The upper back, known as the thoracic spine, is made up of 12 vertebral segments and 12 pairs of ribs. The thoracic spine is designed to allow a greater degree of rotational movement compared to the other parts of the spine.

The 12 pairs of ribs attach to the spine at the back and then at the front, form the rib cage which protect the lungs and heart and provide the mechanics that are essential for breathing. As you can see, this area of the spine is used a lot everyday and accounts for being the source of around 15% of all back pain.

So, what causes upper back pain?

A specific event

• Refers to an injury which is caused by a certain activity or movement. It is easily the one you remember most!
• Common specific incidents, such as that time you lifted an object that was a little too heavy or when you suddenly twisted and felt a sudden pain
• This type of mechanism might involve a joint sprain, muscle injury or nerve irritation
• Managing these types of injuries initially focuses on settling down symptoms to help the injured tissues to recover and then a gradual early return to activity to assist in full recovery
• The costovertebral joint is where the rib attaches onto the vertebra segment at back. Due to the ribs moving all the time during breathing and when performing rotation movements, it can often be irritated. This area can be aggravated by a sudden twist or a sneeze in an awkward position and is usually on a background of general sedentary behaviour or a restriction in joint mobility or muscle tightness
• Direct trauma to the thoracic spine. Rib fractures are usually a result of a trauma, whether that is due to a direct blow, or due to a fall. At the time of the injury, a crack or pop is often heard, followed by sharp and specific pain in the area. Breathing, coughing and quick rotation movements are often extremely painful.
• An assessment is required to determine to extent of fracture and to make sure it is stable. Once this has been assessed and cleared, reduced mobility and direct pressure to help immobilise the rib is recommended. Ribs usually get better over a six week period and are often self limiting

Gradual onset and overuse

• Gradual onset and overuse injuries are usually linked to those tasks we do at home or work that require repetitive movements or positions. Pain can arise if we perform these activities or positions in awkward postures
• These types of injuries are pretty common, as a vast majority of us spend a significant time at home or work at a desk hunched over a screen. Sustaining an awkward position for eight hours can cause overloading on your upper back muscles and joints, causing pain

For these types of injuries, it is important that we not only focus on making the sore tissues happier, but more importantly, identify the specific causes of pain. These can include a poor desk setup, inadequate strength for the requirements of the job/activity or poor technique with performing the task.

Other names for upper back related pain

Facet joint syndrome

The facet joint is the main load-bearing part of each vertebra, with the thoracic spine designed to withstand large amounts of forces from weight bearing and rotation movements. Over an extended period of time, the joint can gradually wear down, resulting in less mobility and flexibility. This however, is usually pain free.

The area can become painful, but only when a specific incident or trauma has occurred, or when there is repeated loading or a sustained awkward posture. Like all other upper back injuries, it is important to identify the cause, encourage gradual movement and let the tissue settle. It is also important to identify and modify the activity that caused the area to become painful in the first place!

Thoracic outlet syndrome

Thoracic outlet syndrome refers is a condition caused by irritation or compression of nerves or blood vessels between your collarbone and first rib. This is usually caused by repetitive activities or being in sustained positions.

Symptoms include numbness or pins and needles in your arms or fingers and pain can refer into the neck and shoulders.

Treatment will focus on identifying the causal factor and modifying that activity through a change in technique or strengthening the area to allow the body to handle the demands placed upon it.

Brachial plexus pain

Brachial plexus is defined as a network of nerves that relay signals from your spinal cord to your shoulders, arms and hands. This nervous tissue is extremely strong and robust but can be irritated through a traumatic incident such as a tackle during sport or a repetitive loading or sustained awkward positions during actions like using a mouse at your computer.

Symptoms can include changes in sensations, pins and needles and a pain that radiates down the arm. The pain may be frightening and make you worried, but most of the time it is nothing serious. We will need to help the tissue settle and get it moving in a way that will help the tissue recover.

Herniated disc or slipped disc

The term slipped disc really shouldn’t be used — the disc certainly doesn’t go anywhere and it makes it seem like they are a fragile structure when it is in fact quite the opposite.

A herniation refers to when the shock absorbing inner layer of disc can protrude into an outer fibrous layer. It is not as common in the thoracic spine as in the lower back, but in an acute injury where a herniation is potentially suspected, a thorough assessment is needed. Even though this can be very painful, the pain generally gets better with time and when performing specific exercises and with education from your therapist. In many cases, the presence of a herniation is symptom and pain free, and is a common finding on individuals without pain on scans.

Remedial physiotherapy and massage treatment for upper back pain

Thoracic back pain can be a complex issue with many factors contributing to the overall problem. With the correct diagnosis and a comprehensive management, it can be treated effectively to get you and back up and running.

At Life Ready Physio, we’re driven to not only to reduce you discomfort and pain but also to develop a treatment plan to identify the cause and to work towards rehabilitation and prevention.

Get in touch with one of our practitioners for a rejuvenated tomorrow or click here for more information on the services we offer.

Book an appointment now to get started on your health journey

One life. One body. Life Ready Physio

Book Now

Share this article via