Upper Back
Pain Causes
Upper back pain can
occur as a result of
trauma or sudden
injury, or it can
occur through strain
or poor posture over
time. As an example
of the latter cause,
in recent years,
upper back pain has
become a familiar
complaint from people
who work at computers
most of the day.
Often, upper back
pain occurs along
with neck pain and/or
shoulder pain.
The vast majority of
cases of upper back
pain are due to one
(or both) of the
following causes:
Muscular
irritation causing
upper back pain
The shoulder girdle
attaches by large
muscles to the
scapula (the shoulder
blade) and the back
of the thoracic rib
cage. These large
upper back muscles
are prone to
developing irritation
(myofascial pain)
that can be painful
and difficult to work
out.
Often, muscular
irritation and upper
back pain is due to
either
de-conditioning (lack
of strength) or
overuse injuries
(such as repetitive
motions). Muscle
strains, sports
injuries, auto
accidents, or other
injuries can all
result in pain from
muscular irritation.
This type of Upper
Back Pain is most
amenable to manual
treatments, such as:
-
Exercise/Active
and passive
physical therapy
-
Chiropractic or
osteopathic
manipulation
-
Deep massage or
massage therapy
-
Acupuncture
Because the upper
back pain is related
to large muscles in
the shoulder area,
most rehabilitation
programs will include
a great deal of
stretching and
strengthening
exercises.
A conservative care
specialist such as an
osteopathic
physician, a
physiatrist/physical
medicine and
rehabilitation
physician, or a
chiropractor would be
appropriate to see
for treatment of
upper back pain.
If there is a
specific area that is
very tender, the
source of the upper
back pain may be an
active “trigger
point”. Trigger
points are usually
located in a skeletal
muscle and can be
worked on by either
one or a combination
of the following
treatments:
Pain medications can
also be helpful.
Muscular irritation
usually includes some
form of inflammation,
so anti-inflammatory
medications (such as
ibuprofen or COX-2
inhibitors) can be
helpful to reduce the
inflammation.
Joint dysfunction
causing upper back
pain
The ribs connect with
the vertebrae in the
thoracic spine by two
joints that connect
with each side of the
spine. Dysfunction in
these joints can
result in upper back
pain.
Treatment for this
type of injury
usually includes
manual manipulation
(with an osteopathic
physician,
chiropractor or a
physical therapist
trained in
manipulation) to help
mobilize the joint
and reduce the
discomfort. Lasting
relief usually also
requires a home
exercise program for
stretching the spine
and shoulders as well
as strengthening.
Aerobic conditioning
is also very
important to maintain
sustained upper back
pain relief.
In addition to manual
treatments, pain
medications can help.
Usually the most
helpful medications
are the
anti-inflammatory
medications (such as
ibuprofen or COX-2
inhibitors), as the
joint dysfunction can
create inflammation.
If you have tried
these treatments and
still suffer from
upper back pain, then
back
surgery
may be right for you.
Injections (e.g.
epidural steroid
injections) are
usually not warranted
for thoracic pain
other than local
trigger point
injection.
Uncommon causes of
upper back pain
Because there is
little motion and a
great deal of
stability throughout
the thoracic spine,
it does not tend to
develop disc
herniations, spinal
stenosis,
degenerative disc
disease, or
instability (e.g.
spondylolisthesis).
As an example, only
about 1% of all disc
herniations occur in
the thoracic spine.
The vast majority of
disc herniations
occur in the lumber
spine, where there is
a lot of motion.
Rarely, upper back
pain can be caused by
thoracic disc
disease—such as a
degenerated disc or
herniated disc. A
correct diagnosis of
thoracic disc disease
or injury requires
diagnostic tests
(such as an MRI scan)
and correlation with
physical symptoms.
Additionally,
significant impact or
trauma to the spine
can result in a
fracture of the
thoracic vertebrae.
If this happens, a
physician needs to be
consulted immediately
and diagnostic tests
(such as an X-ray or
MRI scan) are
required to determine
the extent of the
damage and develop a
treatment plan.
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