Upper Back Pain

The thoracic spine, also referred to as the upper back or middle back, is located between the cervical spine (neck) and lumbar spine (lower back). 

The upper back is designed for stability and serves as an attachment point for the ribs and for many muscles and bones. It anchors the rib cage and protects the vital internal organs within the chest in a fixed and stable manner.

(ANATOMY IMAGE HERE)

Compared to the neck and lower back, the middle back is remarkably resistant to injury and pain. When pain is felt in the upper back, it is typically due to long-term poor posture or an injury that weakens and overpowers the sturdiness of the thoracic spine.

Since the upper back or thoracic spine area has a great deal of stability with limited and restricted movement, pain in the middle of the back is far less common when compared to neck pain or lower back pain. 

When upper back pain does occur, muscular irritation due to pressure on sensitive points in the middle back muscles (myofascial pain linked to A-Z) and joint dysfunction (improper movement of the upper back joints) are often the cause of the pain, prompting significant discomfort. 

Upper back pain usually responds best to manual treatments such as exercise, chiropractic manipulation, physical and massage therapy, or acupuncture. In most cases, pain in the upper back can be managed with self-care, including rest, adjusting posture, or applying heat or ice to the affected area. If the pain persists, other treatments may be needed, such as medication or following a physical therapy treatment plan, which typically involves manual manipulation of the middle back region.

Due to a combination of the thoracic spine’s rigid design and close proximity to the heart, lungs, and other vital organs, surgery is less likely to be performed on this area than the cervical and lumbar spines. Only in rare and isolated cases will a CT scan or an MRI detect a structural problem in the thoracic spine, that is amenable to any sort of surgical solution for upper back pain.

Upper Back Anatomy

The upper back (thoracic spine) starts beneath the neck and is comprised of twelve (12) vertebrae, labeled T1 through T12, which go down the back of the torso. Unlike the cervical spine and lumbar spine, the thoracic spine is relatively immobile because each its vertebrae are connected to a pair of ribs (one on either side), with the sternum at the front of the chest combining to form the rib cage.

(Thoracic Spine IMAGE HERE)

At each level of the thoracic spine, two (2) nerve roots (one on each side) separate into networks of nerves that enable sensation and motor functions on each side of the body. If a nerve root becomes compressed or inflamed, such as from a herniated disc, then thoracic radiculopathy note: to link to A-Z (commonly referred to as a pinched nerve, where one or more nerves are affected and do not work properly) occurs and is likely to result in symptoms of pain, tingling, numbness, and/or weakness. These symptoms can radiate in different directions in the middle back, depending on the specific vertebral level of the compressed nerve.

Upper Back Pain Symptoms by Location

T1 and T2. 

If nerve roots located at the top of the thoracic spine become compressed and irritated, symptoms can be felt radiating into the arm and possibly the chest.

T3, T4 and T5. 

Nerve roots in this region are likely to radiate symptoms into the chest.

T6, T7 and T8. 

Symptoms felt radiating into the chest and/or down into the abdomen, are likely due to nerve roots in this region of the upper back. 

T9, T10, T11 and T12. 

Nerve roots located at the bottom of the thoracic spine, are more likely to project symptoms into the abdomen or lower in the back. 

The above thoracic radiculopathy symptoms are usually only felt on one side of the body. 

Thoracic Spine Anatomy and Upper Back Pain (IMAGE HERE)

Upper Back Pain Symptoms

Upper back pain symptoms differ from person to person. For some, the pain felt in the middle back may be faint and go away within a few days, for others, the pain can worsen and interfere with daily tasks. This being the case, upper back pain symptoms and treatment plans can vary greatly depending on the pain’s underlying cause.

Pain in the upper back can feel like one or more of the following:

  • General discomfort. This is where a continuous throbbing pain is felt in part of the upper back, and it may spread into the nearby areas of the neck, shoulder, or lower back.
  • Sharp pain. This pain is typically described as excruciating and can feel like a burning knife-like sensation. It is usually located in one spot rather than across a region.
  • Stiffness. If either sharp pain or general discomfort worsens and becomes distressing, it can lead to reduced mobility of the upper back muscles, ligaments, and/or joints. While reduced mobility in the upper back is usually not significant, due to the mid-section of the spine being built more for rigidity than motion, it can make certain arm movements, such as lifting or rotation, more difficult or even impossible.
  • Radiating pain. Radiating pain can travel along a nerve from the upper back (thoracic spine) and into the chest, stomach arm, or further down the body. Radiating pain in the middle back can range from dull to sharp, usually felt on only one side of the body and may either be continuous or come and go. 
  • Tingling, numbness, or weakness. Just like radiating pain, these symptoms can also radiate along a nerve from the upper back and into the arm, chest, stomach, or lower in the body. Numbness or pins-and-needles tingling projected from the thoracic spine, may be felt running along one of the ribs.

