Treat Upper Back Pain

Upper back pain (in the thoracic region of the spine, below the neck and along the length of the ribs) is often the result of poor sitting or standing posture, or is due to minor trauma from playing sports or exercising. The pain is often characterized as achy and sore to the touch, which typically indicates a muscle strain. Muscle strains often respond well to rest or other home treatments and resolve within a few days. If your upper back has sharp and/or burning pain which persists for more than a week of self-treatment, seeing a healthcare professional is recommended.

Steps

Managing Upper Back Pain at Home

1. Change or take a break from your normal routine. Upper back pain is often caused by repetitive motions at work or minor injuries related to playing sports or vigorous exercise. As a first measure, take a break from the activity that may have resulted in the strain and rest for a few days. If your problem is work related, talk to your boss about switching to a different activity or improving the ergonomics of your work station. If the pain is exercise related, you may be working out too aggressively or with bad form. In this case, consult with a professional trainer or sports therapist.
   • Total bed rest is not a good idea for any type of back pain because some movement (even just leisurely walks) is needed to stimulate blood flow and healing.
   • Practice better posture at work and at home. Sit up straight and don't slouch or lean to one side excessively.
   • Examine your sleeping conditions. Mattresses that are too soft or pillows that are too thick may contribute to upper back pain. Avoid sleeping on your stomach as it can cause the head and neck to twist in ways that aggravate back pain.
2. Take over-the-counter NSAIDs. Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, naproxen, or aspirin can be short-term solutions to help you deal with pain or inflammation in your upper back. Keep in mind that these medications can be hard on your stomach, kidneys, and liver, so it's best not to use them for more than two weeks at a stretch.
   • Dosage for adults is usually 200 – 400 mg, by mouth, every four to six hours.
   • Alternatively, you can try over-the-counter analgesics such as acetaminophen (Tylenol) or muscle relaxants (such as cyclobenzaprine) for your upper back pain, but never take them when you are taking NSAIDs.
   • Be careful not to take any medications on an empty stomach, as they can irritate the lining of your stomach and increase the risk of ulcers.
3. Apply ice to your upper back. The application of ice is an effective treatment for essentially all minor musculoskeletal injuries, including upper back pain. Cold therapy is most effective for acute injuries (injuries that have occurred in the last 48 hours). Cold therapy should be applied to the tender part of your upper back in order to reduce the swelling and pain. Ice should be applied for 20 minutes every two to three hours for a couple of days, then reduce the frequency as the pain and swelling subside.
   • Compressing the ice against your back with a wrap-around elastic support will also help control the inflammation.
   • Always wrap ice or frozen gel packs in a thin towel in order to prevent frostbite on your skin.
4. Take an Epsom salt bath. Soaking your back in a warm Epsom salt bath can significantly reduce pain and swelling, especially if the pain is caused by muscle strain. The magnesium in the salt helps the muscles relax. Don't make the water too hot (to prevent scalding) and don't soak in the bath for much more than 30 minutes because the salty water will pull fluid from your body and start to dehydrate you.
   • If swelling is a particular problem in your upper back, then follow the warm salt bath with cold therapy until your back feels numb (about 15 minutes or so).
5. Try gently stretching your upper back. Stretching the affected area of your back might reverse the condition, especially if you address the problem during its early stages. Use slow, steady movements and take deep breaths during your stretches. In general, hold stretches for about 30 seconds and repeat three to five times daily.
   • Kneel on a padded surface with your buttocks resting on the soles of your feet. Then bend forward at the waist, walking your fingers forward as far as you can go while trying to touch your nose to the floor.
   • While standing, place both hands behind your head and slowly push your head backwards while arching or extending your spine so that your stomach sticks out.
   • While standing with your feet shoulder width apart (for stability and balance), place your arms in front of you, bent at the elbows, and in a controlled fashion, rotate your upper body as far as you can in one direction, then switch and do the other way a few seconds later.
6. Use a foam roller. Rolling on a piece of firm foam is a good way to massage your back and potentially relieve mild-to-moderate discomfort, especially in the mid back (thoracic) region. Foam rollers are commonly used in physiotherapy, yoga and pilates.
   • Pick up a foam roller at a sporting goods or big-box store — they're very inexpensive and nearly indestructible.
   • Place the foam roller on the ground, perpendicular to where you're going to lay your body. Lie down on your back so that the foam roller is beneath your shoulders. Your body and the roller should form a "t" shape.
   • Put your feet flat on the floor, bend your knees, and lift up your lower back so it rolls over the foam in a back and forth manner.
   • Use your feet to move your body over the foam, so that your entire spine is massaged (at least 10 minutes). Repeat as many times as necessary, although your muscles might be a little sore after the first time you use a foam roller.

