Upper Back Pain Treatment

Todd Lloyd
June 22, 2022

Do you have tightness between your shoulder blades, and it makes the muscles in your upper back go into knots? Here is my guide on what causes the pain, and what you can do about it.

Pain in the upper back is one of the most common things I see in my clinic. Someone comes in to get a routine adjustment, and when I ask them how they are feeling, they say, "The usual." And, that's when I can rely on their upper back being tight, along with some other stuff.

Pain in the upper back is often caused by pain in the neck

I know how it feels to have pain in the upper back. This pain is usually there with some tight muscles, and stiffness in the upper back. This pain responds to stretching sometimes, but sometimes not. It can be very vexing when the tightness just does not go away. People often try to take care of this tightness and pain by punishing the muscles that are trying to support your posture. But this may be a misguided attempt to relieve the problem. Don't punish your muscles just because they're trying to do their job.

Have you experienced what they call "referred pain?" Pain starts at the lower neck often refers to the area between the shoulder blades. This is a dull, diffuse ache that is hard to pinpoint. This ache is not very well represented by the cortex of your brain, so like an itch that you can't reach, the pain is hard to point to.

Some medical researchers back in the 1950s conducted a study on some medical students who are otherwise healthy. The purpose of the study was to map out pain referral patterns. So what they did was inject a salt solution into the joints and muscles of the student's neck and low back. They mapped out the pain response by having them draw where they felt the pain. What they found was that when they injected an irritating solution into the joints of the lower neck, the pain referred to that area between the shoulder blades and down the upper arm.

I have observed the same thing in 20 years of practice. When someone comes in with a lot of pain between the shoulder blades, I can feel the joints of the upper neck, identify restrictions, press into it and the patient will have a pain response. And after adjusting the patients, they often feel a lot better in the area between the shoulder blades.

Old whiplash injuries will often leave your lower neck slightly degenerated or degraded. X-rays will show bones spurs. And along with the tightness that the bone spurs give you, you usually have chronic referred pain from the neck to the shoulder blades. This is why it's so important to rehab your neck properly after a whiplash injury.

But of course it's not always just the lower neck and the old injuries that cause tightness in the muscles of your upper back.

Pain in the upper back is often caused by poor posture

We have an epidemic of poor posture in today's society. The iPhone was invented in 2007, and we have developed tech neck ever since. Poor posture place is greater demands on the muscles that run up and down your neck and your upper back. These muscles across multiple joints and they are easy to appreciate when you see a picture of them.

Every inch that your head goes forward into worse posture, the more torque is placed on the muscles of your upper back trying to support your spine. It doesn't take long before all of this workload in the muscles translates to pain in the muscles. Posture produces pain.

Poor posture also, over time, will lengthen the supporting ligaments of your spine, and shorten the ligaments on the other side. This creates a wind up loop that makes your posture worse and worse. This makes it harder and harder to fix your posture over time. Pain gets worse. Pain gets more chronic. And this pain is harder and harder to treat.

Your upper back is tight, and here's why that's making you hurt

When I hear people talk about tightness in the upper back, I know they are talking about tight muscles. Tight muscles are common problem, and a big pain generator for people who have tightness in the upper back. You can reach back and feel the muscles in your back and you can feel the knots that are in the middle of it. When you press on the knots in it it can refer pain around the muscle.

However, when I talk about tightness in the upper back, I am talking about rigidity in the way the spinal joints articulate with each other. Most people have lost flexibility in the upper back. This creates a rigid foundation upon which the neck sits. This can lead to further problems in the neck, overlapping with the direct problem of tight muscles in the upper back.

When your upper back has lost flexibility and become rigid, this leads to further tightening of the muscles in your back because the muscles don't have good feedback from the nerves in the joints to know how to contract and coordinate movement. So tightness in the joints can lead to tightness in the muscles.

Also, when you lose flexibility in the upper back, this creates problems in the shoulders. The shoulders rolled forward, the muscles become tight in the front of the shoulders, and they become weak in the back of the shoulders. This gives you that hunched over look. This also creates an impingement syndrome in both shoulders that can be painful.

Your upper back is tight, and here's what to do about it

When your back is tight and rigid, it is usually hunched forward in a flexed position.

To fix this, you need to stretch and mobilize your upper back to go more into extension. You need to improve the posture if you're ever back by improving the mobility. Here are some exercises:

And here is one I did that takes the stretch one step further. Try this exercise to extend that tough area between the shoulder blades.

Stretching your upper back is not enough; you have to strengthen it

This is an exercise I recorded for a Udemy course on neck pain and posture. As you can see, it's important to exercise muscles that have become tight and weak:

One of my favorite exercises for her neck and upper back tightness, stiffness, or pain is a direct exercise to the neck that uses a kickball. I called this the kickball exercise. There is no better exercise for such little money for neck rehabilitation. To demonstrate this exercise I broke it up into two different videos. One video shows how to do the exercise when you press against a kickball without any muscle movement. This is an isometric contraction.

The other video demonstrates a kickball exercise where your head and neck move using the ball as a guide for range of motion.

A good chiropractor will look at both your neck and your upper back to fix it

When someone comes in to me as a new patient, and they have upper back pain, I'm comprehensive. I'll assess upper back mobility, neck mobility, shoulder mobility, and neck strength. I'll adjust both the lower neck and the upper back (thoracic), and evaluate and adjust the ribs and shoulders. It feels great, as if you're taking pressure off the tight spots.

Todd Lloyd
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