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Understanding and Treating Upper Back Pain: A Guide

Upper back aka Thoracic pain is not very common.  This area of the spine (thoracic) is more stable than the cervical spine above or lumbar spine below and therefore, it tends not to break down as easily. One key distinction of the thoracic spine are the ribs which attach to each of the vertebrae.  This creates a “cage” for our vital organs and provides stability to the region.  That said, the thoracic spine IS a common area to develop stiffness.  Even though pain in the thoracic region is not common, it does contribute quite a bit to the problems we see in the neck, shoulders, and lower back.  Mobility problems of the thoracic spine lead to poor mechanics and the neck, shoulder, and back which increases the chance of developing pain in these regions.

It is important to know that pain in the upper back and shoulder blade (scapula) region is often referred pain meaning that the source is elsewhere.  The neck often refers back to the upper back and in between the shoulder blades.  The shoulder can refer pain here, too.   Muscles and joints of the upper back can be sources of pain (see Muscle & Joint Pain page).  In addition to those, here are some thoracic conditions that physical therapy can help you with:

Disc Bulge or Herniation- The intervertebral discs of the spine provide shock absorption and stability throughout the neck, upper back, and lower back.   The disc has two basic components; the nucleus pulposus which is a gel-like substance and the annulus fibrosus which is a rubber-like substance.  Acute or repetitive trauma of the neck can cause the rubber-like part of the disc to crack like a used tire which results in the gel-like nucleus of the disc to “bulge” or herniate through the annulus.  There are 4 types of disc herniations which can result in varying levels of pain or dysfunction.  Disc herniations in the the thoracic spine are very rare.

Rib dysfunction – As mentioned, the ribs attach to the thoracic spine.  There are 12 vertebrae in the thoracic spine and thus 12 pairs of ribs (one attaching on each side of the vertebrae).  Rib pain is typically caused by a traumatic event such as a motor vehicle accident, sports injury, or fall.  This can lead to a rib fracture or “dysfunction” where the rib moves slightly out of place and gets “stuck.”  This shift of the rib leads to pain and difficulty with breathing as well as movements of the spine.  Other problems with thoracic and rib pain or mobility comes from poor breathing habits, poor sitting or sleeping posture, or asymmetrical activities that we do in our daily lives.

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Common Causes of Upper Back Pain

Upper back pain, also known as thoracic pain, can arise from various sources, often stemming from issues within the spine itself or referred pain from surrounding areas. While less frequent than lower back or neck pain, thoracic discomfort can significantly impact daily activities and overall well-being.

Key contributors to upper back pain include disc bulges or herniations within the thoracic spine, though these are relatively rare. More commonly, pain can be linked to rib dysfunction, where the ribs become misaligned or restricted in their movement. Traumatic events like car accidents, sports injuries, or falls can directly cause rib pain. Additionally, lifestyle factors such as poor breathing habits, prolonged poor posture during sitting or sleeping, and asymmetrical daily activities can lead to thoracic discomfort and mobility problems.

Understanding Thoracic Disc Herniation

Thoracic disc herniation occurs when the soft, gel-like center of an intervertebral disc in the upper back protrudes through its tougher exterior, potentially pressing on nearby nerves. While these injuries are uncommon in the thoracic region compared to the cervical or lumbar spine, they can still be a source of significant pain and neurological symptoms.

The rarity of thoracic disc herniations is often attributed to the protective nature of the rib cage and the relatively lower mobility of the thoracic spine. However, when they do occur, symptoms can include localized pain in the upper back, radiating pain into the chest or abdomen, and in severe cases, numbness, tingling, or weakness in the extremities. Diagnosis typically involves imaging techniques like MRI to visualize the disc and surrounding structures.

The Role of Rib Dysfunction in Upper Back Pain

Rib dysfunction is a frequent, yet often overlooked, cause of upper back pain. This condition involves restricted movement or misalignment of the ribs within the thoracic cage, which can lead to localized pain, stiffness, and a feeling of tightness in the upper back and chest area.

Rib pain or dysfunction can manifest due to various factors, including acute injuries from impacts or falls, repetitive strain from certain activities, or even chronic issues related to poor posture and inefficient breathing patterns. When ribs are not moving optimally, it can also affect the mechanics of the thoracic spine, leading to compensatory strain in adjacent areas and potentially contributing to neck and shoulder pain.

How Physical Therapy Addresses Upper Back Pain

Physical therapy plays a crucial role in diagnosing and treating the multifaceted causes of upper back pain. Through a comprehensive assessment, physical therapists can identify the root of the problem, whether it's related to spinal mechanics, rib mobility, muscle imbalances, or postural habits, and develop a personalized treatment plan.

Treatment strategies commonly employed in physical therapy for upper back pain include manual therapy techniques to restore joint mobility and soft tissue mobilization to release tight muscles. Exercise programs are designed to strengthen weakened muscles, improve posture, and increase the flexibility and stability of the thoracic spine and surrounding areas. Therapists also educate patients on proper body mechanics, ergonomic adjustments, and breathing exercises to prevent recurrence and promote long-term relief.