Severe pain in the thoracic spine can affect normal activities, such as being able to lift moderately heavy objects, throw a ball, or even sit or rest comfortably.

If upper back pain is accompanied by any of the following, it should be checked by a doctor immediately (Find a Specialist):

  • Problems with walking or balance.
  • Weakness, numbness and/or pins-and-needles with a tingling sensation anywhere in the middle back or below, i.e in the chest, stomach, buttock, or down the legs.
  • Difficulty with bowels or the bladder.
  • Trouble breathing, fever or chills and severe headaches.

See your doctor if upper back pain lasts for weeks and/or interferes with daily tasks, such as getting a good nights sleep or going to work.

Causes Of Upper Back Pain

If the upper back becomes painful, it is usually for one of the following two (2) reasons:

  1. Muscular irritation. Muscular irritation in the middle back area is typically due to either de-conditioning (lack of strength) or overuse injuries (such as repetitive motions).
  2. Joint dysfunction. Upper back joint dysfunction can either be due to a sudden injury or a result of natural degeneration from ageing where joints in the upper back become dysfunctional and painful.

Common Causes of Upper Back Pain

  • Accident or collision. Trauma from an accident, a fall from height, or a sports collision, can cause pain in the middle back by injuring the muscles, ligaments, spinal bones, discs, nerves, and other soft tissues.
  • Overuse. When the upper back is put through more work than usual, such as moving into a new apartment or painting a ceiling, this could cause muscle strains, ligament sprains and inflammation in the upper back.
  • Poor posture. Routinely sitting for long periods with poor posture or living a sedentary lifestyle, can cause structural changes in the back and neck. As the shoulders and head hunch forward, more pressure is placed on the spine’s muscles, ligaments, bones, discs and other soft tissues, causing an imbalance in the upper back that leads to pain.
  • Improper lifting technique. Excessive stress is placed on the middle back when lifting heavy objects without keeping the spine aligned. Especially when  lifting these objects above the head more toward the left or right, as opposed to being centred. This can leave the shoulder and upper back susceptible to injury.

It is possible that upper back pain can ensue by a combination of these causes, such as from both improper lifting technique and overuse.

Less Common Causes of Upper Back Pain

Less common causes of upper back pain may include:

  • Thoracic herniated disc. It is rare for herniated disc in the upper back to cause pain. In general, natural age-related disc degeneration is much more likely to cause symptoms in the neck or lower back.
  • Compression fractures. A vertebral bone can weaken and become unable to support weight, developing small fractures most commonly caused by osteoporosis in older adults.
  • Arthritis. Various types of arthritis can occur such osteoarthritis (from natural wear and tear) or rheumatoid arthritis (an autoimmune disease).
  • Severe spinal deformity. 

Diagnosing Upper Back Pain

Diagnosing upper back pain compared to other regions of the spine can be especially complicated because it has more potential sources of pain. These sources range from the ribs connecting at each level of the upper back and vital internal organs as well as those muscle groups which are in close proximity.

While it is sometimes impossible to find the exact cause of a person’s upper back pain, the following three-step process is typically followed to narrow down which causes are more likely.

1. Patient History

A thorough medical history of the patient is taken, which includes:

  • When the symptoms started. 
  • How current symptoms feel. Where is the pain located in the upper back? How intense is the pain? Do certain types of activities or movements make the pain worse or better?
  • Injury history. 
  • Lifestyle and habits. 
  • Family health history.

A patient’s history is likely to provide strong clues as to the underlying cause.

2. Physical Exam

A physical examination helps to further narrow what might cause the upper back pain. This process typically entails:

  • Observation. 
  • Palpation. The doctor presses against the upper back, moving up and down the back feeling for tenderness, rib instability or any abnormalities.
  • Clinical tests. Tests that are performed in the exam room to see if certain movements exacerbate symptoms. 

3. Diagnostic Tests

One or more of the following diagnostic tests might be performed when trying to diagnose upper back pain:

  • X-ray.
  • MRI. 
  • Medial branch nerve block. An anesthetic is injected near the medial nerves using x-ray guidance (fluoroscopy), and if numbing the nerves of that joint results in pain relief, then the source of pain has been identified which can then guide future treatments.
  • Bone mineral density exam. This test uses x-rays to measure bone density and is commonly performed to check for osteoporosis, which can occur in the thoracic spine and cause upper back pain.

