UPPER BACK PAIN

How Prevalent Is Upper Back Pain Among Workers and the General Population?

Upper back pain, though less studied than lower back pain, is still a significant issue affecting many people. Research shows varying prevalence rates depending on the demographic and occupational group.

For instance, a notable study reported that approximately 9% of men and 17% of women across various professions experience upper back pain. These numbers, however, can fluctuate when considering different studies. Some research indicates lower prevalence, while other studies reveal higher percentages.

Such variability highlights the need for more comprehensive studies to accurately gauge how widespread upper back pain is among both workers and the general population. Factors like posture, job type, and lifestyle likely contribute to these differences in reported cases.

By understanding these patterns, we can better address and manage upper back pain, ultimately improving the quality of life for many.

Causes of Upper Back Pain

Injuries from car accidents, slipping and falling, and incorrect lifting of objects or weights amongst other reasons can also lead to upper back pain. The injury may occur externally and the pain felt immediately but in other cases, the injury occurs internally with little pain. But over time the pain may get worse and more limiting. When pain exists because of an accident, doctors advise that people should get examined to avoid problems that may surface later in life.

Posture-related Pain

Poor posture can lead to upper back muscles becoming longer, weaker, and more susceptible to fatigue and pain. When the upper back is put through more stress than it can handle, muscle and ligament strains can occur and joints may become damaged.

High-Energy Impacts

High-energy impacts, such as those from car accidents or significant falls, can cause damage to the spine and surrounding muscles and connective tissues. If upper back pain develops as a result of a high-impact collision or fall, seek medical attention immediately.

Compression Fractures and Osteoporosis

Compression fractures, often resulting from weakened vertebral bones due to osteoporosis, can lead to tiny fractures in the thoracic spine. This condition is more common in older adults and requires medical evaluation.

Herniated Discs

Sometimes a disc in the thoracic spine or upper back will break down and herniate, leaking inflammatory proteins that cause pain. However, this is more likely to occur in the cervical or lumbar spine.

Osteoarthritis

Wear and tear over time may lead to osteoarthritis, which involves the breakdown of protective cartilage and bone grinding against bone. This causes inflammation and the development of bony overgrowths.

Other Causes

Many other causes of upper back pain are possible, such as infections, tumors, or severe deformities. While less common, these conditions can also lead to significant discomfort and should be evaluated by a healthcare professional.

Understanding Muscle Strains vs. Sprains in Upper Back Pain

When dealing with upper back pain, it’s crucial to discern between muscle strains and sprains as their causes and symptoms vary.

Muscle Strains:

• Occur when a muscle or tendon is injured.
• Often result from overuse, sudden movements, or heavy lifting.
• Symptoms typically include pain that worsens with movement, muscle cramps, and spasms.

Sprains:

• Involve overstretching or tearing a ligament.
• Commonly caused by sudden twists or impacts.
• Lead to pain that also intensifies with movement, alongside swelling and reduced joint mobility in nearby areas like the shoulders and neck.

In both cases, movement tends to exacerbate the pain and can limit your range of motion. Understanding these differences can guide better treatment and recovery strategies.

Risk Factors Associated with Upper Back Pain

Sometimes it is not about injuries, posture, or anything physical, there are risk factors that could increase the chances of you having upper back pain. These include:

Excessive Weight

Your spine is a major support system for your body since it supports your weight, especially in the midsection. Being obese, especially in the belly area increases your chances of being affected by upper back pain. This is caused because the additional weight puts strain on your spine and all the soft tissues in that area. Losing weight might lessen the pain and experience better back health.

Smoking

If you’re a smoker, the effects of reduced blood flow to your spine are something to worry about since it can result in spine and disc degeneration. Quitting smoking can help in regeneration in some cases or ameliorate the pain from inflammation. There are lots of different aids nowadays to help a person stop smoking.

Osteoarthritis

The cartilage which protects the bones may wear down as a person ages. Osteoarthritis is a common form of arthritis that may eventually lead to the cartilage between the bones wearing away completely and causing the bones to rub together. This involves the breakdown of protective cartilage and bone grinding against bone, causing inflammation and bony overgrowths. This causes spine pain and can also lead to increased pressure on the nerves in the spine causing numbness in the arms and legs.

In the upper back, the inflammation and bony overgrowths can create additional complications. The bony overgrowths, also known as bone spurs, can narrow the spaces where nerves exit the spine, intensifying discomfort and potentially leading to nerve compression. This can result in not just localized pain but also radiating pain and numbness in the shoulders and arms. Understanding these detailed mechanisms helps in managing and treating the symptoms more effectively.

