Upper or Mid-Back Pain

Pain in the upper back or mid-back, which can radiate into the shoulder blades or chest.

Causes

• Annular tears – tears in the outer 1/3 of the disc which increase probability of disc bulges and herniations
• Disc bulge/herniation – an actual bulging of the disc in one area
• Facet joint sprain or locking – partial tearing of the ligaments surrounding  the facet joints in the spine, or facet joints actually locking or being limited in their normal motion
• Poor posture – causing forward head, shortening of the anterior muscles of the neck and shoulders, lengthening and weakness of the posterior muscles of the shoulders and upper back
• Subluxed rib heads – since the ribs attach to the spine and the sternum, certain injuries can cause a slight subluxation of the rib head at the spine leading to pain into the chest as well

Treatment

• Ice- always on acute injuries of any type
• No heat– causes increased inflammation in acute injuries
• Directional exercise– to reduce disc involvement and inflammation
• Stability exercise– to increase upper back stability and postural stability
• Modalities to decrease inflammation and muscle spasming
• Decompression– to decompress discs, reduce bulges, assist healing and ensure proper tissue reformation
• Mobilization– improve and increase joint mobility in the spine including facet joints
• Postural Re-education
• Treatment should progress into a more specific exercise program for directional exercise and stabilization

Be Wary Of

• Medication that only covers up the existing mechanical cause of your condition
• If leg pain or changes in sensation appear get proper medical care
• In cases of annular tears early intervention is important to reduce the chance of chronic spine pathology
• Of any rehabilitation which does not involve very specific and extensive exercising, modalities and massages will not produce lasting results
• Rehabilitation that doesn’t teach you how to manage your condition on your own when not coming to the clinic

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