Most diagnostic tests for upper back pain are performed for confirmation purposes as opposed to diagnosing a suspected cause itself. 

Treatments Upper Back Pain

If upper back pain develops without severe discomfort and radiating pain, which requires immediate action, measures can be taken as a first step in preserving and improving one’s own health. Several self-care treatments for upper back pain exist and in some cases a combination of one or more are needed to help reduce the pain.

Self-Care for Upper Back Pain

Some early treatment options one can try when upper back pain develops include:

  • Short rest period and activity modification. If pain in the upper back gets worse with certain movements or activities, a short rest period of a day or two may help. Trying to become active again after the initial rest period is advised, too long of a rest period can cause muscles in the back to become weaker, which may lead to more pain.
  • Ice and/or heat therapy. Within the first few days of the onset of pain, ice can be applied to reduce swelling, and heat is typically recommended after the first 48 hours. It is important to limit the application to 20 minutes at a time regardless of which temperature is preferred and to check the skin regularly to avoid tissue damage. (Link to products ice pack/heat therapy here)
  • Over-the-counter (OTC) medications.  Most OTC medications work to reduce inflammation in the body or prevent pain signals from reaching the brain. Though most of these medications do not require a prescription, it is important to read and follow the directions on the label to avoid serious side effects. (OTC link here)
  • Dietary Supplements for Back Pain. Supplements and herbal medicines have been found to help reduce inflammation and pain. Having a discussion with your healthcare provider is important before you consume a supplement, as certain types may interact with prescription and/or over-the-counter medicines you already take. Supplements that some people have found helpful to reduce inflammation and pain, include: Glucosamine/Chondroitin, Methylsulfonylmethane (MSM),Turmeric, Devil’s claw and Capsaicin cream. (Link to Supplements here) 
  • Massage. A massage can provide temporary relief from back pain. A good massage helps to loosen tight muscles and get more blood flowing to the painful area. (Find a professional link here).

Alternative Treatments

Alternative treatments are gaining popularity and commonly referred to as complementary and alternative medicine (CAM). While these treatment methods tend to have less scientific backing, compared to traditional medical treatments, it is not to say that they are ineffective. Some examples of alternative treatments include:

  • Manual manipulation. Also known as chiropractic manipulation, manual manipulation helps loosen stiff or misaligned joints which may reduce pain. (Link)
  • Nutritional supplements: Supplements and herbal medicines have been found to help reduce inflammation and pain. (Link)
  • Acupuncture. Placing thin needles in strategic locations of the body can theoretically alter energy flows, ease tension, and reduce pain.
  • Electrotherapy. Pain can be alleviated by various electrotherapy treatments by sending small electrical pulses to the painful area, causing a soothing, tingling sensation and reducing the perception of pain.
  • Mindful meditation. Helpful in dealing with the challenges and stresses of daily life, meditation and breathing exercises help reduce stress.

Surgery for Upper Back Pain

Treating upper back pain with surgery is rare, however surgery may be considered if one or more of the following conditions are met:

  • When the health of the spinal cord or nerve roots are at risk.
  • If severe spinal deformity has developed or is likely to develop.
  • When debilitating pain cannot be controlled with nonsurgical methods.

Preventing Upper Back Pain

Most upper back pain can be prevented by taking a few easy steps today.

  • Whether you’re sitting, standing, or moving, learn and practice good posture.
  • Exercise regularly by doing movements that get your heart rate elevated to an appropriate level, such as doing cardio workouts and strength training.
  • Maintain or seek to attain a healthy weight.
  • Stop smoking (if you smoke).
  • Be aware when lifting objects, do so with proper lifting techniques (ARTICLE Lift properly).
  • Eating well – Eating healthy. Give your body the nutrients it needs to function properly.
  • Take care of your body while at work: (ARTICLE Avoid Stressing Your Back).

Preventing back pain is an everyday kind of activity. You can’t just sometimes have good posture or only exercise and eat well on rare occasions.

Although the upper back is less susceptible to degenerative (age-related) changes, as we age our spine ages too. Osteoporosis (a condition that weakens bones, making them fragile and more likely to break) is a particularly preventable condition. Keeping your bones healthy and strong, by eating foods rich in calcium and other essential nutrients, does your body and bones good.