Other causes of upper back pain:

• Myofascial Pain: This refers to pain caused by muscle irritation and tightness. Trigger points in the muscles can lead to referred pain in the upper back region.
• Pinched Nerve: Nerve compression can occur due to various reasons, including herniated discs or bone spurs, leading to radiating pain and discomfort.
• Spinal Infection: Infections such as osteomyelitis can affect the spine, causing severe pain and requiring immediate medical attention.
• Lung Cancer: Tumors in the lungs can press against the spine or spread to spinal structures, causing significant upper back pain.

Additionally, compression fractures can result from the weakening of vertebral bones due to osteoporosis, leading to tiny fractures in the thoracic spine. This condition is more prevalent among older adults. Other potential causes include tumors, or severe deformities that can directly or indirectly impact the upper back, leading to chronic pain and discomfort.

Understanding Muscular Irritation and Its Connection to Upper Back Pain

Muscular irritation in the upper back is a common issue that can significantly impact daily activities. But what exactly is it, and how does it cause discomfort?

What is Muscular Irritation?

Muscular irritation occurs when the muscles in the upper back become strained or tight. This region involves the shoulder girdle, which connects to the scapula (shoulder blade) and the rib cage through large muscles. These muscles can become irritated due to a couple of primary factors:

1. De-conditioning: A lack of strength and endurance in the upper back muscles can make them more susceptible to strain. This often occurs from a sedentary lifestyle or prolonged periods of inactivity.
2. Overuse Injuries: Repetitive motions, such as continuous lifting or certain sports activities, can lead to muscle fatigue and eventual irritation.

How Does Muscular Irritation Cause Upper Back Pain?

When the muscles in the upper back become irritated:

• Pain and Discomfort: These muscles can develop tightness and strain that leads to significant pain. This pain can be a dull ache or a sharp, stabbing sensation.
• Limited Mobility: As the muscles tighten, they restrict your range of motion, making it difficult to perform routine tasks.
• Inflammation: Irritated muscles can become inflamed, further contributing to pain and tenderness in the upper back.

Common Symptoms of Muscular Irritation

• Persistent ache or tightness in the upper back
• Difficulty moving the shoulders or neck
• Sharp pain during specific movements

Tips to Alleviate Muscular Irritation

• Regular Exercise: Strengthening exercises for the upper back can enhance muscle endurance and reduce the risk of irritation.
• Proper Ergonomics: Ensure that your work and home environments support good posture and reduce repetitive strain.
• Stretching: Incorporating daily stretching routines can help maintain flexibility and reduce muscle tightness.

By understanding these factors, you can take proactive steps to manage and prevent upper back pain caused by muscular irritation.

What is Joint Dysfunction and How Can It Lead to Upper Back Pain?

Joint dysfunction in the upper back refers to problems that arise when the joints in the thoracic spine become impaired. This can result from various factors, ranging from sudden injuries to gradual wear and tear due to aging. Let’s break down how this dysfunction can lead to upper back pain.

Causes of Joint Dysfunction

Sudden Injuries:

• Trauma: An impact or accident can damage the cartilage or joint capsule in the thoracic spine.
• Falls or Collisions: These can cause immediate joint damage, leading to pain and limited mobility.

Degeneration:

• Age-Related Wear: Over time, the cartilage that cushions the joints can erode.
• Osteoarthritis: This common condition involves the gradual breakdown of joint cartilage, causing stiffness and pain.

How it Leads to Pain

When joint dysfunction occurs, several mechanisms contribute to the ensuing upper back pain:

• Inflammation: The body’s response to joint damage often involves inflammation, which can compress nerves and create a persistent ache.
• Muscle Spasms: Compensating for a dysfunctional joint, surrounding muscles may tighten or spasm, amplifying pain and discomfort.
• Reduced Mobility: Stiffness in the affected joints can limit your range of motion, making everyday activities painful.

Recognizing the Symptoms

• Localized Pain: Typically felt around the affected joint, sharper during movements.
• Stiffness: Difficulty in bending, twisting, or turning the upper back.
• Tenderness: Soreness or sensitivity when pressing on the joint areas.

Managing and Treating Joint Dysfunction

• Physical Therapy:
• Strengthening Exercises: To support the spine and improve joint function.
• Stretching Routines: To maintain flexibility and reduce muscle spasms.

