Upper Back Pain

The upper back, or thoracic spine, is the area between the neck and low back.

Upper back pain is pain that is felt between the bottom of the neck and top of the low back (lumbar spine). The upper spine is very strong and stable to support the weight of the upper body, as well as to anchor the rib cage which provides a cavity to allow the heart and lungs to function and protect them. But, often times the musculoskeletal support for this system can break down, resulting in upper back pain.

Anatomy

The upper back (thoracic spine) comprises the upper portion of the spine that corresponds to the chest area. The upper spine includes twelve vertebrae, and each of the upper nine vertebrae in this section attach to ribs on either side of the spine.

Each of the ribs then curves around the side of the body and attaches to the breastbone in front. This forms a sturdy structure (the thoracic cage) that supports and protects the internal organs - the heart, lungs and liver.

In addition, the muscles of the thoracic spine (paraspinals) are numerous. They are responsible for the majority of upper-mid back movements as well as a number of upper extremity movements and are a common source of injury and pain.

Symptoms

-Pain (sudden or chronic): Acute (sudden) pain is usually a result of trauma or flare-up and Chronic pain is experienced for a very long time (3 months or more)
-Weakness which might make it difficult to perform everyday activities properly
-Strong pain in legs, arms and hand
-Bowel problem
-Stiff muscles waking up in the morning
-Sudden tightness in neck, back, arms or legs
-Numbness of muscles or extremities
-Increased pain with coughing, laughing, or sneezing

Common Causes

-Muscular irritations or improper movement of joints
-Disc injuries in the upper back
-Excessive or no exercise
-Poor posture and ergonomics
-Obesity or excessive weight gain

Treatment

For Sudden (Acute) Upper Back Pain place a cold pack over painful muscles and avoid things that may increase swelling (i.e. hot showers, hot tubs, hot packs, alcoholic beverages) for 48 to 72 hours.

In addition, at Green Health Acupuncture we provide gentle massage to the affected areas allows increased blood-flow, which will help the affected tissues heal faster.

Studies show exercise and manual therapy (i.e. acupuncture, massage therapy), used either separately or together, are beneficial in the treatment of uncomplicated upper back pain and allow quicker recovery periods. In more severe cases, injections and/or surgery may be necessary following appropriate diagnostic imaging.

For Long-Lasting (Chronic) Upper Back Pain the same protocol for acute upper back pain can be utilized for chronic upper back pain. In addition, the presence of a longstanding condition warrants additional care. Manual therapies, such as chiropractic, acupuncture, massage therapy, physical therapy, and structured exercise programs are extremely effective in decreasing pain and preventing future injury.

In addition, it is important to identify causative factors of your daily life that could possibly be the cause of upper back pain (i.e. poor posture at work, poor sleeping habits, etc.). Maintaining good health habits are also integral for long-term relief of upper back pain. If possible, reduce stress and tension at work and home. Stop smoking.

Smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking and eat a healthy diet to maintain an overall balanced body.

Prevention

-Participate in a wellness program like those offered at Green Health Acupuncture (i.e. acupuncture, massage therapy, physical therapy, personal training program, etc.), to maintain correct biomechanical balance, promote healthy whole body functioning, and increase strength of musculature to prevent injury.

-Perform exercises to strengthen/stretch neck and shoulder muscles, especially prior to activity

-Learn proper posture, ergonomics, and sleep habits

-When lifting, always get close to the object, bend your knees and grasp the object firmly, lift straight up (don't twist!) in one fluid motion, hold the object close to your body, move close to where you want to place the object, and bend your knees when lowering the object

-Maintain proper back & neck support for your car/bed/sofa/chair

-Perform regular exercise, eat right, don’t smoke, and stay hydrated

*Correct posture when standing should look like the following:

-Feet slightly apart

-Knees straight

-Chin slightly tucked in

-Shoulders back

Common Upper Back Conditions

Thoracic Strain/Sprain

Strains and sprains of the upper back are the most common cause of upper back pain. Strains/Sprains are often caused by overuse of a muscle or overloading a muscle. When a muscle is stressed beyond its limits, injury occurs.

A muscle strain (or pulled muscle) is an overstretched or torn muscle. With injury comes inflammation, which is part of the healing process. Inflammation causes pain and can also trigger muscle spasms. The severity of a muscle strain can range from mild to severe.

These types of injuries occur due to overuse-type injuries (i.e. poor posture while working at the computer), sports injuries (overexertion of upper back ligaments/muscles), and poor posture (sleeping and work station).

Common symptoms of thoracic strains/sprains include: pain in the upper back that increases with movement, pain in shoulders, delayed onset back pain that shows up 24 to 48 hours after a neck injury, muscle spasms or pain in the upper regions of the shoulders/back, headache, and stiffness/decreased range of motion in the upper back.

The treatment provided at Green Health Acupuncture can decrease the amount of recovery time through our comprehensive rehabilitation program.

Herniated Thoracic Disc

Herniated discs occur mostly in the lumbar and cervical spines, thoracic spine disc herniations account for only 1-2% of all herniated discs. Even though, thoracic disc herniations are less common in the upper back, they can still present a muriad of painful symptoms.

A herniated thoracic disc occurs when a nerve root is irritated and/or compressed as a result of a thoracic disc’s inner core extruding through the outer core. This extrusion can then come into contact with the nerve root and cause interference within the nerve.

