Upper Back Pain

This article was written, reviewed and contributed to by some of Australia’s leading experts in the field of pain and upper back pain. Our goal is to empower you to better understand what’s causing your upper back pain and alleviate any concerns or worries you may have.

If you have been dealing with this issue for a long time, we hope to provide you with some new information that may help you on your road to recovery.

Included below is a practical and actionable plan, backed by the latest medical research to treat your upper back pain (including things you can do from home) and help you get back feeling your best.

Read on as we guide you to understand the different types of upper back pain and discover what type you may have.

What is Upper Back Pain?

Upper back pain is a term used for describing conditions or issues that lead to discomfort between the base of the neck and the thoracic spine (ribcage area). Injuries to structures, such as muscles, joints and ligaments can lead to upper back pain.

According to the Australian Institute of Health and Welfare, upper back pain is categorised as Australia’s second leading burden of disease and affects 4 million people.[1] Australian research from the National Health and Medicine Research Council also found that women were more likely to develop upper back pain.[2] Factors which may contribute to this finding include posture, body shape and hormonal differences.

Some people with upper back pain can also experience rib and chest pain. This phenomenon is known as ‘referred pain’ and is associated with the shared nerves of structures, including the thoracic spine, ribs and muscles.

Pain is categorised as either acute, subacute or chronic back pain

Acute upper back pain: (0 days - 6 weeks)

Acute upper back pain is pain that lasts anywhere from a few days, up to six weeks. The cause of acute upper back pain is usually related to minor injuries, like muscle strains or ligament sprains. Of course, not all pain has to have damage, sometimes we may just sleep awkwardly or do something else that may flare up pain without any structural damage. This type of pain usually resolves itself with movement and the appropriate rest.

Subacute upper back pain: (6 weeks - 3 months)

Sub-acute upper back pain usually results from acute pain that doesn’t resolve itself. This can be due to a more serious injury, or sometimes a poor recovery. If you are still aggravating your upper back pain with painful movements then it may take longer to heal and recover.

Chronic upper back pain: (3 months +)

Chronic upper back pain is any pain that lingers beyond the three-month period. Usually more difficult to resolve, this type of pain can occur and usually does have multiple causes, such as other underlying health issues or other injuries that compound the problem. Other potential causes of chronic pain are lifestyle factors that slow down recovery like chronic stress and lack of sleep.

What are the symptoms of upper back pain?

Upper back pain is the primary symptom that can be the result of various types of physical conditions. Symptoms vary from mild pain, described as a dull ache right through to sharp and stabbing pain. Upper back pain that is new or lasts a relatively short time is called acute, and pain lasting three months or longer is considered chronic.

Common complaints of pain in the upper back

• Muscle spasm

• Muscle tightness

• Easy fatigability

• Headache

• Tenderness to touch

• Radiating pain to the arms

• Numbness of the arms

• Pain (aching, sharp or burning)

• Right sided upper back pain

• Left sided upper back pain

People may experience

Pain areas: in the upper back, neck or shoulders

Sensory: headaches, pins and needles

Also common: back joint dysfunction or muscle spasms

What causes upper back pain?

Upper back pain is usually caused by poor posture and a lack of movement,particularly during the workday. Other causes of upper back pain include muscle strains, poor lifting techniques, or more serious medical conditions like osteoarthritis.

According to Spine Health, upper back pain is defined as “pain originating from the upper back, middle back, or mid-back. With almost 90% of people expected to have some form of back pain during their lifetime, we know this is a huge problem”.[3]

Upper back pain can result from a problem in one or several parts of the upper back, including:

• Muscles (strain)

• Ligaments (sprain)

• Nerves

• Bone injuries - in the upper back, the bones are referred to as vertebrae

• Discs - the shock absorbers between each vertebra

Common reasons why people experience pain in the upper back:

• Strain or injury to the spine

• Poor posture

• Myofascial pain

• Prolonged computer work

• Sitting for long periods

• Arthritic or inflammatory issues

• Sporting injuries

• Excessive coughing

• Obesity.

