Thoracic spine pain is often overlooked and accepted as part of the stress of everyday life. It, often times takes a back seat to the more flagrant presentations of neck and lower back pain. However, it is important to realize that common referrals to the thoracic spine from visceral structures are very common and must be recognized in order to avoid serious consequences. To better understand injuries to and pain generation from the thoracic spine we will break down concerns by age categories; adolescent, middle age, and elderly. A general strategy will be given to aid in better assessment of the thoracic spine. Evaluation, diagnostic study, and treatment protocols with be reviewed in order to allow for a more guided assessment and treatment of thoracic spine pain and injury.