Upper Back Pain: Rehabilitation Tips and Exercises

 What is upper back pain?

Upper back pain is the pain originating from neck and reaching up to the middle of the back (lumbar portion of the spine). Upper back is useful for maintaining our erect posture as well as it is designed specially to protect the internal organs.

Irritation in the muscle or joint dysfunction is the commonest cause for upper back pain. Upper back muscles are very large and any trauma or injury can cause irritation which leads to significant pain. Wear and tear injuries (caused by repetitive movements) as well as lack of physical conditioning (less physical activity) can also cause muscle irritation. Dysfunction in the joints connecting ribs and vertebrae could also be cause for pain. Less often, disc problems such as herniated or prolapsed vertebral disc could lead to significant pain in the upper back.

The other causes for upper back pain are:

•    Sitting in the same posture for considerable time without moving anywhere for e.g., sitting in front of computer for a long period of time

•    Obesity and poor nutritional supplements can also cause back pain

•    Lifting heavy objects

•    Shoulder problems such as bursitis, separation, fracture, arthritis and tendonitis can also cause upper back problems

•    Lung diseases (sometimes cancer) and respiratory illness 

•    Muscle spasms: this occurs when muscles have been over stressed. Strenuous activities can sometimes lead to muscle spasms contributing to upper back pain

Upper back pain presents as sharp pain, spine aches or stiffness. Dull chronic aches are seen after prolonged sedentary position. Weakening of muscles due to poor posture along with strained joints sets the stage for further progression of upper back pain. Trapezius muscle is the most commonly affected muscle as it is a large muscle present in the upper back and is involved in different actions of the shoulders, neck and the lower back.

Types of back pain:

These include acute or chronic pains. Acute pain occurs due to trauma or accident to the upper back. Chronic pain which lasts for more than 3 months is usually associated with some disease conditions like arthritis, disc degeneration etc.

Based on the location of the pain upper back pain can also be classified as:

•    Upper right back pain

•    Upper middle back pain

•    Upper left back pain

Treatment of upper back pain:

Rest is the first thing that has to be tried in upper back pain. Inadequate sleep and improper sleep positions could also lead to upper back and neck pain. Triggering factors and all stressful conditions that are related to upper back pain should be avoided.

In case of acute pain, applying ice and hot packs can minimize pain. Ice packs could be placed on the pain area for 20-30 minutes till pain subsides. Hot and cold packs can minimize inflammation as well as prevent pain progression.

Medications commonly advised include pain killers and anti inflammatory agents. In case of severe chronic pain, opioids like codeine, morphine may be advised.

Other alternative treatment options include massage therapy, chiropractic manipulation, acupuncture and physiotherapy. Trigger point injections of lignocaine (which is a local anesthetic) may be given to any tender area of the upper back to control pain. 

Passive treatments for upper back pain include:

•    Massage to deep tissues: in this, application of pressure and friction relieves muscle spasms and decreases stress buildup within the muscles

•    Transcutaneous electrical nerve stimulation: electrical stimuli are used to relieve muscle spasms and pain relief

•    Ultrasound can also be used for increasing blood flow by the use of sound waves

Rehabilitation exercises:

Rehabilitation exercises are crucial for recovery from back pain, various exercises are advised in individuals suffering from upper back pain. The rehabilitation exercises can result in an improvement in flexibility of the joints in the back, strengthen the muscles and increase range of motion. Individualized exercise plan are generally advised to ideally suit a particular individual suffering from a particular type of back pain.

The first and foremost step will be to correct the body’s posture by adopting ergonomic principles.

Back Stretching Exercises

Stretching exercises should be done daily to relieve pain. Some of the common exercises include:

•    Pelvic tilts

•    Knee to chest stretching

•    Chest stretch

•    Arm and knee stretches

These stretching exercises are usually done to loosen the stressed muscles. The important point to remember is to perform a bit of warm up exercise like a short walk or jog before stretches to get the maximum benefit.

Shortened muscles can also lead to upper back pain. This can cause misalignment of spine, causing severe pain. Exercising for tightened hamstring (back of thigh), quadriceps (thigh muscles), can loosen them thus causing proper alignment.
Another advantage of stretching exercise is that it improves mobility of the back bones and spinal muscles.

Strengthening exercise

This type of exercise should be practiced in moderation to avoid excessive back strain. Strengthening the muscles like quadriceps can help in avoiding injury as well as in providing strong back support. Strengthening exercises need not be done daily. Performing these exercises 3-4 times a week will suffice but, it may take a longer time for the results to become noticeable.

Some of the strengthening exercises include:

•    Crunches (abdominal exercises)

•    Squats

•    Leg lifts

•    Backward leg swing

Balancing exercise

The important muscles in the back which help in balancing are the target of these kinds of exercises. Arm and leg extension, using exercising ball are some types of balancing exercises that are generally advised to relieve back pain.

Low intensity aerobic exercises

These are relatively safe for those with chronic back pain and also help in decreasing excess body weight. In people with weak muscles, gradual exercise buildup is advised. Walking, jogging and swimming are all aerobic exercises; water exercise is also a part of aerobic workup.

Rehabilitation tips:

Upper back pain arising from less severe causes like muscle spasms, irritation and joint dysfunction can be cured or prevented by following some useful tips given below:

•    Avoid uncomfortable postures

•    Ensure proper care while lifting heavy weights so as not to cause damage to the spine

•    All exercises should be performed in the presence of appropriately qualified persons

•    Always start up exercise should be light

•    Deep breathing and other relaxation techniques will help control back pain

•    Routinely performing exercises is a must

•    For chronic pain, weight reduction and identifying and treating underlying disease cause is the main factor to be considered