Upper Back Pain

Upper Back Pain

Working From Home Thoracic Spine Pain

Pain of the upper back – particularly between the shoulder blades – can be a tricky problem to get on top of. With the recent advent of working-from-home, combined with the closure of gyms, our upper backs have not had much luck through 2021. Pain localised through the thoracic spine is one of the main reasons people come to see us. Often they report an insidious pain that has come on gradually over many years. They have tried pushing, pulling, cracking, rolling and stretching to no avail.

The causes of mid-back pain

The thoracic spine has many structures that can be the cause of pain. The 12 thoracic vertebra have many articulations and provide the attachment site for the ribs. The muscles that control both shoulder stability and motion attach around the thoracic spine, scapula and ribs. Importantly, the thoracic spine provides structure and protection for the chest cavity.

Usually pain in this region occurs in the muscles above and between the shoulder blades. This can be a result of the muscles themselves being the cause, the muscles responding to postural load, or the muscles being sore from a referred source of pain – often higher up in the neck.

Signs and symptoms of upper back pain

Our patients often present with upper back pain, usually one-sided in the muscles between the shoulder blades. Often they report that the pain has been on and off for years! Most commonly these pains are aggravated by prolonged sitting and computer work. This has certainly been the case through lockdown, as people have taken to working from their dining tables and lounges.

Sometimes our patients report that the pain has been exacerbated by some upper body movements. Exercises like chin ups, dips and kettlebell swings – while generally not harmful to the upper back – can put certain muscles and nerve tissue in irritated or stretched positions that can exacerbate upper back pain. The result can be spasming muscles in the upper back that can make movement, coughing or even deep breathing uncomfortable.

So what’s the solution?

In most of our patients, pushing, pulling and cracking the upper back has generally failed to fix the problem. It isn’t uncommon for us to see patients who are bruised from trying to trigger-ball the pain away.

Accurately identifying the irritated structures, movements and positions that are contributing to the pain is the most important place to start. For upper back pain that is being impacted by neck positions, the use of mobilisation, stretches and range of motion exercises are a great place to start. Massage and mobilisation of the upper back are often really helpful; but we usually stress to patients that more and more pushing and pulling on the upper back is rarely the answer.

Physio exercises for upper back pain

Mobilisation of the cervical spine and upper thoracic spine can be a great way to encourage the joints to move. From here we want to encourage movement with large, gentle exercises. This often involves big rotational movements like:

  • Extension over a foam roller
  • Chest-opening movements in side-lying
  • Thread the needle

And if possible, strengthening exercises that promote hard work in the muscles of the upper back, while also helping to strengthen the postural muscles. For this, we love using:

  • Banded rows
  • Single arm rows with dumbbells and kettlebells
  • TRX suspension trainer rowing
  • Upright rows
  • Overhead pressing

And while it seems like a non-specific approach, any general movement and exercise that gets the upper back and neck moving away from the computer should help. Hopefully now that gyms are open and sport is back up and running, our patients will be able to get back to all the good movements that keep their necks and backs happy and healthy.

If you have persistent upper back pain, come and see our physios at the Movement Centre in Randwick. We will help you come to a clear diagnosis, and explain strategies for you to get to the bottom of it.

Disclaimer: The Movement Centre provides this information as an educational service. The information contained on this website and in this blog is not intended to serve as or replace actual medical advice. Anyone seeking specific advice or assistance should consult their local Randwick Physio, general practitioner, medical specialist, or otherwise appropriately skilled practitioner.