Mark is a 62-year-old mechanic who presents with several months of worsening mid-thoracic back pain.

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<p>Mark is a 62-year-old mechanic who presents with several months of worsening mid-thoracic back pain.</p><p>He does not recall any specific trigger or injury.</p><p>The pain is worse with thoracic flexion and extension, and it is not improved with simple analgesia, hot packs or stretching.</p><p>Mark avoids going to the doctor and has been seeing a chiropractor for the pain. This was helpful initially, but the benefit was not sustained.</p><p>For this reason, the chiropractor sent him for X-rays (pictured on the next page), then recommended Mark see a GP to discuss the results.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.