Back pain is the leading cause of disability and absence from work worldwide. It prevents you from participating in sports or life in general. Muscle spasm is the involuntary contraction of a muscle. It causes pain and discomfort. Leave it unattended for long enough and it can lead to pain elsewhere in the body too. Upper back muscle spasm commonly occurs in large muscle groups. Physiotherapy treatment of muscular spasm in the upper back can relieve your pain and get you back to living your life to the fullest.
What structures lead to upper back muscle spasm?
The upper back or thoracic spine can be seen as the main train station, where all the major lines connect. The neck, shoulders, lower back and hips can all influence or be influenced by pain and imbalance of the upper back muscles.
If you travel through the layers of the upper back muscles you will find:
- Lattisimus dorsi
- Trapezius
- Rhomboid major and minor
- Serratus posterior
- Splenius cervicis
- Longissimus thoracis
- Splenius thoracis
- Semispinalis thoracis
- and finally multifidus
- intercostal muscles attach between the ribs
Its a connected network
All these muscles have a left and right counterpart and together work in harmony to move your upper back to turn and look behind you or lift and elongate the body for good posture. Unfortunately, poor posture leads to lazy, elongated muscles in the upper back that are more comfortable slouching forward over your steering wheel, phone or laptop.
We have 12 thoracic vertebrae, with 12 sets of ribs on either side. This makes the thoracic spine less flexible that the neck and lower back. But rightly so, because it protects such precious cargo. The lungs and heart fill most of the chest cavity. Poor posture can influence your lung capacity, quality of your breath and if you have ever experienced an anxiety attack, you know that the ease you breathe with can influence your state of mind. So I’ll argue that by affecting the quality of your breath, upper back muscle spasm can break down your quality of life, pain intensity set aside. Your liver, on the right, and stomach, on the left are located under the lowest ribs on either side.
Just like the neck and back, the thoracic spine has discs in between the vertebrae. Because of the ribs and immobility, the risk of injuring a disc is much less than the neck or lower back, but a rare slipped thoracic disc can give you quite intense upper back muscle spasms.
Nerve roots are found between the bones and supply the muscles and skin of the upper back and chest.
What do the upper back muscles do?
The muscles of the upper back work synergistically to stabilise your thoracic spine when you need to move your neck, shoulder or even your back. The muscle pairs can work independently or together to bend backwards, turn to the side or bend to the side. The upper back muscles also lift the ribs to allow chest expansion during deep breathing or force the ribs together when you cough.
The table below gives detailed action of the specific muscles of your upper back.
| Upper back muscles | Muscle action |
|---|---|
| Latissimus dorsi | medial rotation + adduction + extension shoulder |
| Trapezius | upper fibres: elevation + lateral rotation of the scapula middle fibres: adduction + lateral rotation of the scapula lower fibres: adduction + depression + lateral rotation of the scapula |
| Rhomboid major and minor | adduction + elevation + downward rotation of scapula |
| Serratus posterior | aids inspiration by lifting and moving ribs back & down |
| Splenius cervicis | extension + lateral flexion + rotation of the neck |
| Longissimus thoracis | extension + lateral flexion of the upper back |
| Splenius thoracis | extension + lateral flexion + rotation of the upper back |
| Semispinalis thoracis | extension + rotation of the upper back |
| multifidus | extension + rotation of the upper back |
| intercostal muscles | chest expansion |
How does an upper back muscle spasm happen?
A pulled upper back muscle can be caused by new or unaccustomed exercise or lifting more weight than you are used to. But mostly upper back muscle spasm happens because of overuse, poor posture and muscle fatigue.
The body is a master of adaptation and taking short cuts. If you sit slouched over a computer all day in flexion, the upper back muscles are lengthened and almost hanging on your skeleton like a jacket. The lever that they need to overcome to create movement is too big and therefore the muscles create trigger points or knots to shorten the lever and lessen the force needed to contract. This is the spasm in your upper back muscles.
