Upper back pain is the sensation of discomfort from below the neck to the middle of your back to your rib cage. Your thoracic spine stretches along the same area and is not as common as neck or back pain. Upper back pain can be injury to any of the upper back tissues like ligaments, muscle, tendon, meniscus, cartilage & bone in your thoracic spine.
The area has a number of overlapping conditions with the neck, mid-back and lower back. It generally becomes a secondary site of pain due to poor posture or habitual positions. It has a close relationship with your shoulder blade form compensatory patterns. We’ll discuss all the causes & symptoms of different types of thoracic back pain. From torn muscles, rib fractures, joint pain & much more. You need a trained eye to test all the structures in and around your upper back to determine there your pain is coming from.
Muscle pain
Rhomboids, Tapezius and Lats are the main shoulder blade muscles that move and stabilize your shoulder blade to your spine. Rhomboids runs between the edge of your shoulder blade & anchor onto the thoracic spine, where as Tapezius fans out over your upper back to anchor onto the spinous processes of your upper thoracic vertebrae. Lats runs from your armpit, attaches to the bottom border of your shoulder blade & anchors along your lower back. These muscles control the position of your shoulder blade, to give your arm a stable base to move from. They are vulnerable to repetitive overuse injury & postural fatigue.
An Upper back muscle stain always affects the shoulder blade & thoracic spine. Your upper back muscles radiates pain over your neck & shoulder blade that’s worse with movement, better with rest.
Your upper back muscles that keep you upright is a group called the Thoracic extensors. When these muscle contract they arch your upper back backwards. They get overworked sitting hunched over a desk all day. The anchors of the muscle’s attachment causes acute inflammation on it’s rib and vertebral attachment sites. Your upper back extensors is made up of three layers of muscles that run vertically along your spine.
Ligament tears
Your thoracic spine relies on ligaments for stability, to reinforce the joints & vertebrae. Upper back ligaments are injured when forceful movements load them beyond their normal range while being stretched at the same time. A ligament sprain in your spine is a common upper back injury that occurs when you forcefully twist or rotate your spine.
When ligaments are injured, they struggle to steady your spine’s movements. Stretching and compressing ligaments causes damage and result in upper back pain. This is often as a result of a fall or car accident.
Disc
Disc bulge, herniation, prolapse, slipped disc in your thorasic spine. The intervertebral (in between the vertebrae) discs act as shock absorbers for the spine. They are found in between each of the vertebrae, from the base of your neck down to your lower back. These 12 intervertebral discs transfer load in your upper back, as you hop, skip and jump through your day. If you injure the discs in your middle & upper back it may slip towards the spinal nerves, resulting in pain radiating over your back.
There’s classifications for these discs, but what you must understand is that this cushioning discs are vital to keep the spine’s bones tracking on each other. When a discs slips out of place, it feels like your back is stuck, not to mention the excruciating muscle spasms in your upper back. This leads to a cascade of swelling & pain. Thoracic discs are prone to tearing. A bulging disc can limit the space meant for nerves, essentially pinching the nerve. A pinched nerve is commonly known as a “slipped disc” and can be very dangerous.
Blood Vessels
Alongside the vertebrae run important blood vessels which supplies your brain with rich, oxygen filled, blood. Interrupting the blood supply is potentially devastating. Blockages in the vessels or pooling of blood (in the tissues) can put pressure on the other upper back structures, which would cause pain.
Upper back joint pain
Cervical pain could be caused by damage to any one of the twelve thoracic vertebrae. These 12 vertebrae connect to one another by a facet joint or Z-joint. Each vertebrae has connections above and below, as well as to a rib. The rib connects to the vertebral body called a costo-vertebral joint as well as the transverse process called the costo-tranverse joint. Each joint is surrounded by a joint capsule & lubricating liquid called synovial fluid, that allows the bones to move smoothly.
