Introduction
In recent literature, increasing attention has been given to the fact that, in dorsalgia, not only vertebrae, discs, and costovertebral joints contribute to symptoms, but also muscles and connective tissue, which respond to overload through structural remodeling and altered tension.
Taut bands — tense strands within the muscle
In overloaded thoracic and scapular muscles, clinicians frequently identify taut bands — dense, cord-like strands of muscle fibers.
They are characterized by:
increased tissue density,
palpable tenderness,
reduced elasticity,
a tendency to provoke referred pain.
Taut bands are thought to develop as a consequence of:
chronic static overload,
microcirculatory disturbances,
local hypoxia,
accumulation of inflammatory mediators.
This creates an environment that favors activation of myofascial trigger points, which — particularly in the thoracic region — may clinically mimic:
cardiac or angina-like pain,
upper gastrointestinal complaints,
biliary pain,
pleuritic chest discomfort.
As a result, patients frequently perceive pain between the shoulder blades or along the ribs, even though the primary source lies within the muscle.
Connective-tissue dysfunction — fascia as a “hidden tension organ”
Fascia, as part of the connective-tissue system, forms a continuous three-dimensional network connecting muscles, bones, and visceral organs.
In dorsalgia, it plays a crucial role.
Fascial dysfunction may involve:
Thickening and adhesions
loss of inter-layer gliding,
altered hydration of the extracellular matrix,
disturbed proprioceptive signaling.
Such alterations can contribute to:
Persistent interscapular pain
a sensation of tightness across the chest,
impaired thoracic mobility and breathing mechanics,
compensatory patterns in the cervical and lumbar spine.
Importantly, fascia is richly innervated.
Its overload is believed to maintain and perpetuate pain, even after the initial insult has resolved.
Interaction: spine — sympathetic system — soft tissues
In dorsalgia, three interacting levels are typically involved:
1️. Structural
(degenerative changes, segmental overload, mechanical dysfunction)
2️. Myofascial
(taut bands, trigger points, fascial restrictions)
3️. Neurophysiological
(sympathetic activation, central sensitization, Head’s zones)
This interplay helps explain:
fluctuating symptom intensity,
wide pain referral patterns,
weak correlation with imaging findings.
Summary
In dorsalgia
taut bands represent an important generator of local and referred myofascial pain,
connective-tissue / fascial dysfunction stabilizes and perpetuates symptoms,
the sympathetic nervous system modulates both muscle tone and pain perception,
clinical presentation may closely imitate visceral disease.
A comprehensive interpretation therefore requires segmental and neurophysiological reasoning, together with careful examination of soft tissues — while simultaneously ruling out visceral causes.