Medications:

• Anti-inflammatory drugs: Such as ibuprofen alleviate pain and reduce inflammation.
• Analgesics: Pain relievers to manage acute discomfort.

Injections:

• Corticosteroids: To provide temporary relief by reducing inflammation directly at the joint.

Lifestyle Adjustments:

• Ergonomic Support: Using chairs and desks that promote proper posture.
• Regular Exercise: Staying active to prevent stiffness and maintain joint health.

Addressing joint dysfunction promptly helps in managing symptoms and improving the quality of life, allowing you to resume daily activities with less pain and greater ease.

Symptoms of Upper Back Pain

Symptoms of upper back pain can vary depending on the underlying cause, but they often include localized pain or discomfort in the upper back region, stiffness, muscle spasms, decreased range of motion, and in some cases, pain that radiates to the shoulders, arms, or chest. Other associated symptoms may include headaches, numbness or tingling sensations, or weakness in the arms.

However, some symptoms accompanying upper back pain should prompt a visit to the doctor. These include:

• Pins-and-needles tingling in the chest or abdomen
• Reduced coordination
• Fever or chills
• A severe headache

If you experience any of these specific symptoms along with upper back pain, it is important to seek medical attention promptly. Upper back pain often arises from poor posture while working. Few studies have been done to track the frequency of upper back pain. A study of workers across various professions found about 9% of men and 17% of women reported at least some upper back pain, but other studies have found numbers that range lower and higher.

Upper back pain can appear suddenly, such as from an injury or for no apparent reason. It can also start gradually, such as from sitting with poor posture at work. In some cases, upper back pain can be managed with self-care, including:

• Rest
• Adjusting posture
• Applying heat or ice

Due to a combination of the thoracic spine’s rigidity and proximity to the heart, lungs, and other vital organs, surgery is less likely to be performed on the thoracic spine compared to the cervical and lumbar spines. Only in rare cases will an MRI or CT scan find an anatomic problem in the thoracic spine that is amenable to any sort of surgical solution for upper back pain.

What are the symptoms of a herniated disc in the upper back?

Herniated discs are more common in the lower back but they can affect the upper back as well. Discs are soft rubbery cushions located between each vertebra in the spine. Herniated discs occur when a piece of the disc pokes through and pressure gets placed on the spine, resembling a flat tire. Symptoms of a herniated disc include pain in the arms and legs or numbness.

In the upper back, herniated discs can cause a variety of symptoms. When a disc in the thoracic spine herniates, it can leak inflammatory proteins that lead to pain. This pain might radiate to the chest or abdomen, and in some cases, you might experience pins-and-needles tingling or reduced coordination.

Other causes of upper back pain can also contribute to these symptoms. For instance, poor posture can weaken and fatigue the upper back muscles, leading to strain. High-energy impacts like collisions or falls can damage the spine and surrounding tissues, often requiring immediate medical attention.

Additionally, conditions like compression fractures and osteoarthritis can exacerbate upper back pain. Osteoporosis, common in older adults, can lead to tiny fractures in the thoracic spine. Osteoarthritis involves the breakdown of protective cartilage, causing bone to grind against bone, leading to inflammation and bony overgrowths.

If you experience upper back pain accompanied by troubling symptoms such as fever, chills, or a severe headache, it’s crucial to see a doctor. These signs could indicate more serious underlying issues like infections, tumors, or severe deformities that require prompt medical evaluation.

Diagnosing Upper Back Pain

Upper back pain can be difficult to diagnose due to the variety of potential causes. However, our expert physicians are here to help you identify the root cause of your discomfort. This article will explore the symptoms, potential causes, and modern diagnostic methods for upper back pain to provide you with a thorough understanding of the process.

Symptoms and Potential Causes

Upper back pain can manifest in several ways, from sharp pain to a dull ache. The causes can range from muscle strain and poor posture to more serious conditions such as herniated discs or spinal infections. Understanding these symptoms and their possible origins is crucial in accurately diagnosing and treating the pain.

Diagnostic Methods

The exact cause of upper back pain becomes difficult to diagnose since there are several types. However, our expert physicians can help you pinpoint the reason for your pain.

The diagnostic process narrows down to a 3-step process.

1. Patient History

Our doctors need a complete patient history. This enables them to critically evaluate your situation and where the problem could have stemmed from. The patient history includes the following:

• When the pain started
• How your current symptoms feel
• Injury history
• Lifestyle and habits
• Family health history

2. Physical Exam

After the first step of getting the patient’s medical history, the doctor will conduct a thorough physical exam to help narrow down the cause of the upper back pain.