Seeking Medical Help

1. See a medical specialist. Medical specialists such as an orthopedist, neurologist, or rheumatologist may be needed to rule out the most serious causes of your upper back pain, such as infection (osteomyelitis), cancer, osteoporosis, spinal fracture, herniated disc, or rheumatoid arthritis. These conditions are not common causes of upper back pain, but if home care and conservative therapies are not effective, then more serious problems need to be considered.
   • X-rays, bone scans, MRI, CT scan and ultrasound are modalities that specialists may use to help diagnose your upper back pain.
   • Your doctor may also send you for a blood test to rule out rheumatoid arthritis or a spinal infection.
2. Get a facet joint injection. Your upper back pain may be caused by chronic joint inflammation. A facet joint injection involves real-time fluoroscopic (X-ray) guidance of a needle through the back muscles and into the inflamed or irritated spinal joint, followed by a release of an anesthetic and corticosteroid mixture, which quickly relieves both pain and inflammation at the site. Facet joint injections take 20 – 30 minutes to do and the results can last from a few weeks to a few months.
   • Facet joint injections are limited to three within a six-month time frame.
   • The pain relief benefits from facet joint injections typically begin on the second or third day post-treatment. Until that time, your back pain may get a little worse.
   • Potential complications of facet joint injections include infection, bleeding, local muscle atrophy, and nerve irritation/damage.
3. Ask your doctor about scoliosis. Scoliosis is a sideways curvature of the spine that usually occurs in young people before puberty. It can cause pain in the upper and middle back. You may not notice mild forms of scoliosis, but even mild scoliosis can cause pain or worsen over time, leading to more serious complications such as lung and heart damage or changes to the body's appearance, such as uneven shoulders and hips and a prominent rib cage.
   • The doctor will check for scoliosis by asking the person to bend forward at the waist so he can see if one side of the ribs sticks out more than the other side. The doctor may also check for muscle weakness, numbness, and abnormal reflexes.
   • Learn more about managing pain caused by scoliosis by reading this article: Relieve Back Pain from Scoliosis.
4. Consider surgery. Surgery for back pain is the last resort and should only be considered after all other conservative therapies are proven ineffective and if the cause warrants such invasive techniques. Reasons for upper back surgery may include to repair or stabilize a fracture (from trauma or osteoporosis), to remove a tumor, to repair a herniated disc, or to combat a deformity such as scoliosis.
   • Spinal surgery may involve the use of metal rods, pins or other devices for structural support.
   • Possible complications from back surgery include local infection, allergic reaction to anesthesia, nerve damage, paralysis, and chronic swelling and/or pain.

