Upper Back Pain Causes
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
The vast majority of cases of upper back pain are due to
one (or both) of the following causes:
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
injuries (such as repetitive motions).
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
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
Pain medications can also be helpful.
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 to help
mobilize the joint and reduce the discomfort.
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.
Injections (e.g. epidural steroid injections) are usually
not warranted for thoracic pain other than local trigger
Uncommon Causes of Upper
Because there is little motion and a great deal of stability
throughout the thoracic spine, it does not tend to develop
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