The first symptom of a herniated disc is usually pain. The pain is most often felt in the back, directly over the sore disc. If the herniated disc is in the thoracic spine, the pain may also radiate around to the front of the chest. Depending on the location of the thoracic disc herniation and which thoracic nerve is affected, various symptoms may occur.

Unlike cervical and lumbar disc herniations that cause radicular symptoms up or down the spine, thoracic spine herniations can cause that will radiate around the chest and squeeze the sufferer as if they were in a vise. Pressure or irritation on the nerves in the thoracic area can also cause other symptoms. Depending on which nerves are affected, a thoracic disc herniation can include pain that feels like it is coming from the heart, abdomen, or kidneys.

Herniated thoracic discs sometimes press against the spinal cord causing muscle weakness, numbness/tingling in one or both legs, increased reflexes in one or both legs that can cause exaggerated movement, and in severe cases, changes in bladder or bowel function and possible paralysis from the waist down.

At Green Health Acupuncture, we offer non-surgical treatment measures such as acupuncture, chiropractic (traction/distraction therapy), and physical therapy modalities which often provide relief of cervical disc symptoms within 6-12 weeks.

In serious cases when relief is not achieved, orthopedic referral may be necessary to determine if more invasive measures are needed. A surgery can be performed by a spinal surgeon that removes the pressure on the irritated nerve(s) and creates more room for it to heal and function.

Thoracic Degeneration (Bone Spurs and Osteoarthritis) aka Mid-Back Arthritis or Spondylosis

Spinal osteoarthritis affects more than 20 million Americans and is more common in women than in men. It is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual to each person affected.

A bone spur (known as an osteophyte) is an enlargement of the joints stabilizing the thoracic spine. Bone spurs are smooth structures that can grow on thoracic vertebrae and tend to occur in adults over 50 years of age. Bone spurs can biomechanically impede function of the thoracic spine.

Patients with thoracic spine bone spurs may or may not have symptoms, which could include upper/mid back pain and/or referred pain and weakness in the chest, thorax, shoulders and arms. Pain associated with thoracic degenerative disease is often triggered by forward flexion and hyperextension.

Thoracic osteoarthritis is typically treated at our clinic with chiropractic, traction, strengthening, and physical therapy modalities. Low-impact or non-weight-bearing activities, such as walking, stationary training, and light weight training work best for patients with osteoarthritis.

In addition, use of strengthening exercises are important and if you are overweight, start exercising to decrease added weight on the spinal structures (stair climbing, water aerobics, Theraband workouts, and similar exercises will help to keep the joints mobile without straining them).

Green Health Acupuncture will evaluate your specific needs and develop a customized exercise program to maximize your body’s potential and strengthen body structures to reduce pain and prevent further injury.

Kyphosis aka "Rounded Back"

Kyphosis is a progressive spinal disorder that can affect children or adults. This disorder may cause a deformity described as humpback or hunchback. Abnormal kyphotic curves are more commonly found in the thoracic or thoracolumbar spine, although they can be cervical.

Causes of kyphosis include: postural round-back, Scheuermann's Disease (juvenile disease), congenital kyphosis, kyphosis associated with neuromuscular disorders, and kyphosis secondary to trauma, tumors, infection, and arthritis.

Kyphosis can be considered postural or structural. Postural means the kyphosis is attributed to poor posture, which can be corrected by the patient. Structural kyphosis is caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or muscles. Kyphosis with a structural pathology may require medical intervention because the patient alone cannot control curve progression.

Most often patients exhibit kyphosis or “rounded-back” as a result of poor posture while sitting, standing, or during activities. This condition can be treated at our clinic conservatively achieving excellent results. Treatment recommendations include physical therapy/massage therapy for strengthening/elongation of weak muscles, and acupuncture for associated pain relief.

Scoliosis

Scoliosis affects about 2% of the population. It’s most common in young girls, but boys and adults can have scoliosis as well. Scoliosis is defined as a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Deviance from the midline greater than 10 degrees is described as scoliosis.

In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis.

Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. There are three other main types of scoliosis: Functional (caused by another problem in body like shortened leg or muscular imbalance), Neuromuscular (caused by a problem when the bones of the spine are formed from birth defects, muscular dystrophy, etc.), and Degenerative (Occurs in older adults caused by changes in the spine due to arthritis).

The most common symptom of scoliosis is an abnormal curve of the spine and possible associated back pain. Often this is a mild change and may be first noticed by a friend or family member. It can also be found on a routine school screening examination for scoliosis.

Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain. Most often there is no pain associated with scoliosis, but progression of scoliosis can produce pain/dysfunction.

Diagnosis of scoliosis is accomplished by physical examination and x-ray studies. The more growth that a person has remaining increases the chances of scoliosis getting worse.So, continual assessment of the spine is suggested so the physician may track the progress of the curvature and provide treatment accordingly.

Treatment of scoliosis is based on severity of the curve and the potential for the curve to increase. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment.

Functional scoliosis can be treated conservatively by strengthening muscles, massage therapy, and using chiropractic adjustments to promote relaxation and retraining of the back muscles. For more serious types of scoliosis, conservative measures may also be applied, but may need bracing or surgical intervention if spinal function or organs are compromised.

Come in to Green Health Acupuncture today to have you or your child examined for scoliosis.

Green Health Acupuncture, Inc.
A Professional Acupuncture Corporation
150 West 6th Street, Suite 200
San Pedro, CA. 90731
310-831-2202
© 2010 Green Health Acupuncture, Inc.,