Muscles are similar to the pawns on a chessboard, as they are our first line of defense against injury. A muscle spasm can form to protect against further injury. Structures in the thoracic spine that sustain an injury, like a thoracic disc, nerve root or joint, will be accompanied by muscle spasm. It is therefore important to have a returning upper back muscle spasm properly assessed to make sure there isn’t injury to any underlying structures.
Causes of spasm of the upper back muscles
Muscle spasm is a protective mechanism. It is the body’s way to limit movement, which may potentially lead to injury. Like having a curfew as a teenager, because potentially bad things can happen after midnight, right? Muscle spasm commonly occurs after combination movements, like bending and twisting. If you add weight to that scenario, like heavy lifting, you increase your risk of sustaining an upper back muscle spasm. Muscle spasm isn’t all bad, it protects an injured area and is commonly found surrounding a fracture or nerve injuries, to protect the area and minimise further movement. It is almost like the body can put on its own protective brace.
- prolonged positions, like computer work, knitting or nursing a baby
- poor posture, computer work or handbags/school bags
- muscle weakness or imbalances
- faulty movement patterns
- scoliosis
- new hobbies
- unaccustomed exercise
- excessive coughing or sneezing, after being ill
- trauma (falls or accident)
- rib fractures
- flexed work position, hairdressers, chefs, nail technicians or surgeons
Symptoms of upper back muscle spasm
You will experience pain and cramp like stiffness in the affected muscle. This is often in the upper back area and may extend to the neck and shoulders. Redness and swelling may be visible and you could find it difficult to move the area without significant pain and discomfort. You may find it difficult to get comfortable especially when lying down at night which may disrupt your sleep. Additional symptoms include:
- reduced range of movement
- weakness
- deformity
- cramps
How bad is my upper back muscle spasm?
Upper back muscle spasm is usually just a pesky symptom of something lurking beneath the surface. Constant upper back muscle pain that isn’t relieved by medication, rest, heat or gentle exercise with severely limited movement and sharp pain should be evaluated to find the cause and treat it accordingly. Nobody has “a bad or weak back” permanently. Genetics plays a minor role in back health. It is within your ability to change your symptoms by getting the cause of your upper back muscle spasm treated.
Intermittent pain of bearable intensity with general stiffness and muscle fatigue which is neglected can become constant. Minor symptoms call for less aggressive treatment of shorter duration. When upper back muscle spasm influences your day to day function, be it major or just a small bit, rather have it assessed and get the root cause treated. This prevents long term pain.
Diagnosis of a pulled upper back muscle
We are experts at testing the structural integrity of your joints, nerves, ligaments and muscles and will be able to give you an accurate diagnosis. From there we can tackle the problem together and stop your back muscle spasm from returning.
X rays
X rays give us valuable information about the bones. Are they aligned, are they moving well? It does not show soft tissue. Although we can make conclusions about muscle health from bony alignment, we can not accurately diagnose a pulled muscle from a X ray.
Sonar
Diagnostic ultrasound gives information about soft tissue structures like ligament, tendons and muscles. A pulled upper back muscle can be visualised on a sonar. It is uncommon to have an ultrasound done for an upper back muscle spasm because of the sheer size of most of the upper back muscles.
MRI
Magnetic resonance imaging is a costly procedure ordered by a specialist that gives us information on all the different structures. It is not necessary for the diagnosis of a pulled upper back muscle.
Why is my muscle spasm not going away?
Because the cause is not being addressed, as simple as that. Passive treatment, like thai massages, manipulations and adjustments, alone will alleviate your symptoms, but the problem will keep coming back. Usually when most inconvenient. You need to address the posture, movement patterns and habits that contribute and keep your upper back muscle spasm returning.
A big problem we see with upper back muscle spasm these days
A lot of upper back muscle spasm is misdiagnosed rotator cuff pathology or even missed cervical disc injuries. Patients are often promised an easy, permanent fix for a problem that was not well examined and accurately diagnosed. There is no such thing as an easy fix for a problem that you have had for a long time.
