Checkout
Before and After Photos

Upper Back Pain Information

While upper back pain isn't very common, when developed, pain and discomfort do occur. The most common causes of upper back pain are joint dysfunction and muscle irritation. Injuries to a disc (such as a degenerated disc) in the upper back are also possible, although they are very rare.

It's important to know that the thoracic spine (upper back or middle back) is not the same as the cervical spine (the neck) or the lumbar spine (the lower back). The thoracic spine is designed to be strong and stable, which allows us to stand upright and protect vital organs in our chest. The neck and lower back are designed to provide us with mobility. Because the upper back is so stable, there is little risk of injury or degeneration over time.

Anatomy of the Upper Back

"Thoracic" means relating to the chest. The thoracic spine (upper back) is the part of the spinal column that corresponds to the chest area.

• The twelve vertebrae in the middle of the spine with ribs attached make up the thoracic spine.
• Every vertebra in the thoracic spine connects to a rib on both sides, and at every level. These meet the front and attach to the sternum (breastbone). This creates the thoracic cage, which provides protection for vital organs (heart, lungs, live) and creates a cavity so the lungs can expand and contract.
• The upper nine ribs start at the spine, curve around and then join at the front of the chest. These ribs allow very limited motion, as they are attached firmly at the back (at the spine) and the front (at the sternum).
• The three lower ribs allow slightly more motion while still protecting vital organs, but they do not join together at the front.

Since there is little motion and a lot of stability in the upper back, spinal disorders are not commonly developed here. While disorders such as a herniated disc or degenerative disc disease can cause upper back pain, they are very rare in the upper back. As a result of the stability, generally anatomic causes of upper back pain are not found.

Causes of Upper Back Pain

Pain to the upper back can occur as a result of trauma or sudden injury, or through strain or poor posture over time. Usually, upper back pain is accompanied by neck and/or shoulder pain.

Most upper back pain cases are due to one or both of the following: muscular irritation or joint dysfunction.

Muscular Irritation and Upper Back Pain

Large muscles attach the shoulder girdle to the scapula (should blade) and the back of the thoracic rib cage. These large upper back muscles can develop irritation (myofascial pain) that can be painful and difficult to fix.

Usually, upper back pain and muscle irritation is a result of de-condition (lack of strength) or overuse injuries (repetitive motions). Straining a muscle, a sport injury, auto accident, or a number of other things can result in pain from muscle irritation.

This type of upper back pain responds well to manual treatments, such as:

• Exercise
• Physical therapy
• Osteopathic or chiropractic manipulation
• Massage therapy
• Acupuncture

Because pain to the upper back involves large muscles, most rehabilitation programs will involve a lot of stretching and strengthening exercises.

For specific, very tender areas, the source of the pain may be an active "trigger point". These are usually located in a skeletal muscle and can be worked on by either one or a combination of the following treatments:

• Massage therapy
• Acupuncture
• Trigger point injections with a local anesthetic

Medications for pain might also be helpful. Inflammation is usually an occurrence with muscle irritation, so anti-inflammatory medication can be helpful to reduce the inflammation.

Joint Dysfunction and Upper Back Pain

The ribs are connected to the vertebrae in the upper back by two joints that connect with each side of the spine. Dysfunction in these joints can result in pain in the upper back.

Treating this type of injury generally involves manual manipulation (with a chiropractor, osteopathic physician, or physical therapist trained in manipulation) to help mobilize the joint and reduce discomfort. Keeping the relief usually also requires a home exercise program that involves stretching the spine and shoulders, as well as strengthening them.

Pain medications can also help. Anti-inflammatory medications are usually very helpful, as joint dysfunction can cause inflammation.