Causes of upper back pain
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 shoulder pain.
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
overuse injuries (such as repetitive motions). Muscle
strains, 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
-
Deep massage or massage therapy
-
Acupuncture
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
exercises.
A conservative care specialist such as an osteopathic
physician, a physiatrist/physical medicine and rehabilitation
physician, or a chiropractor would be appropriate to
see for treatment of upper back pain.
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:
Pain medications can also be helpful. Muscular irritation
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 (with an osteopathic physician,
chiropractor or a physical therapist trained in manipulation)
to help mobilize the joint and reduce the discomfort.
Lasting relief 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.
In addition to manual treatments, pain medications
can help. Usually the most helpful medications are
the anti-inflammatory medications (such as ibuprofen
or COX-2 inhibitors), as the joint dysfunction can
create inflammation.
Injections (e.g. epidural steroid injections) are
usually not warranted for thoracic pain other than
local trigger point injection.
Uncommon causes of upper back pain
Because there is little motion and a great deal of
stability throughout the thoracic spine, it does not
tend to develop disc herniations, 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 treatment plan.
By: J.
Talbot Sellers, DO
April 17, 2002
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