Upper Back Pain
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.