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Upper Back Pain

Upper back pain is pain in the upper thoracic spine from the low neck down to mid shoulder blade level with potential to radiate across the back and into the arms. It is a common occurrence especially with neck pain secondary to poor posture and work positions.

Upper back pain is less common than low back pain or neck pain but can be severe and disabling in some cases. Due to the likelihood that structures may be affected more on one side than another it is common to have left upper back pain or right upper back pain, with shoulder pain and upper back pain often going together due to neck involvement.

Upper back pain symptoms can vary considerably, giving what feels like upper back muscle pain, upper back pain left side or upper back pain between shoulder blades.

Further resources about upper back pain can be accessed at Wikipedia and Spine-Health.


The Upper Back

The upper back is variously defined but I have defined it from the lower neck and thoracic junction (the cervico-thoracic junction, the C7/T1 junction) down the the mid shoulder blade area around the T6 level. Lower than this and above the lumbar spine I have classified as the middle back area or mid-back and the pain problems are described in middle back pain.

The thoracic spine is different from the spine in the neck and low back pain in that these areas are specialised for movement but the thoracic spine is much less mobile to protect the heart and lungs inside which would not react well to being squashed. The thoracic spine has limited forward and backward movement but good rotation, giving it a degree of stability.

The thoracic area has narrow and stable discs and disc degeneration is uncommon and disc prolapses very rare indeed and give serious symptoms when they occur. The spine in this area has the facet joints on each side but also has at each level the joints where the ribs connect to the spine at the back which can also be a source of pain. The ribs go round the front and mostly connect to the sternum, although the lower ones connect via the rib cartilages.

There are 12 thoracic vertebrae with the ribs making up the rib cage with the spine looking convex from the side, known as the thoracic kyphosis. This kyphosis can be exaggerated in cases of scoliosis, ankylosing spondylitis, degenerative changes and osteoporotic fractures of the vertebrae.

The typical spinal disorders which we see in the neck and lower back are not so prevalent in the upper back due to its stability and lack of movement and most pain is presumed to stem from stresses and strains on the joints, muscles and ligaments.

Upper back pain causes are dealt with in another page and back pain causes are often difficult to establish even with imaging.

Investigations for Upper Back Pain

Due to the much reduced occurrence of degenerative changes and disc prolapses in the upper back region, MRI or X-rays are rarely helpful in that they do not show up anything which could be connected with the pain you are suffering. It is very rare to suffer a nerve root problem equivalent to sciatica in the leg but any severe thoracic pain should always be reported right away to your doctor.

Upper Back Pain Treatment

Neck and upper back pain is relatively easily treated by physical means such as manual therapy from a physiotherapist or other professional, unlike much back pain treatment. Once the assessment has determined the pain and its severity, any loss of range of motion, muscle power or sensibility alterations and the response of the structures to manually applied stresses the treatment options include:

  • Physiotherapy mobilisation or manipulation techniques

  • Acupuncture

  • Exercise prescription – either specific for the upper back to strengthen or stretch out the local muscles or more general exercise such as swimming which can be very effective.

  • Massage

  • Trigger point treatment

The usual painkilling medications as advised by your doctor or pharmacist can also be used.

There are a large number of other potential causes for upper back pain but they are much rarer such as lung pain. If in any doubt about what is going on you should consult your doctor immediately. Kidney pain is usually felt too low down to be involved with upper back pain problems. Upper back pain during pregnancy can be troublesome although sacroiliac pain and lower back pain are more common.


Shoulder Pain

A diagnosis of shoulder pain needs to be considered before the upper back can be established as the cause of a person's pain. A shoulder pain "trapped nerve" problem can give severe pain in the side of the neck, upper back pain, shoulder blade pain and arm pain and be caused by a disc protrusion pressing on one of the neck nerves. Frozen shoulder is another cause of severe pain in this quarter of the body, a condition which is not well understood and which can require significant treatment for frozen shoulder pain relief.

As with upper back pain, a person may have left shoulder pain or right shoulder pain due to the joint and disc changes occurring more strongly on one side than another, which is more common than similar pain on both sides. Shoulder muscle pain is common and is often attributed to a trigger point problem within the muscles, treatable by physiotherapy. In shoulder pain, cancer is a very uncommon cause of shoulder and arm pain but any suspicion of a serious condition should be reported at once to a doctor.

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