Common injuries that cause upper back pain

Muscle Strain

Tears to the muscles around the upper back are common during heavy lifting or with repetitive motion of the shoulder. Rhomboid pain is the most common injury in the upper back.

Osteoarthritis

Osteoarthritis is a natural wear and tear process of the body as we get older. The spinal vertebrae lose their protective cartilages, which can cause swelling and pain.

Herniated Disc

Herniated or bulging discs can occur when the spinal disc goes out of its place and puts pressure on the nerves around the spine. Constant bending of the head and neck together with improper posture increases the risk of disc herniation.

Myofascial Pain Syndrome

This is a complex pain problem in the connective tissues of the back muscles. Certain areas of your back muscles can become sensitive to pressure causing pain and discomfort.

Fractures

Fractures are usually quite rare but typically occur in more serious accidents, like motor vehicle accidents or falls from significant heights. Compression fractures can also occur in the elderly due to osteoporosis, in which the vertebra becomes weak and unable to support the weight above it.

Common conditions that cause upper back pain

Several conditions may cause upper back pain, including:

• Scoliosis

• Fibromyalgia

• Thoracic kyphosis

• Spinal stenosis

• Spinal infection.

Sports that increase the risk of upper back pain

Upper back pain also occurs as a result of intense physical activities such as sports.

Here is a list of the most common sports that cause upper back pain:

• Gymnastics

• Tennis

• Golf

• Competitive weightlifting

• Swimming

Other risk factors

Upper back pain can happen to anyone, even people who are young and healthy. However, these risk factors generally increase your likelihood of getting upper back pain:

• Age - The risk of upper back pain generally increases with age, becoming common as you approach 30+ years of age.

• Lack of exercise - When muscles aren’t used, they become weak and stiff and can lead to upper back pain.

• Excess weight - Excess body weight will put extra stress on your back.

• Improper lifting - Poor lifting can cause problems in both your upper back and lower back.

• Smoking - Smoking has been shown to increase the rate of back pain. The cause of this isn’t 100% clear, but safe to say, we all know smoking is just all-round not good for us!

How is upper back pain diagnosed?

There are several options available when it comes to diagnosing the underlying cause of your upper back pain. One of the most common options, and one that is most recommended by Australian GP’s, is a physiotherapist assessment.

Physiotherapists are highly specialised medical professionals that deal with pain and other spinal concerns. A physiotherapy assessment is simple yet comprehensive.

Like visiting a GP, your assessment will start with your physiotherapist asking you vital questions about your health. This is referred to as consultation. Your consultation will last for about 30 to 60 minutes. Take this time to discuss relevant issues relating to your ankle.

After establishing the background of your condition, your physiotherapist will perform specific physical tests to determine the best possible root cause of your problem and rule out other conditions.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on your condition.

From here, your physiotherapist will give you the details of your treatment program; this will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Timeline for your full recovery.

How is upper back pain treated?

When upper back pain stops you from doing the things you love, it is time to take action and get some help. It is important to address the underlying causes of your pain to prevent worsening of your condition.

There are several options when it comes to treating upper back pain. One of the more common treatment options that is referred to by Australian GP’s is physiotherapy.

Upper back pain is an injury that physiotherapists come across regularly, and the process of treating it is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

A combination of manual therapy, modalities, and specific movement exercises will be given to you by your physiotherapist. Physiotherapists are experts in dealing with pain and musculoskeletal conditions.

Depending on the severity of your upper back pain, the physiotherapist may provide you with a combination of the following types of treatments:

• Manual therapy - Hands-on physio, useful in reducing pain and increasing range of motion.

• Specific exercises - Specific exercises tailored to improve your upper back pain

• Advice and education - Speaking to a qualified physiotherapist is helpful in learning what to do when it comes to upper back pain.

• Therapeutic massage - A hands-on-technique, primarily used to reduce muscle tension.

• Heat and electrotherapy - Used to reduce tension and pain in acute situations

• Soft tissue and joint mobilisation - Specific joint mobilisations are used to reduce stiffness in certain areas of the upper back.

• Stretching - Stretching will help lengthen muscles and increase range of motion

• Dry needling - A technique used to help alleviate pain and reduce muscle tension

Next step: Creating a treatment plan made for you.

