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 (myofascial pain)
- Joint dysfunction
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
- Massage therapy
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 (nonsurgical) 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:
- Massage therapy
- Trigger point injections with a local anesthetic (such as Lidocaine).
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.
Injections (e.g. epidural steroid injections) are usually not warranted for thoracic pain other than local trigger point injection.
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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.