No manipulation or machine is sufficient to sort out your problem without changing certain behavioral patterns.
Physiotherapy treatment for muscular spasm in the upper back
We are trained to differentiate between the issues within the different tissues. Our physiotherapists can load joints, determine stability, length, strength and endurance of muscles, end diagnose tendon or ligament injuries. We consider local and compensatory movement patterns that cause or sustain your problem. You can trust us to determine the cause of your upper back muscle spasm to prevent recurrence in the future.
1st Phase: Protection & initial Healing
Protect
The main concern is to prevent your injury from worsening. Stop doing any aggravating activities. Change or adjust your working posture and avoid heavy lifting.
Rest
Your body needs rest, helping your natural healing processes from kicking in. Limit activities that are worsening your pain. As soon as there’s no pain, don’t test it. Give it time to heal.
Avoid anti-inflammatory mendication
The use of anti-inflammatory medication should be avoided, especially during the first 48 hours after injury. Inflammation is the body’s way of getting all the supplies needed for healing at the site of injury. If you hamper this process you can delay healing taking place.
Compression and heat
Strapping or taping can relieve your pain by supporting the upper back muscles and limiting movement. Any form of heat, like a hot water bottle, bean bag or warm bath can aid in relieving your pain.
Information & Load
It is important to understand what is going on in your body to make informed decisions. We are happy to answer all your questions. It is important to avoid movement and activities that aggravate your symptoms, but not moving at all is equally harmful. You find to find the sweet spot between the two to fast track the healing process without causing unnecessary delays.
2nd Phase: Establish pain free range of movement
During your examination and test, it’ll become clear what you’ll be able to do, and what you should avoid. We identify factors that contribute to your pain, specific to your case. There is a pain free range of movement that you’re safe to move in, this may be turning, bending and extending just half way. On completion of this phase you should be able to perform moments within these limits without any pain.
As your rehabilitation progress, we aim to gain a larger pain free range of movement while your painful range becomes less intense. We aim to maintain and improve bending forward and to the side, as well as turning to look behind you.
3rd Phase: Tissue healing
We monitor the progression of your healing, the fibrous tissue formation. On a cellular level, we’re able to accelerate tissue healing using dry needling, Laser, Ultrasound and electrotherapy. This phase will be specific to your case and underlying cause of your upper back muscle spasm.
4th Phase: Stability
During each session, we will re-evaluate if you are achieving the necessary targets for the tissue to be able to handle tensile, elastic and compression forces. It is important to have stability from your centre to enable control of movement further down, that is in the limbs. This can be very difficult to maintain if you have had long term problems and faulty movement patterns. Firstly we will guide you to keep the thoracic spine in neutral with small movements. As you get more accustomed to this we will change your exercises to keep the thoracic spine in neutral with larger movements elsewhere in the body. This enhances the recovery process by increasing circulation to the tissue while maintaining strength and avoiding muscle atrophy.
5th Phase: Muscle Strength & Full Range of Movement
The most important component of rehabilitation is to regain full range of movement of the muscle fibres. The scar tissue that forms inside the site of the injury must be able to lengthen and allow the muscle to contract without any restrictions. We use massage, stretches and neurodynamic mobilizations to achieve full range of movement.
On completion of this phase, you should be able to bend and turn to your full capacity without any pain or restrictions.
6rd Phase: Muscle Strength
Its common to feel some pain when we start contracting the muscle – this is due to breaking down abnormal fibrous tissue adhesion. Once the muscle has control over movement, we aim to increase endurance by adding load, like weights to your exercises or making the repetitions more or faster.
On completion of this phase you should be able to lift something of average weight, carry groceries and sit comfortably at work, in a better posture, for half a day.
7th Phase: Testing for return to activity
Gradual build up toward your previous intensity of normal activities and training to determine if your injury is able to withstand the repetitive loading without flare-ups. Our physiotherapist guides you to reengage in safe increments, and adjust where necessary. We’ll follow your progress and adapt where needed. Be is playing golf or making a wedding dress, we’ll get you back to where you need to be.