All the joints (T1 to T12) need to work in harmony and naturally form a curve, called the thoracic kyphosis. Injury, damage or displacement (in the curve) of any one of these joints can cause a sore upper back.
Arthritis is a progressive condition where the cartilage between your bones degenerate over time. Lubrication from synovial fluid becomes less, the ends of the connecting bones are eroded & less smooth causing jerky spinal movement.
Nerve pain
Your thoracic spine has 12 vertebrae stacked on-top of each other. From T1 to T12 below each vertebra, nerves branch out to form nerve roots. These nerve roots merge and divert to supply and relay messages of sensation from your ribs, upper & middle back to your brain.
These nerves can be scratched or irritated by the surrounding structures as these nerves run out your spine. As the nerve weaves through muscles, ligaments & joints they may become trapped between some of these tissues, essentially pinching the nerve. A pinched nerve in your upper back should be treated promptly to prevent chronic upper back pain.
What causes my Upper back pain?
In order to understand where your upper back pain is coming from, you’d have to determine how you injured it, or if you can remember when it started. Some are outright obvious like a slip on the floor, meanwhile others are subtle and creeps up on you – getting worse day by day. So, it’s easier to establish how your pain started and changed until now. Changes in your upper back pain gives us many clues to understand where your pain is coming from.
Upper back pain usually has to do with your posture and ergonomics (how you sit or work). It often is painful together with the neck , shoulder, ribs or lower back. Muscular pain in the shoulder blade area can be so severe that patient often mistake it for a fracture or even a heart attack as it can restrict your breathing.
Our body consists of various types of tissue, some elastic like tendons, or strong like cables (ligaments), some tissue can generate movement & force like muscles. We rely on your spine’s ligaments to keep our spine stable, muscles coordinate your spine’s movements, and joints are the foundation of our frame. The structures in your thoracic spine is quite vulnerable to injury, especially poor postural positions. There are more than 86 structures in your upper back that can get injured, some problems are more common that others, but just to be safe – we test them all.
Here’s a breakdown of a few conditions that we frequently see, and how things go wrong to cause your upper back pain:
Get to the root of your Thoracic back pain
Different structures, cause different types of upper back pain, although these are not concrete it’s a good guideline to which structure produces what type of pain
- Muscle — Dull ache or stiffness, sharp pain with contraction
- Nerve — Numbness, tingling, weakness, electrical stabbing feeling
- Tendon — Burning pain with certain specific movements, pain comes & goes
- Joints — Cramp, constant stiff feeling, worse after rest, better with movement
- Bone — Constant pain, sharp pain with certain movements
- Cartilage — Sharp pain when at certain point, painful arch of movement
- Ligament — Pain at the end of range, unstable, clicking
- Referral from other joints — Difficult to pinpoint pain, vague painful area
Causes of upper back pain
- Myofascial pain — Irritation, trigger points or spasm of the muscle
- Joint dysfunction — Intervertebral joint, zygapophyseal joint (facet joints)
- Disc — Disc bulge, disc hernia, disc prolapse (very rare)
- Nerve immobility — Usually around C7-T1 and T4 vertebra levels
- Referral — From neck, shoulder, mid-back or lower back
Size – The larger the area of your upper back pain, means it’s worse, because muscles in your upper back stretch from your hip to your rib cage. These large muscle groups tends to guard your spine & spasm to protect the deeper joints. Pain radiates along the thoracic back muscles and affect large areas. However, muscles heal easier & recover faster, but usually a deeper joint is the actual problem.
Area – Upper back pain between your shoulder blades restrictive during walking, while pain in your ribs limits your breathing. If your upper back pain causes you to lean to one side you must be more concerned. Sharp pain over a small area makes it easier to pinpoint structures near your pain. Vague, dull & deep upper back pain can take longer to identify the root cause. Compensatory patterns develop, sometimes it takes a while to just get rid of those.