The process includes:

• Observation – The back is thoroughly observed for any abnormal bend in the neck or back.
• Palpation – The thoracic spine is pressed against your doctor’s hand. Your doctor slides his hand up and down your back while feeling for any tenderness, rib instability, or abnormality.
• Clinical Test – Some movement tests are performed to show which movements aggravate the symptoms and where.

3. Diagnostic Tests

To diagnose the cause of upper back pain, usually, one or more of the following tests are conducted:

• X-ray – A radiograph is used to create an image of the bones of the thoracic region. This shows any abnormality in the spine.
• MRI – Magnetic Resonance Imaging shows an even more detailed image of the spinal bones. It is the best method for detecting any spinal nerve or cord compressions, infections, tumors, and damaged ligaments.
• Medial Branch Nerve Block – This is the use of fluoroscopy to inject a numbing medication near the medial nerves that exist at the facet joint. If the numbing of the joint results in the disappearance of the pain, the source of the pain can be localized and used as a guide to further treatment.

Modern Treatments

Once the cause of upper back pain is determined, a range of modern treatments can be employed. These may include physical therapy, medications, or minimally invasive procedures designed to alleviate pain and improve quality of life.

By thoroughly understanding the symptoms, potential causes, and detailed diagnostic methods, you are better equipped to manage and treat upper back pain effectively.

Treatments for Upper Back Pain

Medications

The severity of the pain determines which treatment plans are adopted and which medications are administered to cater to the pain. Chronic pain requires a more severe approach than just mild fleeting pain.

Physical Therapy

Physical therapy is one of the most effective conservative treatments for upper back pain. It involves the manipulation of the muscles to get better use and relieve the pain.

Some techniques we can use include:

• Chiropractic Manipulation
• Massage Therapy
• Acupuncture

These techniques involve the gentle stretching of the muscles combined with strength training to help with reducing irritation. This also increases the ability of the muscles to withstand use and regain their respective functions. Physical therapy can help to mobilize your joints and reduce your overall discomfort levels.

Exercise

At the Southwest Scoliosis and Spine Institute, depending on what you need, our doctors may suggest that you’re instructed on an exercise regime to help in stretching your spine, shoulders, and muscles to achieve relief from pain.

Exercise for Prevention and Relief

Physical activity is essential not only for addressing upper back pain but also for preventing it from recurring. Research supports this: a meta-analysis of 16 studies found that regular exercise—combining strength training, stretching, or aerobic exercise performed 2 to 3 times a week—reduced the risk of back pain by 33%.

Expert Endorsement

“Exercising will prevent many back issues because it strengthens the muscles of the back and improves range of motion” says Dr. Hostin.

Specific Exercises to Try

If you already have pain or are looking to prevent it, incorporating movement done at a slower pace and with mindfulness can be beneficial. Here are some specific exercises recommended:
Arm and Leg Raises:

• Get down on your hands and knees in a tabletop position.
• Pull in your belly button and tighten your abdominal muscles to support your spine.
• While keeping your abdominals tight, raise one arm and the opposite leg away from you.
• Hold this position for 5 seconds.
• Lower your arm and leg slowly and change sides.

Scapular Squeeze:

• While sitting or standing with your arms by your sides, squeeze your shoulder blades together.
• Hold for 5 seconds.

Thoracic Extension:

• Sit in a chair and clasp your hands behind your head.
• Gently arch backward and look up toward the ceiling.

Thoracic Stretch:

• Sit on the floor with your legs out straight in front of you and hands placed on your thighs.
• Curl your head and neck toward your belly button.
• Hold for a count of 15.

Consistency is Key:

• The best exercise of all? The one you’ll continue doing. Consistency and frequency are more important than trying to choose the “perfect” exercise when it comes to strengthening your upper back and preventing pain.

Tips for a Healthy Upper Back

To maintain a healthy back, both upper and lower, there are some essential tips to guide your daily activities.

Correct Lifting

It is fairly easy to twist the wrong way and damage your spine if you are not lifting things properly. To lift correctly, you need to stand as close to the object as you can and use your legs and knees rather than your upper body.

Good Sleep

Your body requires good sleep to stay healthy and repair itself. However, it is best to sleep on your side and not on your stomach as sleeping on your stomach tends to put pressure on the spine. Additionally, evaluating your mattress and sleep setup can prevent back pain caused by improper sleeping positions.

Stretching

Starting your day with stretching not only feels good but also promotes good spinal health. Doing gentle stretches during work breaks can also help ensure your muscles aren’t in one set position for too long.

