Upper and Middle Back Pain

Your guide to upper and mid back pain

Upper back pain is…pain in upper back! Our spine is divided into 3 main areas: the neck (cervical), the middle (thoracic), and the lower (lumbar). So upper back pain can also be known as “Thoracic pain”.

Most people, estimated 60-70% of the population, will complain about their lower back pain at least once in their lives. On the other hand, upper left back pain and upper right back pain can affect up to 20% of the population, which is still a significant number.

There are two main types of upper back pain which are either mechanical or serious pathology. Mechanical upper back pain is the one we’re more familiar with as it’s to do with your muscles, tendons, joints, ligaments, and bone. These tend to be more chronic (long-term) and tend to feel more like a dull ache, muscular tightness and restriction.

On the other hand, the other cause can be due to underlying diseases which can require emergency treatment. But don’t worry! These are rare and if you do experience upper back pain, it’s more likely to be mechanical than serious.

A study has found that mechanical upper back pain is significantly associated with existing musculoskeletal pain, posture, backpacks, age, psychological, and environmental factors. Let’s break this down one by one:

This makes sense as the spine works as a whole. As stated in the previous point, the middle/upper portion of your back is important in linking the neck and lower back. Poor posture is typically described as the head being too far forward, rounded shoulders, and the lack of movement in the thoracic spine. This is sometimes referred to as Upper Cross Syndrome, where the poor posture has caused imbalances in the muscles in the head and upper shoulders. Not doing anything about poor posture, especially not improving the adaptability of your upper back, is a risk factor for upper back pain, especially upper back pain between the shoulder blades, as it unnecessarily stresses the relevant muscles such as the upper trapezius and rhomboid muscles.

Any constant load that is worn for a prolonged period is going to start causing stiffness and aches. Our muscles get engaged when we lift something, like a dumbbell, and consequently relax when we drop it. However, as soon as you wear a weight on your shoulders for a long time, it will cause the upper shoulder muscles to continually contract. When the muscles have reached its capacity to contract, they will start to ache. Eventually, this can even start involving using the shoulder joints to take on the load as the muscles simply get too tired. This can then lead to upper back and neck pain.

Our body will always respond to what we give it. It’s like how people say “You are what you eat”, but it’s also very true for “You are what you MOVE”. This means if you don’t use the parts of your body for a prolonged period, it’s likely going to stiffen up as you’re not providing the necessary nutrition for those joints. A very common area of the body that won’t be used is the upper back. Technology has become such a huge part of our lives and it promotes the positions that are not ideal for the upper back, such as looking down on your phone or sitting down for long periods in front of a computer. As we get older, our body’s ability to adapt gets less so it’s even more important to stay moving! Remember, motion is lotion. Doing upper back pain exercises and stretches for upper back pain can help in improving mobility.

This is a major risk factor for any musculoskeletal condition to become long-term (chronic) and one that tends to be overlooked by the general population. It is very important to note that the part of your brain that deals with how you feel pain is very closely linked to the part that deals with emotion, memories, stress, etc. You may have noticed your pain can get worse at times of emotional stress, and that’s because of this very link. The psychological stress is able to turn off (to a major extent) your own body’s innate system to calm the pain down, what we refer to as “descending inhibition”. In other words, the body is unable to “turn the volume down” for the pain. If you are constantly stressed, then you can definitely say that it’s going to prolong your pain.

One of the main environmental risk factors for upper back pain is the workplace. Remember how we talked about “You are what you move”? There’s two main scenarios at work, one of which is sitting-based and the other involves more lifting. Sitting at your desk for 8 hours a day 5 times a week, especially one that’s not ergonomically set up, promotes a sedentary lifestyle. If you are not moving, the thoracic spine hardly moves and may even begin to adapt to that rounded position you are exposing it to. This tends to lead to upper back tension and ache as the muscles are under constant strain. On the other hand, lifting jobs are a risk factor for upper middle back from constant lifting, however, this tends to affect more of the lower back due to poor lifting mechanics.

• Fractures
• Heart attacks
• Bone cancer
• Gallbladder inflammation
• Inflammatory conditions like Ankylosing Spondylitis or Rheumatoid arthritis

Before anything else, it is important to screen whether your upper back pain is of serious origin or not. The main signs and symptoms to look out for are constant pain that is severe upper back pain and progressive, no relief from bed rest or postural modification, history of trauma, or history of cancer. To be certain, it is always best to get it checked by a physical therapist, like an osteopath.

In most cases where your upper back pain is mechanical, meaning the main symptoms of muscular ache, feeling of restriction, and tightness matches with the risk factors described above, then the best medicine is to begin moving the thoracic spine! Here are a couple effective exercises for upper back pain:

Thread the needle: Place one hand on a wall and flex forward from your hips with your back straight. With the other arm (the “needle”) thread through the “hole” you created. Be mindful of what you’re trying to mobilise as you do this movement which is the upper back (thoracic spine).

Cat-dog: Start on all fours with your hands underneath your shoulder and knees underneath your hips. Begin hunching your mid-back (creating a cat-like position) as high as you can. As you breathe out, sink your mid-back towards the floor. Again, be mindful of what you’re trying to achieve because it will be much more effective with the mind-joint connection.

On top of moving the thoracic spine which addresses the biological side of things, it’s also important to address the risk factors as previously mentioned. For example:

• Take regular breaks during work, especially if it’s sedentary. This also means active rest, which means to move and stretch appropriately.
• Manage your stress through breathing exercises, yoga, cardiovascular exercise, meditation, etc.
• To reduce usage of one-sided bags or excessive backpack wearing times. If not possible, increasing your capacity to adapt by strengthening your back muscles and taking regular breaks is essential.

Osteopaths are able to look after your body by finding out the cause of your upper back pain and kick-start your recovery. They do this by:

• Mobilising the tissues that have become tight and restricted with their hands.
• Acknowledging and tackling your barriers to recovery, from the psychological and social factors.
• Implementing appropriate and tailor-made exercises for your recovery.

Always remember that “Stillness is Illness”, in other words, “Motion is Lotion”!

World Health Organisation. Priority diseases and reasons for inclusion. Ch. 6.24. Low back pain.

Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77. Published 2009 Jun 29. doi:10.1186/1471-2474-10-77

Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77. Published 2009 Jun 29. doi:10.1186/1471-2474-10-77

Physiopedia. Thoracic Back Pain Red Flags. Website: https://www.physio-pedia.com/Thoracic_Back_Pain_Red_Flags