Swelling – Swelling is your body’s way of healing itself by sending cells to heal the tissue. More swelling could mean more tissue damage, however its very rare to find swelling in your upper back. Injury to tissue that develops over a few weeks doesn’t swell, because the tissue trauma is continuous and repetitive, so your body stops the inflammatory reaction.
Colour – Unless you’ve had a car accident or fall, bruising is very rare over the upper back. Blood vessels rupture on impact, so these capillaries leak plasma,giving you that blue bruise. Blue discoloration always justifies a lung X-ray, just to be safe there’s no rib fractures.
Motion & sore upper back
Stiff – Upper back stiffness followed by pain is regressing and getting worse. Seek help. Pain followed by stiffness is a good sign of tissue healing, specifically scar tissue formation. Scar tissue is hardening wound tissue that tends to shorten and pull on structures surrounding the injured site.
Range of movement – Difficult bending forwards or backwards is a big problem. A painful arch means the structure injured only takes tension over that specific range. If you feel pain only at the end of your range its less severe and easy to fix. When your upper back pain stops movement completely and too painful to move you should definitely come see us as soon as possible.
Monitor over time:
Intensity – When you grade your pain from 0 – 10. You may think it’s not that bad because it’s not that painful. On the contrary, pain intensity is not a sign of how severe your tissue injury is for example, complete ruptures of ligaments are less painful than partial tears. When fibers are stressed while it’s anchors are completely loose, there’s not much pain, but fibers that are partially torn will produce severe upper back pain. People have different pain thresholds, so be careful to ignore your back injury.
Position – Upper back pain while you’re sitting vs standing vs lying. Pain gets worse when you’re sitting means that your sitting position is contributing to your pain. When you’re lying down and your pain eases indicates that your pain is produced by a structure that’s being loaded when you’re up against gravity, meaning a load bearing structure.
Frequency – Pain that’s fleeting or intermittent short burst of pain must not become more frequent and constant. This shows that the tissue damage is not getting any better. Pain that only lasts for a few seconds tend to heal faster, so the longer your pain lasts the faster you should get to us.
Latency – If your pain lags to come on and builds up over the day you must be very cautious. This is a sign of a relapse of your tissue pathology. It’s difficult to judge what makes it worse, because the upper back pain only comes on a few hours after your activity, and not during.
Loading – Pushing through your upper back pain while you are walking, sitting or training is not a good idea. Putting compromised tissue under strain is dangerous. Weight training in particular, loading soft tissue without knowing what it’s able to handle is dangerous & reckless.
Diagnosis of Upper back pain
Our physiotherapists know and understand the intricacy of the anatomy of your upper back. There are many structures to test, and we even consider the complex biomechanics of your spine movements. We’ll accurately diagnose which structures are involved, and to what degree.
During your physiotherapy evaluation, we’ll be stretching & stressing the soft tissue structures like joints, muscles, ligaments, nerves and tendons. This way we can diagnose muscle tears, ligament sprains, joint problems and nerve irritations. We’ll test different aspects like muscle strength, range of motion, flexibility and stability in order to confirm how severe your tissue damage is.
Gathering information through our assessment allows us to make a diagnosis based on your individual injury. Then we’ll customize the treatment to your specific needs. Therefore our physiotherapists are the best at diagnosing upper back pain & thoracic injuries.
The Process of Diagnosis:
There is a misconception that medical practitioners are able to know exactly that’s the problem the moment we see our patients. People tend to point to their back and say, “treat it”. As if we already know what’s the problem by just looking at it. Sorry to disappoint, but unfortunately this is not how it works. Let me explain:
Diagnosis is a process of exclusion, not inclusion. Medical professionals are taught a process of elimination and deduction to identify the most possible diagnosises for your upper back pain. The better you can describe & elaborate on your pain, the better picture you’ll give your Physio to understand what’s happened as well as, what you’re feeling.