Using Alternative Therapies

1. See a massage therapist. A strained muscle occurs when individual muscle fibers are taken beyond their tensile limits and subsequently tear, which leads to pain, inflammation and some degree of guarding (muscle spasm in attempts to prevent further damage). A deep tissue massage is helpful for mild-to-moderate strains because it reduces muscle spasm, combats inflammation, and promotes relaxation. Start with a 30 minute massage, focusing on your upper back and lower neck areas. Allow the therapist to go as deep as you can tolerate without wincing.
   • Always drink lots of water immediately following a massage in order to flush out inflammatory by-products, lactic acid, and toxins from your body. Failure to do so might cause a headache or mild nausea.
   • As an alternative to professional massage therapy, position a tennis ball underneath your body and between your shoulder blades (or wherever your upper back pain is). Roll on the ball slowly for 10 – 15 minutes a few times daily until the pain subsides.
2. See a chiropractor or osteopath. Chiropractors and osteopaths are spinal specialists that focus on establishing normal motion and function of the small spinal joints that connect the vertebrae, called spinal facet joints. Manual joint manipulation, also called an adjustment, can be used to unjam or reposition facet joints that are slightly misaligned, which triggers inflammation and sharp pain, particularly with movement. You can often hear a "popping" sound with a spinal adjustment. Traction techniques or stretching of your spine may also help your upper back pain.
   • Although a single spinal adjustment can sometimes completely relieve your back issue, more than likely it will take three to five treatments to notice significant results.
   • Chiropractors and osteopaths also use a variety of therapies tailored more towards muscle strains, which may be more appropriate for your upper back issue.
   • A chiropractor or osteopath may help with improving mobility in the joints.
3. Seek out physiotherapy. If your upper back problem is recurring (chronic) and caused by weak spinal muscles, poor posture or degenerative conditions such as osteoarthritis, then you need to consider some form of rehabilitation. A physical therapist can show you specific and tailored stretches and strengthening exercises for your upper back. Physiotherapy is usually required two to three times per week for four to eight weeks to positively impact chronic back problems.
   • If need be, a physical therapist can treat your sore muscles with electrotherapy such as therapeutic ultrasound or electronic muscle stimulation.
   • Good strengthening exercises for your upper back include swimming, rowing, and back extensions, but make sure your injury is resolved first.
4. Try acupuncture. Acupuncture involves sticking very thin needles into specific energy points within the skin in effort to reduce pain and inflammation. Acupuncture for back pain can be effective, especially if it's done when the symptoms first occur. Based on the principles of traditional Chinese medicine, acupuncture works by releasing a variety of substances including endorphins and serotonin, which act to reduce pain.
   • It's also claimed that acupuncture stimulates the flow of energy, referred to as chi.
   • Acupuncture is practiced by a variety of health professionals including some physicians, chiropractors, naturopaths, physical therapists, and massage therapists.
5. Talk with a mental health professional. Though it may initially seem counter-intuitive to see a mental-health professional for physical pain, cognitive-behavioral therapy has shown to help reduce stress and back pain in many people.
   • Keeping a pain diary can also help you deal with your pain and it can be useful information to bring to your doctor.
   • Stress-relieving practices like meditation, tai chi, and breathing exercises have been found to help alleviate chronic pain and help prevent future injury.

Tips

• Avoid carrying bags that distribute weight unevenly across your shoulders like single-strap messenger bags or purses. Instead, use a bag with wheels or a traditional two-shoulder backpack with well-padded straps.
• To maintain proper posture when standing, stand with your weight equally distributed over both feet and avoid locking your knees. Tighten your stomach and buttock muscles to keep your back straight. Wear flat and supportive shoes if you’ll be standing for long periods of time; alleviate muscle fatigue by periodically resting one foot on a small footstool.
• Quit smoking because it impairs blood flow, resulting in oxygen and nutrient deprivation to spinal muscles and other tissues.
• To maintain proper posture when sitting, choose a firm chair, preferably with armrests. Keep your upper back straight and your shoulders relaxed. A small cushion behind your lower back can be helpful in maintaining the natural curve of your back. Keep your feet flat on the floor, using a footstool or other flat surface for assistance if necessary. Stand up and stretch periodically to keep muscles from tensing up.

Warnings

• See a doctor immediately if:
  • Your back pain is accompanied by fever, numbness, tingling, abdominal pain, or sudden weight loss
  • Your injury is the result of serious trauma like a car accident
  • You have loss of bladder or bowel function
  • Your feet suddenly begin to drag significantly
  • You experience pain for longer than six weeks
  • The pain is constant and continues to get worse
  • You experience severe or worsening pain at night
  • You’re over 70 years of age

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