Upper Back and Chest Pain

What is Upper Back Pain?

Upper back pain can be a frightening condition. In this article we discuss the causes, symptoms and treatment options.

Many people naturally assume it must be related to the heart, but there are several other musculoskeletal causes of upper back pain, related to the thoracic spine, ribs or sternum (breastbone). 

The thoracic spine is a collection of 12 bones (vertebrae) which are stacked vertically on each other. Each of these vertebrae has attachments to the ribs, which wrap around the chest wall and join onto the sternum at the front of the chest. 

There are a multitude of joints, ligaments, tendons and muscles that hold the thoracic spine together, and any one of them can cause upper back pain.

Causes of Upper Back Pain:

Some of the most common upper back injuries include:

• Postural pain – probably the most common reason for upper back pain. We often tend to hunch forward through the upper back, which places the joints, ligaments and muscles under stress. By sustaining those positions for a long time the tissues become painful
• Thoracic facet joint sprain – the joint between one vertebra above and the one below can sometimes be over-stretched or become ‘blocked’, which prevents it from moving optimally
• Costovertebral joint sprain – the joint between a rib and the spine can be stiff or blocked. Often caused by over stretching or sneezing in an awkward position
• Crush fracture – the main body of the vertebra in people with poor bone density can collapse onto itself. These fractures are usually very stable,but can also be very painful
• Scheuermann’s Disease - in ammation of the surfaces between the vertebrae. Usually only experienced during adolescence, and tends to resolve after 12 to 24 months
• Rib fracture – most often caused by direct trauma to the rib cage, but it can sometimes happen spontaneously with coughing or sneezing in people with osteoporosis or poor bone density
• Thoracic disc prolapse +/- nerve impingement – similar to the classic ‘slipped disc’ in the lower back. This condition is an injury to the ‘cushion’ between two vertebrae, and can place pressure on the nerve nearby

Signs and symptoms of upper back pain:

The signs and symptoms of upper back pain vary depending on the specific cause.

Here are the most common symptoms:

• Postural pain: A constant ache between the shoulder blades, particularly after prolonged periods in one position
• Thoracic facet joint sprain: sharp pain just to the side of the spine, usually between the shoulder blades. Often worse with twisting
• Costovertebral joint sprain: sharp pain on taking a deep breath or coughing. Also worse with twisting movements
• Crush fracture: constant ‘burning’ pain in the middle of the back, with a sharp pain on movement (especially bending forwards)
• Scheuermann’s Disease: moderate upper back pain, often aggravated by exercise. May also feel stiff when trying to stand straight
• Rib fracture: sharp pain in the side of the chest wall. Particularly painful with coughing, sneezing or taking a deep breath
• Thoracic disc prolapse: moderate to severe pain in the middle of the back, which feels worse with movement and may cause pain to ‘shoot’ around the chest wall

Treatment and Management of Upper Back Pain:

In the majority of cases, manual therapy treatment is beneficial for pain relief in the early stages.

Gentle manipulation and mobilisation of the stiff joints and massage of the protective muscle spasm can be particularly effective. Superficial dry needling (Western acupuncture) is also great for reducing upper back pain.

Once the acute pain is settling, it is critical to address the underlying cause of the problem. This may be poor posture, muscle imbalances, work habits, bone density, nerve tightness, joint stiffness or other factors specific to your circumstances.

A program of stretching exercises for the upper back may help to address those issues that the physiotherapist identifies in your assessment, and can prevent the problem from coming back. 

Depending on your particular condition, you may also benefit from Clinical Exercise, personal training or Whole Body Vibration Therapy (WBVT).

Self Management Strategies of Upper Back Pain:

• Back brace for support when it is needed
• BakBalls™ for relief of trigger point pain
• Heat pack for easing spasm
• Home exercise program consisting of specific stretching exercises suited to the individual
• Personal training guided by physiotherapists who know how hard to push you (and when to stop)
• Clinical Exercise classes for postural correction, stretching and strengthening the spine
• Whole Body Vibration Therapy for bone density and core muscle strength

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You may also be interesting in reading our article on lower back pain.