The practitioner uses their skills to eliminate diagnosis’s it’s not and zoom in on your problem. This elimination brings us to only a few possibilities to what could be causing your upper back pain. Then we test & assess all our possibilities to get to the root cause of your pain. In many cases your main problem is not at the site of your pain due to compensation, guarding or muscle spasms.
Our professional experience with upper back pain
From our experience most upper back pain conditions are due to incorrect posture, poor ergonomics and incorrect training programs. Generally it can easily be managed with corrective treatment. A simple assessment is that the scapula (shoulder blades) inside edge should be 5-6cm away from the spine. If it is more than that it means there are a lot of scapular muscle and severe strain on your thoracic joints.
This forward slouching position of the scapulae is generally due to working in a bent over position or an exercise program with too much emphasis on the front and not enough on the back musculature. Upper back pain often resolves slower without first addressing the scapula position.
Most common upper back injuries we treat
- Myofascial pain due to scapular muscle weakness or overuse
- Joint dysfunction due to arthritis or locked facet joint (hypomobile joint)
- Postural pain syndromes e.g. postural cross syndrome
- T4 Syndrome (Joint and neural immobility syndrome)
- Degenerative Disc Disease
Can I treat it on my own?
To an extent certain things you do my decrease the intensity of the pain, but a good rule of thumb is that you don’t try to treat without having a good diagnosis.
- Rest from pain inducing activities — Research has shown bed rest doesn’t relieve back pain better than active rest.
- Use a heating pad/bag — An age old modality which many people underestimate. Now ideally a warm swimming pool/Jacuzzi will allow you to move actively while you are applying heat.
- Over the counter medications might decrease the pain. Consult with a medical professional like your pharmacist on the best choice. Remember non-steroidal anti-inflammatories (NSAids) will only help if the pain is of inflammatory origin and not if it is due to mechanical causes.
- Exercise — It goes without question that it needs to be the correct exercise or it might worsen your condition. This makes the corrective exercises prescribed during a physiotherapy appointment very important.
- Postural/Ergonomical correction — Making sure your working surfaces are the correct height and that your sitting position is correct.
- Reducing stress — This may be done by any method, don’t forget that many cognitive therapies can help with control of chronic pain such as those applied by a psychologist with a special interest in chronic pain.
Physiotherapist treatment
We have seen many patients with upper back pain and provide the best possible treatment for a faster recovery. Pain and stiffness preventing you to move and you might feel afraid, or scared you’ll damage it even more. We know you’re anxious about the unknown, so that is why we are here to guide you and give you all the answers.
Your upper back pain treatment will be tailored according to various factors, but just to give you a broad idea, our focus of our treatments are:
- Determine what structures are injured in your upper back
- How bad is it injured?
- Protect it from further injury
- Help accelerate healing
- Re-evaluate to monitor progress
- Change and adapt as you get better
Our team of experts can diagnose, test and treat any kind of upper back pain. We work together to get rid of your pain as fast as possible. We have the best tools, techniques and machines to make sure you get the best value for your money. Our Physios will test a lot of different possibilities why you’re feeling this upper back pain in order to explain what’s going on in your body. It all depends on the results of our tests to determine what needs to be done. All our physios are MSK specialists that can determine the slightest problem coming from your spine, so if you’re uncertain – we can help you.
Our experts determine multiple problems that can be involved, this means that we test movements to see if you may have a muscle imbalance, weakness, instability and much, much more. This is our expertise & what we’re best at. We take on many roles to achieve your goals: Teacher, counsellor, trainer and coach. As a teacher we explain the extent of damage & the intricate details of your upper back pain & how it may affect other problems. As a counsellor & pain expert, we’ll guide you every step of the way.