Stay Active

If you are not physically fit or if you are a couch potato, you are at a higher risk of having upper back pain. Try to stay active by taking walks, working out when you can, and constantly using your back muscles.

Maintain a Healthy Weight

Unhealthy weight gain could put a strain on your spine and increase your back pain. Consistent exercise and healthy eating habits can help to maintain a healthy weight and prevent upper back pain.

Change Your Position Often

Whether you’re seated or standing, changing your position more often during the day can prevent stiffness and pain. Standing up for a few minutes every hour or moving around if you are standing in one spot can make a significant difference.

Ergonomics Matter

Reconfiguring your work setup to be more ergonomic can prevent muscle fatigue and strain. For example, if you sit, evaluate whether your chair is positioned correctly in front of your desk or computer. If you stand, make sure you aren’t bending or straining the muscles.

Reduce Emotional Stress

Research suggests there’s a significant association between chronic low back pain and emotional stress. Taking steps to reduce stress, such as practicing yoga, going for a walk, or meditating, could help prevent back pain or keep it from worsening.

By incorporating these strategies, you can better manage and prevent both upper and lower back pain, ensuring a healthier, more active lifestyle.

Why Is Surgery Less Commonly Performed on the Thoracic Spine Compared to the Cervical and Lumbar Spines?

Surgery on the thoracic spine, which is the mid-section of your spinal column, is notably less frequent than procedures on the cervical (neck) and lumbar (lower back) spines. There are a few key reasons for this:

• Rigidity of the Thoracic Spine: The thoracic spine is designed to be more rigid and stable as it supports the rib cage and protects vital organs like the heart and lungs. This rigidity means there is less movement and, subsequently, fewer issues that can be corrected surgically.
• Complex Anatomy: The thoracic spine is surrounded by crucial structures, including major blood vessels and the aforementioned vital organs. This complex anatomy increases the risk associated with surgical interventions, making surgeons less likely to perform operations in this area.
• The rarity of Surgical Problems: Conditions that require surgical intervention in the thoracic spine are relatively rare. Most issues tend to be degenerative or muscular and can often be managed with non-surgical treatments such as physical therapy, medication, or lifestyle changes.
• Diagnostic Challenges: Diagnosing a problem that necessitates surgery in the thoracic spine often requires advanced imaging techniques like MRI or CT scans. However, even with these tools, it’s uncommon to find anatomical problems in the thoracic spine that can be effectively addressed with surgery.

Consequently, the combination of these factors means that when it comes to spinal surgery, the thoracic spine is often left untouched unless absolutely necessary.

Understanding the Differences: Thoracic Spine vs. Cervical and Lumbar Spine

Mobility

The cervical spine, located in the neck, is highly flexible, allowing for a wide range of head and neck movements. In contrast, the lumbar spine, found in the lower back, provides flexibility and supports the body’s weight, enabling bending and lifting movements.

The thoracic spine, which spans the upper and mid-back, is less mobile compared to its cervical and lumbar counterparts. This reduced mobility is because it’s designed to provide stability and support to the rib cage, which protects vital organs like the heart and lungs.

Injury Resistance

One key feature of the thoracic spine is its remarkable resistance to injury. The rib cage and the increased rigidity in this region offer robust protection against trauma. Additionally, its stable structure makes it less susceptible to common strain injuries.

In comparison, the cervical spine is more prone to injuries, such as whiplash, due to its greater range of motion and less support. Similarly, the lumbar spine is vulnerable to lower back pain and injuries, often resulting from lifting heavy objects or poor posture.

Summary

The thoracic spine stands out for its durability and limited mobility, which help shield it from injuries that frequently afflict the more flexible cervical and lumbar spine areas. This difference underscores the thoracic spine’s crucial role in providing stability and protection within the body’s framework.

Why Choose Southwest Scoliosis and Spine Institute

The spine is the specialty of our doctors and surgeons at the Southwest Scoliosis and Spine Institute. The physicians understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge and advanced training to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, and adults, and can help their patients get back to living the life they enjoy.

A few of the many reasons why patients choose the Southwest Scoliosis and Spine Institute.

• Expertise in the spine: The team of specialists is recognized as spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat spine patients. Southwest Scoliosis and Spine Institute doctors and surgeons are experts with offices in  Dallas, Plano, and Frisco,  TX.  They offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Call today to make an appointment.

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Footnote:

Medical News Today: Upper Back Pain