Upper Back Pain

Upper back pain, sometimes called mid-back or thoracic pain, is the tight, aching band that settles between and around the shoulder blades. It’s one of the most common things people bring in after a run of long days at a desk, and it responds well to treatment once the cause is clear.

The thoracic spine is the section of your spine that your ribs attach to, running from the base of your neck to the bottom of your ribcage. It’s built for stability more than movement, but it still needs to rotate and extend, and when it stops doing that the surrounding muscles take up the slack. That’s the ache most people describe.

What causes upper back pain

Sustained posture is the most common driver. Holding a slightly rounded position at a desk, in a car or over a phone loads the muscles between the shoulder blades for hours at a time, and stiffens the joints of the thoracic spine and the small rib joints either side of it. Muscles that are asked to hold a position rather than move through one fatigue and become painful.

Other patterns turn up regularly too. Lifting or carrying awkwardly can strain the muscles directly. A stiff or painful neck often refers pain down into the upper back, and neck pain and mid-back pain frequently arrive together. Shoulder problems can do the same, because the shoulder blade sits on the ribcage and depends on it moving well.

Stress plays a genuine mechanical role here rather than a vague one: the upper trapezius and the muscles around the shoulder blades are among the first to hold tension, and sustained low-level tightness in them produces exactly this ache.

When to see a physiotherapist

Upper back pain that has been grumbling for more than a week or two, or that keeps returning every few months, is worth having assessed, since a recurring pattern usually has a driver that hasn’t been addressed. Earlier is easier, because a stiff thoracic spine and a deconditioned mid-back both take longer to change the longer they’ve been that way.

Some upper back pain needs assessment rather than a booking. Sudden severe pain after a fall or direct blow, pain with a fever or feeling generally unwell, chest pain or breathlessness, or pain that comes with numbness, weakness or pins and needles down an arm all need urgent medical assessment first. If you contact the clinic with any of these, you’ll be told the same thing and helped to get seen.

Physiotherapy treatment for upper back pain

Andrew’s assessment looks at how your thoracic spine and ribs move, how your shoulder blades sit and control, and what your neck is contributing, before anything is treated. Treatment then usually combines:

• Manual therapy to restore movement through the stiff thoracic joints and the rib joints either side, which is often what makes the area feel immediately looser.
• Soft tissue work and dry needling where specific muscles between the shoulder blades have become persistently tight and tender.
• Exercise rehabilitation for the mid-back and shoulder blade muscles, so the area can hold a comfortable position without constant effort.
• Practical set-up advice for the desk, the screen height and how often you get up, chosen from what your assessment actually showed rather than from a generic list.

What to expect

Andrew will explain what he’s found in plain language before treatment starts, including which part is stiffness, which part is muscular, and what your neck and shoulders are contributing. Most people feel a difference in how freely the area moves early on; holding that improvement is what the strengthening and the set-up changes are for.