Upper back pain Treatments we use
- Acute injury treatment
- Ultrasound
- Medications
- Soft tissue massage
- Electrotherapy treatment
- Laser (Low Level Laser Therapy)
- Acupuncture & Dry Needling
- Heat packs (Thermal therapy)
- Kinesiology Tape
- Rigid Strapping or taping
- Neurodynamics (Nerve tissue mobilizations)
- Ridgid Strapping
- Strengthening exercises
- Guided loading protocol
- Stretches (Static, dynamic, and ballistic)
- Moon boot
- Posture correction
- Brace
- Compression Bandage or
- Sleeve
- Supportive strapping and taping
- Biomechanical Analysis
- Gait Analysis
- TENS
Sudden Thoracic back pain
upper back pain is extremely uncomfortable and disrupts the smallest task you must get on with. So, stop the madness. Get your upper back looked at and get all the answers you need. Most upper back pain don’t start after a fall or injury, but usually develops over time. Yes, it’s more obvious in sports injuries, but you’re required to carry on with work even though you have agonizing upper back pain. We know what you’re going through.
If you’re suffering, rather get it checked. Please come visit our your physiotherapists if you are feeling any type of upper back pain. Rather do something about it than wait with your fingers crossed and hope it goes away. If you’re expecting tomorrow will be any different than today. Stop waiting and act.
An accurate diagnosis is vital to manage your pain and treat it appropriately, because what works for one problem rarely works for another. Some conditions can take many months or even years to heal when the diagnosis is incorrect, or treatment is neglected. You could end up spending a lot more time & money to fix your problem later on. So be warned…
How to Stop chronic, daily annoying upper back pain
Without Injections, Without taking Painkillers and
WITHOUT having to wear a Support or Brace…
If you’re living with upper back pain what just won’t go away, they’re painful or they ache – it’s very easy to think that it’s “just something that comes with age”, it’s a bit of “wear and tear”, or that it’s nothing and it’ll go away on its own.
You can’t quite point your finger on why you’re feeling the pain in your upper back – but it doesn’t seem to be getting any better!
If that’s happening to you, you’re not alone – we hear this type of thing all the time. In fact, upper back pain is one of the most common problems that we see in our Physio practice. When it comes to living with upper back pain, everybody we see wants to know the answers to these questions:
Why am I still suffering with upper back pain that keeps getting worse
Most people think that when they get upper back pain, it’ll eventually “ease off” and go away on it’s own. That they’ll wake up one morning and like “magic”, your back pain will be a thing of the past… But 3 months later you’re still living with the annoying upper back pain, often even worse than it was at the start. Does that sound like you?
Another scenario we see all the time in our physiotherapy practice is when people go to their Doctors, and the well-meaning Doctor tells them to “rest”, “try these painkillers” and “come back in 6 weeks if it’s no better” – but then 6 weeks later, they end up going back to the same Doctor again because it hasn’t got any better, only to be given ANOTHER prescription of even stronger pills, and maybe a back brace.
Has this ever happened to you?
Maybe you’re confused because you’ve been told different things, by different people. Maybe you think you have to rest because you’ve been told walking makes upper back pain worse, or that you should be doing ‘this exercise’ and ‘that exercise’ to make it better. It’s very confusing to know exactly what to do – and that’s just to avoid making your upper back pain worse, not to mention getting back to jogging and all the other things you love to do.
And because of this confusion – this often leads people to procrastinate, and put off making a decision about what to do to help fix their upper back pain. Worse, many people just end up accepting it as “part of life” – as if it’s normal, as if it “has” to be that way. Is this how you feel?
We are here to tell you – this is NOT what you deserve. You are made for great things, your back pain is just a bump in the road. Make a decision to help yourself be better.
Why is your upper back pain lasting longer than it should?
Does this sound like you?
If any of these have happened to you – we would love to help you. The fact that you’ve tried any or all of these things already is actually a good thing, because when you know what doesn’t work – you are closer to finding the thing that does!
We invite you to come and see us. Why? Because we do things differently. We’ll do a thorough assessment and test all the possible causes. After we’ve diagnosed your problem, and explained what it’s going to need to heal, we’ll make sure you understand why this is happening.
