A spinal compression fracture in the upper or middle back (thoracic compression fracture) is a vertebra that has collapsed, usually at the front, into a wedge shape. Most are caused by thin bones (osteoporosis), and can happen after a minor fall, lifting, a cough or sneeze, or no clear event. It often causes sudden, sharp pain over the spine at one level. Pain usually eases over 6 to 12 weeks, though some people have aching for months. A medical diagnosis, usually with an X-ray, is needed.
Some compression fractures cause little or no pain and are found later on an X-ray, or noticed as height loss or a more rounded upper back. Others are very painful at first, especially when standing, walking, rolling in bed or getting up from lying down. Lying down often eases the pain.
Compression fractures can also follow a high-force injury, such as a car accident or a fall from height, at any age. Less often, a weakened vertebra comes from cancer that has spread to the bone. That is one reason every new fracture needs a doctor’s review.
Key takeaways
- What it is: a vertebra in the upper or middle back that has collapsed into a wedge shape.
- Most common cause: osteoporosis, where a fracture can follow a minor fall, a lift, a cough or no clear event.
- Typical symptoms: sudden, sharp pain over the spine, worse standing or moving and often eased by lying down.
- Typical course: pain usually eases over 6 to 12 weeks; some people have aching for longer.
- Bone health: one fragility fracture raises the risk of another, so a bone density assessment and treatment plan are usually advised.
Where are you right now?
- Sudden spine pain, not yet seen by a doctor: go to the safety sections near the end first. A suspected fracture needs a doctor’s review today.
- Diagnosed, weeks in and still painful: read “Week by week” and “If it isn’t going to plan”.
- After a procedure (vertebroplasty or kyphoplasty) or surgery: follow your specialist’s plan for activity and bracing. The bone health section still applies.
- Getting back to work or activity: the “When can I…” table gives typical ranges. Your doctor’s advice comes first.
Week by week
This is a typical course for a stable osteoporotic fracture managed without a procedure. Your doctor may give different timings. Use theirs.
- Weeks 0 to 2: pain is usually at its highest. Pain relief from your doctor, short periods of rest lying down, and short walks within comfort are typical. Long bed rest is usually avoided, as it weakens muscle and bone. Some people are offered a brace for comfort.
- Weeks 2 to 6: many people notice the pain easing slowly. Walking time gradually increases. Gentle posture and breathing exercises are often introduced.
- Weeks 6 to 12: the fracture is usually healing, and pain is often much lower. Strengthening for the back muscles, balance work and a gradual return to daily tasks are common.
- After 3 months: many people are back to most daily activities. Some keep an ache or stiffness, especially after long standing. A rounded upper back may remain.
When procedures are discussed
Most compression fractures heal without a procedure. In vertebroplasty and kyphoplasty, bone cement is injected into the fractured vertebra through a needle. These may be discussed when pain stays severe despite several weeks of medicine and activity changes, or when pain is limiting walking or breathing. Evidence on how much they help compared with non-surgical care is mixed, so they are not routine. Surgery to stabilize the spine is uncommon and usually reserved for unstable fractures or pressure on the spinal cord or nerves.
Bone health after a fracture
- Ask about a bone density scan (DXA): it measures bone strength and helps guide treatment.
- Ask about bone medicine: medicines that slow bone loss or build bone reduce the risk of further fractures in many people.
- Calcium, vitamin D and protein: your doctor can advise whether you are getting enough.
- Falls: balance training, a home check for trip hazards and reviewing medicines that cause dizziness all lower the chance of another fracture.
A fracture from a small knock is a message about the bones, not only the back.
Where else this could be coming from
- Muscle strain: pain along a muscle beside the spine, tender to press there rather than on the bone, usually after a clear strain.
- Rib joint irritation: sharp pain a little to one side of the spine, worse on deep breaths and twisting.
- Rib fracture: pain over a rib rather than the center of the spine, after a fall or hard coughing.
- Shingles: burning pain in a band on one side, followed by a rash.
- Organs: the heart, aorta, lungs and gallbladder can refer pain here, usually without tenderness over the bone and often with other symptoms.
Is this normal?
- It hurts most when I get out of bed: common. Moving from lying to sitting loads the fractured vertebra. Rolling onto your side first and pushing up with your arms usually helps.
- Pain wraps around my ribs: common. A fracture can irritate the nerve at that level, sending pain around the chest in a band.
- I have lost some height: common after one or more compression fractures. Tell your doctor, as it helps guide bone health treatment.
- I am scared to move: common. Gentle, regular walking within comfort usually helps recovery more than staying still.
If it isn’t going to plan
It is week five. You have spent most days in the recliner because walking to the kitchen hurts, and your legs feel weaker than they did a month ago. The thought in your head is that a broken bone needs to be kept still until it mends.
A stable compression fracture usually heals best with regular, gentle activity. Long periods of sitting or lying weaken the back and leg muscles, reduce balance and can thin bone further. Short, frequent walks within comfort, posture exercises and later strengthening support healing and lower the risk of a fall.
If pain is not easing after 4 to 6 weeks, or is limiting walking, ask your doctor for a review, and ask about a physical therapist experienced with osteoporosis. Questions worth asking:
- Is the fracture stable, and has it changed since the first X-ray?
- Which movements and lifts are safe for me now?
- Should I have a bone density scan and start bone medicine?
- Would I be a candidate for a procedure if pain stays severe?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Often possible within 1 to 3 weeks; side-lying with a pillow between the knees is often the easiest position |
| Drive | Often 4 to 8 weeks, once you can sit comfortably, turn safely and are not drowsy from pain medicine |
| Reach overhead | Light reaching often within 2 to 6 weeks |
| Lift | Usually limited to light loads close to the body for 6 to 12 weeks; with osteoporosis, ask your doctor for long-term limits |
| Desk work | Often 2 to 6 weeks, with frequent breaks to stand and walk |
| Manual work or sport | Often 3 months or more; avoid heavy lifting, deep loaded bending and twisting until cleared |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Spinal cord signs: new weakness, numbness or heaviness in the legs, unsteady walking, or loss of bladder or bowel control.
- Major trauma: back pain after a car accident, a fall from height or a heavy blow.
- Breathing or chest symptoms: sudden breathlessness, chest pain, or pain with sweating and nausea.
See a doctor today if
- Suspected fracture: sudden, sharp pain over the spine after a minor fall, lift, cough or sneeze, especially over about 50, with osteoporosis or on long-term steroid medicine.
- Pain with fever: back pain with fever, chills or feeling unwell.
- Cancer history: new spine pain in someone who has had cancer.
Get it checked soon if
- Pain not easing: pain is not improving after 4 to 6 weeks.
- New pain at a different level: sudden new pain higher or lower in the spine.
- Height loss: you have lost about 4 cm (1.5 inches) or more in height.
- Weight loss or night pain: unexplained weight loss, or constant pain at night.
More on this area: upper and mid back conditions.
Most compression fractures heal over weeks to a few months, and the bones behind them deserve as much attention as the back.
Written by Louise Yow, Neck & Shoulder Physio.