Physical Therapy for Upper Back Pain
Upper Back Pain 101
If you find yourself wondering what is causing the relentless pain or tightness in your upper back, this article is for you. The upper back, like the rest of the spine, is a multi-layered entity. While not technically its own distinct anatomical area, the upper back is often a target for treatment by physical therapists. Understanding the various structures that compose the upper back is an important first step in addressing pain or dysfunction that occurs here. Let’s review these structures and how they may be contributing to your symptoms.
MANY DIFFERENT STRUCTURES COMPOSE THE UPPER BACK
Bones: The upper back might include the last two or three cervical vertebrae of the neck and the first four or five thoracic vertebrae. These vertebrae are stacked atop one another and separated by an intervertebral disc. Small joints called facet joints, created by adjoining vertebrae, allow for the multidirectional movement of the spine.
Nerves: Running through the column created by the stacked vertebrae is the spinal cord which carries sensory and motor information between the brain and the rest of the body. Exiting through small channels or foramina in the vertebral column are spinal nerves that innervate skin, muscles, organs, and other tissues in the arms and trunk.
Ligaments: thick ligaments like the anterior and posterior longitudinal ligaments help maintain alignment and limit excessive movement of the spine.
Muscles: Many muscles are located in the upper back. These muscles have different functions based on their location and attachment points. The deepest layers of muscles provide stabilization and movement to the spine itself. More superficial layers of muscles often act to move or control the scapulae or shoulder blades, the arms, shoulders and neck.
Fascia and skin: Like the majority of our body, skin plays an important role in protecting and facilitating sensation over the upper back. Fascia, on the other hand, exists as sheets of connective tissue that wind their way throughout the entire body encapsulating organs, separating muscles, imparting strength and stability to the body.
One or many of these structures may be implicated in a case of injury or irritation of the upper back. While it may not always be possible to discern exactly which structures are involved, consideration of these structures is helpful when crafting a customized physical therapy treatment plan. Now that we have examined the different anatomical structures that exist in the upper back, let’s discuss some conditions that may affect these structures.
POTENTIAL CAUSES OF INJURY OR DYSFUNCTION INVOLVING THE UPPER BACK
Bones: The bones of the upper back may be involved in the development of pain or dysfunction in this area or even adjacent areas.
Scoliosis: Scoliosis refers to an abnormal curvature and rotation of the spine. Leading to a dysfunction in posture, scoliosis can cause pain and stiffness, alterations in appearance and even impact breathing if severe. Treatment modalities like the Schroth Method are considered effective tools in helping to slow curve progression and provide symptom relief.
Fractures: It is important that fractures in the upper back are ruled out in the case of trauma to the upper back. These fractures can cause injury to the delicate nerves and spinal cord in this area and may need to be treated with immobilization or surgery.
Hypomobility: Hypomobility or stiffness in the upper back may cause localized symptoms of pain or stiffness but may also cause issues in the neck or arms.
Facet joint syndrome: Facet joints in the spine are susceptible to arthritis just like any other joint in the body. This can result in pain, stiffness or difficulty moving the spine.
Rib dysfunction or injury: While we most often think about the anterior portion of our ribs, they actually originate along each of the thoracic vertebrae. The upper most ribs articulate with the vertebrae of the upper back. Acute injury, muscle stiffness and hypomobility can occur where the ribs attach to the spine and along the upper back.
Nerves: without healthy nerves our ability to perceive and interact with the world around us would be greatly impaired. Pressure, irritation or injury of these nerves can cause an array of symptoms locally and referred to more distal sites. Numbness and tingling, weakness in the forearm or hand and radiating pain into the arm, hand or ribcage can occur. Some conditions that can affect the nerves in the upper back are as follows:
Spinal stenosis: A narrowing of the spinal column or foramina can result in pressure and irritation of the spinal nerves or spinal cord resulting in the above noted symptoms. If the spinal cord is involved, symptoms may extend into the lower body as well.
Disc herniation: Disc herniation is most common in the neck and lower back but it is possible that a disc herniation can occur in the lowest cervical vertebrae causing irritation of the nerves in the area.
Ligaments: The ligaments of the spine are considered quite strong and play an important role in maintaining the structure and alignment of the spine. These ligaments can thicken and contribute to spinal stenosis as we age. Additionally, these ligaments may be sprained or injured in the case of a trauma like a car accident, for example.
Muscles: The muscles in the upper back are workhorses and commonly contribute to upper back pain and discomfort. Tightness in the upper trapezius muscles on top of the shoulders, for example, is common among people working at a desk. A strained muscle from sleeping wrong or getting into a fender bender can also cause symptoms in the upper back as many of the neck muscles attach along the spine or scapulae in the upper back.
Fascia: proper fluid balance and mobility of fascial layers is thought to be extremely important in normal movement of the body. Impairments in fascial mobility in the upper back may contribute to localized problems as well as issues in the neck, shoulders and arms.
YOU DON'T NEED TO DIAGNOSE YOURSELF
While we hope this article provided some insight into the possible cause of your upper back pain, the good news is you do not need to diagnose yourself. Our team of PTs at Evolve are experts in the musculoskeletal system and will help you get to the bottom of your symptoms. Call us today to schedule an evaluation and let us help you get on the road to long term resolution of your symptoms.
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Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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