If you’re looking for solid advice on how to start solving your problem, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make the right decision about what to do next.
What you can do to get rid of your upper back pain quickly?
Ask our knee experts
If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-free “Call me back” phone call.
Note: This Free Call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.
Choose to see a Cilliers & Swart Physiotherapist to help you Get rid of your upper back pain – in the next few days?
What can we do for you?
In short, our Team at Cilliers & Swart Physio help you get back to living life free from upper back pain. For information about costs and availability, click the button below:
Why am I still suffering with upper back pain that keeps getting worse
Most people think that when they get upper back pain, it’ll eventually “ease off” and go away on it’s own. That they’ll wake up one morning and like “magic”, your back pain will be a thing of the past… But 3 months later you’re still living with the annoying upper back pain, often even worse than it was at the start. Does that sound like you?
Another scenario we see all the time in our physiotherapy practice is when people go to their Doctors, and the well-meaning Doctor tells them to “rest”, “try these painkillers” and “come back in 6 weeks if it’s no better” – but then 6 weeks later, they end up going back to the same Doctor again because it hasn’t got any better, only to be given ANOTHER prescription of even stronger pills, and maybe a back brace.
Has this ever happened to you?
Maybe you’re confused because you’ve been told different things, by different people. Maybe you think you have to rest because you’ve been told walking makes upper back pain worse, or that you should be doing ‘this exercise’ and ‘that exercise’ to make it better. It’s very confusing to know exactly what to do – and that’s just to avoid making your upper back pain worse, not to mention getting back to jogging and all the other things you love to do.
And because of this confusion – this often leads people to procrastinate, and put off making a decision about what to do to help fix their upper back pain. Worse, many people just end up accepting it as “part of life” – as if it’s normal, as if it “has” to be that way. Is this how you feel?
We are here to tell you – this is NOT what you deserve. You are made for great things, your back pain is just a bump in the road. Make a decision to help yourself be better.
Why is your upper back pain lasting longer than it should?
Does this sound like you?
If any of these have happened to you – we would love to help you. The fact that you’ve tried any or all of these things already is actually a good thing, because when you know what doesn’t work – you are closer to finding the thing that does!
We invite you to come and see us. Why? Because we do things differently. We’ll do a thorough assessment and test all the possible causes. After we’ve diagnosed your problem, and explained what it’s going to need to heal, we’ll make sure you understand why this is happening.
If you’re looking for solid advice on how to start solving your problem, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make the right decision about what to do next.
What you can do to get rid of your upper back pain quickly?
Ask our back experts
If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-free “Call me back” phone call.
Note: This Free Call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.
Choose to see a Cilliers & Swart Physiotherapist to help you Get rid of your upper back pain – in the next few days?
What can we do for you?
In short, our Team at Cilliers & Swart Physio help you get back to living life free from upper back pain. For information about costs and availability, click the button below:
What your patients say:
This was my first time visiting a physiotherapist. I received very professional service from everyone involved and can definitely recommend this practice to anyone struggling with upper back pain.
M Snyman
I visited Cilliers & Swart after a lot of upper back pains and several body pains. Marlene was patient enough to investigate and determine the problem and after two sessions, my pain was gone.
A Lanse van Rensburg
Been to Carli for a check up and she’s amazing! She explains all procedures and questions in detail on a level most people will be able to understand. I’d recommend her any day.
M Smit
The treatment I received was outstanding, Carli saw me on time and offered very professional and helpful treatment. My follow up treatment with Marlene was equally fantastic. Very impressed.
L Modise
The best physiotherapist in the East of Pretoria. Excellent service and the best advise.
S Snyman
My upper back was killing me – it was agony! Sooo impressed with them. Didn’t really know what to expect, but they were so nice to explain everything. I had excellent results from my visits and highly recommend them.
J Mahlangu
