Upper Back Pain

In humans, the spine is most vulnerable in the neck and upper back. The neck is vulnerable due to it being the most flexible and movable part of the spine and thus at most risk to injuries such as whiplash and cervical spine injuries. The bones and discs of the neck are located away from the trunk of the body and thus do not have the same type of protection as the soft tissues that are embedded within our thick torsos. The elements of the lumbar spine (lower back) are less at risk to injuries due to their being less mobile and flexible. What these structures are at risk for is degenerative processes related to the stress that is put upon them due to the effects of gravity. The lumbar vertebrae and discs take on increased stress due to their location at the bottom of the spine. The structures above them bear down on the lower back as we sit upright, stand, and lift heavy objects. Symptoms that are related to injuries in the neck area are described as neck pain. Symptoms that are related to arthritis and degenerative changes to the lower back are described as low back pain.

Upper back pain describes pain in the upper back. The physical upper back may also be referred to as the mid-back, middle back, or thoracic spine. The thoracic spine (T-Spine) includes all of the structures including and between the 1st thoracic vertebra at its top (T1) and the last thoracic vertebra at its bottom (T12). This may refer to any pain that is located between the upper back to the bottom of the chest cavity (thoracic spine). The same injuries and conditions that may cause neck pain and low back pain may also affect the structures of the upper back, though these types of injuries are far less common. This type of pain may be painful and disruptive to the lives of its victims when it does occur.



Degenerative conditions that are common in the lower back, such as degenerated discs and thoracic herniated discs sometimes are the cause of symptoms, but they are comparatively rare. Upper back pain is more commonly caused by joint dysfunction or muscular irritation (myofascial pain) in the thoracic spine.

The physical makeup of the T-Spine is very different compared to the sections in the neck and lower back. The thoracic vertebra forms the posterior wall of the thoracic cavity and has attachments to all 12 ribs. Medical conditions that affect the ribs and the organs of the thoracic cavity may also be experienced as upper back pain symptoms.

The cervical spine (neck) and lumbar spine (lower back) are designed for flexibility and mobility. The T-spine, however, is designed for stability and strength, in order to protect the vital organs of the thoracic cavity, such as the heart and lungs. A healthy T-Spine allows us to stand upright as well. Because there is such limited movement in this section of the spine, there is little risk to injury and the degeneration of the discs.

Anatomy of the Upper Back: The thoracic cavity is also known as the chest cavity. The anterior wall of the chest cavity is made up of the front of the ribs, sternum, manubrium, and clavicle. The posterior wall of the chest cavity is made up of the back of the ribs and the thoracic vertebrae. Within this cavity are the heart, lungs, pulmonary veins, pulmonary arteries, trachea, esophagus, and thyroid. Upper back pain may be a symptom of diseases to these organs. Conversely, anatomical anomalies in the thoracic spine, such as Kyphosis (Dowager's hump) may affect a person's posture and ability to breathe freely.

Causes of Upper Back Pain: Upper back pain may occur due to muscle strain associated with the upper back, trauma, and injury. Out upper backs may also be affected by our posture. People in occupations that require them to lean forward and slouch all day, such as office workers and software developers, have an increased risk to suffering from this type of pain. Computer jobs may also contribute to neck and shoulder pain as well.

Myofascial Pain (muscular irritation): The shoulder girdle is made up of the humerus (arm), scapula, and clavicle (collar bone). These bones are connected by joints and muscles which aid breathing, the elevation of the chest cavity, and the movement of the arm around the ball and socket joint where the arm connect to the scapula. These muscles may become irritated when overworked, as may occur in sports injuries and occupational hazards.