. GTPS includes6:

  • Tendinopathy: Chronic tendon pain
  • External snapping hip: A muscle or tendon slides over the knobby bone at the top of the femur (thighbone), called the greater trochanter, causing pain and tenderness

    See 3 Types of Snapping Hip Syndrome on Sports-health

  • Trochanteric bursitis: Inflammation of the fluid-filled cavity present on the side of the hip

    See Hip (Trochanteric) Bursitis on Arthritis-health

GTPS typically causes chronic intermittent pain in the side of the thigh, hip, and buttock. The pain increases with activity and while lying down on the affected side.6

Hip osteoarthritis

Wear-and-tear arthritis of the hip joint may cause warmth and other symptoms in the front and side of the thigh. A few symptoms include:

  • Pain along the side and/or front of the thigh, groin, and hip7-8
  • Stiffness in the hip8
  • Locking, clicking, or grinding sound from the hip joint during movements8

See What Is Hip Osteoarthritis? on Arthritis-health

The pain and other symptoms typically increase with activity, after prolonged sitting, or after waking in the morning. Sometimes, the pain may radiate down to the knee.8

See Hip Osteoarthritis Symptoms on Arthritis-health

It is advised to consult a doctor if warmth, pain, or other symptoms develop in the thigh. If symptoms such as fever, nausea, difficulty walking or standing are resent, they may indicate serious underlying conditions, such as tumors, infection, or severe nerve damage. A doctor can diagnose the accurate cause of the symptom(s) and formulate an effective treatment plan.

See Accurately Diagnosing Leg Pain

Learn more:

Leg Pain and Numbness: What Might These Symptoms Mean?

Causes of Leg Pain and Foot Pain


  1. Manchikanti L, Singh V, Boswell MV. Lumbar Radiculopathy. In: Pain Management. Elsevier; 2007:758-768. doi:10.1016/b978-0-7216-0334-6.50087-x.
  2. Wright R, Inbody SB. Radiculopathy and Degenerative Spine Disease. In: Neurology Secrets. Elsevier; 2010:121-130. doi:10.1016/b978-0-323-05712-7.00007-6.
  3. Ellis J, Schneider JR, Cloney M, Winfree CJ. Lateral Femoral Cutaneous Nerve Decompression Guided by Preoperative Ultrasound Mapping. Cureus. 2018;10(11):e3652. Published 2018 Nov 28. doi:10.7759/cureus.3652.

Coming soon.

To relax before bedtime, many people with back or neck pain drink hot tea, hoping its calming effects will help them sleep better.

Image of woman drinking tea in front of the fireplace

Incorporating a bedtime tea into your nighttime routine can help make falling asleep easier.
 Practicing Good Sleep Hygiene

You shouldn’t reach for just any tea, though, as some are more conducive to a restful night sleep than others. Read on to learn the top bedtime tea recommendations.

Chamomile. This herbal tea can help temporarily calm mild anxiety, permitting enough relaxation to fall asleep.1 If you don’t enjoy its floral and slightly apple taste, you may prefer to drink this tea with a little milk or honey.

Passion Flower. Passion flower tea has chemical properties that can soothe a restless mind and promote sleep benefits.2 Drink a cup about an hour before bedtime, and try mixing it with mint or lemon flavors if you want to cut its flowery taste.

Decaffeinated Green Tea. Green tea contains a unique amino acid that has been shown to lower stress levels and lead to better sleep.3 If this tea tastes too bitter and grassy for you, try steeping it at a lower temperature with a temperature-controlled kettle.

Jasmine Flower. Nighttime exposure to the scent of jasmine flower can enhance your quality of sleep.4 Blend together jasmine flower with another herbal tea to experience the relaxing effects of its aroma.

Valerian Root. Valerian root can promote deep sleep and may even help you fall asleep faster.5 Some people do not prefer the strong aroma of this tea, so you may want to blend it with mint or jasmine flower.

Lavender. Lavender is popular in its essential oil form and can also be enjoyed as a pleasantly scented tea. Drinking it at bedtime may help you enjoy a deeper sleep and feel refreshed upon waking up.6

Check out your local tea shop or browse online for a tea blend that contains one or more of the above ingredients—and make sure you have a kettle and a loose tea infuser.

Drinking tea at night is not a cure-all for back pain or insomnia, but it can be a helpful part of maintaining a balanced sleep hygiene.

Learn more:

 Psychological Techniques, Sleep Environment, and Better Sleep

 Using Supplements, Natural Remedies and OTC Sleep Aids Safely


  1. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-82.
  2. Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytother Res. 2011;25(8):1153-9.
  3. Unno K, Noda S, Kawasaki Y, et al. Reduced Stress and Improved Sleep Quality Caused by Green Tea Are Associated with a Reduced Caffeine Content. Nutrients. 2017;9(7)