Following your initial appointment, the physiotherapist will craft a tailored treatment plan that will highlight the course of action required. This will include what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.

Self-care strategies

If you think you have issues causing upper back pain, here are the best things you can do from home and avoid.

Things to do:

• Maintain proper posture

Maintain a proper posture as much as you can. It decreases the amount of pressure on the spine when you do an activity while sitting or standing.

• Stretching the back muscles

Stretching your back can reduce tension in the muscles and decrease your pain. You can also try yoga and tai chi for a combined relaxation and lengthening effect.

Your physiotherapist will also provide appropriate stretching exercises depending on your condition.

• Relaxation / Massage - Gentle massage on your back muscles may help decrease muscle spasms and pain. Try to relax and know that you are in control of your body. Often, pain causes more stress, but stress also increases the pain resulting in a cycle.

• Apply hot compress or shower with warm water - Heat can increase the blood flow to the area and relax your back muscles. This reduces muscle spasms and may relieve your pain.

Things to avoid:

• Avoid activities that worsen the pain: If you feel back pain, take a rest and let the symptoms subside. If you are working on a computer, be sure to take frequent rest in between and practice proper posture.

Do I need a specialist or surgery?

Depending on your symptoms and severity of the condition, you might be required to have diagnostic imaging such as an X-ray or MRI to check the spinal structures. Severe cases such as spinal fractures may require surgery.

Most cases of musculoskeletal conditions can be treated with conservative management such as physiotherapy.

If your GP determines that your upper back pain is manageable with conservative treatment, they may coordinate with your physiotherapist to provide you with proper treatment.

What is the recovery time / prognosis for upper back pain?

Recovery time depends on the root cause of your back pain. Back pain caused by a muscle strain and injury can have a complete recovery between two to six weeks. In comparison, injuries to the spinal ligaments, disc, or fractures can take longer than 12 weeks.

Physiotherapy generally leads to a good outcome and faster recovery.

Important factors in your recovery post-treatment:

• Sticking to the treatment plan provided by your physiotherapist

• Resuming your sports activity when ready, not too early

• Listening to your body and taking it easy when required.

Other factors that may influence your recovery time:

• Age

• Severity of injury

• Lifestyle

• Lack of exercise

• Excess weight/

Can pain in the upper back be prevented?

Guaranteeing prevention can be impossible, however, you can decrease the risk of upper back pain through some of these techniques:

• Exercise - Building strong core and back muscles through regular strengthening exercise can help you stabilise the spine and prevent pain.

• Practice good posture - Being mindful of how you sit and stand can be very beneficial. An optimised posture decreases the stress on the spine and other joints, thus preventing pain and improving overall well-being. Try to keep your ears, shoulders, and hips aligned during your activities. Avoid slouching or sticking your neck forward for a prolonged time.

• Avoid smoking - Smoking decreases the blood flow in your muscles and tissues by restricting the blood vessels. When this happens, your muscles and vital tissues cannot get enough nutrients to support healing.

• Walking - Walking is a great way to relieve back pain. It encourages movements of the joints and weight-bearing of the spinal bones, which stimulate tissue repair. It also strengthens the bones and muscles around your spine.

Outlook and the main takeaways

There are many causes, types, and severities of upper back pain, and the most important thing you can do is act upon your pain signals and start working towards an outcome! Book a time, and have your upper back pain diagnosed by a physiotherapist today.

Anatomy of the upper back (thoracic spine)

Your spine consists of 24 separate bones called the vertebrae, together with five fused bones on the lower part of the spine, the sacrum, and four fused vertebrae of the coccyx.

• 7 Cervical Vertebrae (Neck and Upper Back)

• 12 Thoracic Vertebrae (Mid Back)

• 5 Lumbar Vertebrae (Low Back)

Your upper back muscles consist of the following significant muscles:

• Trapezius - This is the muscle that extends to your neck, shoulders and upper back.

• Latissimus dorsi - This is a large muscle that extends all the way to the upper and lower back.

• Rhomboids - This muscle is located near the trapezius and primarily acts on the shoulder.