8th Phase: High Speed, Power, Proprioception
If you participate in sport, this is the phase where we get you back to training in increments. During this phase our physiotherapist will guide you to return to normal activities, this includes challenging your muscle past its ‘normal’ boundaries to determine how it reacts to different forces. Ultimately we prepare you to return to participating in your sport.
Whatever must be done – we’ll get you there. Throwing, catching, swinging a club or racket.
9th Phase: Sport Specific Training
This is the final stage of rehabilitation that can last anything from 2-4 weeks. Our Physio will still commence with myofascial release, trigger point release and electrotherapy modalities where needed, but functional rehabilitation is most important during this phase.
Depending on your sport, our physiotherapist will tailor specific exercises that will help strengthen the muscles pertaining to your sport. A successful outcome is when you have gained knowledge throughout the rehabilitation program and can participate at full power and speed, not to mention the benefits of minimizing your chance of future injury.
How long does upper back muscle spasm take to heal?
Everybody is different and will react to treatment differently. Your unique circumstances will influence your injury and your recovery. Normally a muscle injury heals within 4 – 6 weeks.
Other medical treatment for muscle spasm in the upper back
Your GP may prescribe medication for pain relief when you experience acute pain associated with an upper back muscle spasm. A combination of analgesics, anti-inflammatories and muscle relaxants can be used to relieve pain. However, if you do not address the cause of your back muscle spasm, symptomatic relief with medication will be of short duration.
Chiropractic adjustments are frequently done to relieve upper back muscle spasm with great efficacy. However, if you do not address the cause of your back muscle spasm, symptomatic relief with manipulation will be of short duration.
Corsets or braces to improve working posture can aid greatly. You do need to remember that a brace works in the same way as a cast or crutch, it keeps the back in position passively. If you do not strengthen your back muscles to ultimately be able to maintain the position independently, the relief will only be of short duration.
Surgery for upper back muscle spasm
Conservative treatment is the first choice for treating a pulled upper back muscle. Surgery is not considered for upper back muscle spasm.
Upper back muscle spasm is also known as:
- pulled upper back muscle
- muscular spasm of the upper back
What else could the pain be?
- Thoracic disc lesion
Because of the thoracic spine’s articulation with the ribcage, the change of sustaining a disc injury in the upper back is highly unlikely, but not impossible. Excruciating pain, worsened by an increase in pressure, like coughing or sneezing, with referral to the front of the chest can be caused by a thoracic disc bulge.
- Misdiagnosed rotator cuff strain
A previous shoulder injury can lead to muscle compensation, in an attempt to stabilize the shoulder, that ends up overworking the upper back.
- Pleural pain from a lung infection
Deep chest pain with general fatigue or fever may be underlying lung infection that causes pain from the inside of the chest cavity.
- Pathology of the heart
Atherosclerosis or narrowing of the blood vessels that supply the heart muscle, caused by high cholesterol, can cause chest pain with referral to the upper back muscles.
- Referral pain from a cervical disc injury
Pain caused by cervical disc injury can refer to the upper back muscles, this is known as Cloward sign. Chronic upper back muscle spasm may be caused by a previous neck disc injury or whiplash.
- Hiatus hernia and heartburn
Organs like the stomach can cause referred pain to the chest and upper back. This will be linked to heartburn, indigestion and bloating associated with meals.
Asymmetry of the spine seen from behind results in muscle imbalance. Overworking and underperforming muscles can then cause upper back muscle spasm.
Can muscular spasm in the upper back have any long-term effects?
With an effective treatment programme, muscle spasm can be resolved reasonably easily with physiotherapy. If the symptoms are ignored, recovery is likely to be longer and there could be lasting complications with the function of your muscles. Physiotherapy can also help with more chronic muscle spasm problems although this type of treatment will take longer.
