Upper back pain

Upper back pain, also called middle back pain or thoracic pain, is pain that is felt between the bottom of the neck and top of the 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.

Anatomy of the upper back
The word “thoracic” means pertaining to the chest, and the 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 the a rib 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 throracic cage) that supports and protects the internal organs - the heart, lungs and liver.

Causes and solutions
The most common cause of upper back pain is muscular irritation or other soft tissue (e.g. ligament) problems. These can arise from lack of strength, poor posture, overuse injuries (such as repetitive motion), or a trauma (such as a car accident or sports injury). Muscular strain in the upper back is usually treated by one or a combination of the following:


 * Exercise/Active and passive physical therapy
 * Chiropractic or osteopathic manipulation
 * Deep massage or massage therapy
 * Acupuncture
 * Ice and/or heat therapy
 * Pain medication, such as NSAIDs

If there is a specific tender spot, then trigger point massage or injections can be helpful.

Another cause of upper back pain is problems with the joints that connect the vertebrae and the ribs. Treatment for joint problems such as this usually includes:
 * Manual manipulation (with an osteopathic physician or chiropractor)
 * Exercise and physical therapy
 * Pain medications, such as anti-inflammatory medications

A compression fracture of the vertebra can also cause acute and/or chronic pain in the upper back. Especially for women over age 50 with complaints of upper back pain, a vertebral compression fracture due to osteoporosis should always be considered a possibility. A painful vertebral compression fracture may be treated with pain medication and rest, or with vertebroplasty or kyphoplasty surgery.

Other, less common causes of upper back pain include a spinal disc herniation, degenerative disc disease, or some type of trauma (such as a fall) that may have fractured a vertebra in the thoracic spine.