The usual primary cause for upper back pain is muscle strain resulting from poor posture. Other less common causes are back injuries like a vertebral fracture, car accident trauma and scoliosis; and other secondary reasons for upper back pain that are more systemic in nature need to be ruled out by a Doctor of Physical Therapy or a physician.
Physical Therapy is the main form of rehabilitation for pain caused by an upper back strain. The physical therapist would help you address the underlying causes of poor posture and home in on the exact joints and muscles that are causing the pain. Your physical therapist can help work with your body through exercise, posture re-education and manual therapy on joints and muscles to restore you to a better and pain-free range of movement. In the process of visiting a physical therapist, you could also very well learn how to minimize and avoid the reoccurrence of upper back pain.
Posture re-education is the crux of healing most upper back pain. It can be difficult to change habits that have formed over decades of life, but a physical therapist can gradually coax the body to improve its posture through progressive strengthening of postural muscles and teaching the patient different cues to obtain this. Sometimes we use mirror aids to help the patient see their dysfunctions, and at other times, we address their work desk environment to help facilitate a healthier posture.
Physical therapy often involves a combination of active and passive methods. Passive treatments relax muscles that have spasmed and have become tight and guarded. These are called passive treatments because the patient does not have to actively participate, and the physical therapy does the work with his/her hands. Your joints in the upper back may need to be worked on as well to promote healthy joint kinematics, and this usually involves the physical therapist mobilizing the joints themselves. This is typically a painless procedure, and the patient usually feels a lot of relief afterward. Your physical therapy plan of care may start first with passive procedures to allow the back to calm down and reduce pain and spasms, but the eventual goal of physical therapy is to have the patient be engaged in active treatments.
Following are a list of examples of passive treatments:
- Deep tissue mobilization: This involves relieving chronic muscle tension, built up by excessive guarding, stress and daily strain on the muscle. The muscles of the upper back may tense up to protect a faulty or injured joint. Your physical therapist will use direct manual pressure, and may use other methods like cupping, ASTYM, or Graston to achieve this. Deep tissue work can be very beneficial in allowing the muscle tissue to release and heal, especially when paired with gentle flexibility and stability exercises.
- Heat therapy: Heat therapy may be recommended or performed by your physical therapist. The application of heat allows for vasodilation and more blood flow to the target injured area and muscle. Since blood contains a lot of restorative nutrients and oxygen, increasing blood serves to facilitate a more rapid healing.
- Cold therapy: Cold therapy is usually applied if the injury is acute and fresh, and when there are signs of inflammation in the injured area. Cold therapy is sometimes useful as a numbing agent if the pain in the area is very distinct and localized.
- Transcutaneous electrical nerve stimulation (TENS): A TENS machine may be recommended to you by your physical therapist or by a physician. TENS machines work by passing an electric current to the region of pain. The electric current varies from each individual and depends on the patient's tolerance. The parameters are set to a safe level where the patient can wear it on them for a long period of time. (However it is NOT advisable to use a TENS machine when you are pregnant, have any form of cancer, have a pacemaker, or in water) A TENS machine works by increasing your production of endorphins (a natural painkiller made by your body) and by stimulating the gate mechanism of pain modulation. The gait mechanism works by giving the patient a vibratory sensation that competes with and supersedes the pain sensations, thereby reducing the pain non-narcotically. Typically, physical therapists choose to use this method when the patient's pain is high and difficult to manage.
As mentioned earlier, the goal of physical therapy is to encourage active participation on posture re-education and strengthening so the patient is armed with the knowledge of how to prevent recurrence of the upper back injury. The active component of physical therapy involves teaching you various therapeutic exercises to help improve flexibility of the chest and paraspinal muscles, as well as strengthening the muscles that help keep good posture alignment so that the posture retraining becomes more effortless. Range of motion is emphasized because oftentimes the upper back pain is due to stiffness and inability to move in certain directions. Core stability is also emphasized to bolster posture and decrease occurrence of future low back pain. Core stability also helps tremendously with return to sports and more strenuous activities that involve trunk and extremity control. Your physical therapy program tailored to you and your history of upper back pain, so each plan of care is individualized to the patient. Though a set of exercises may help you, it may not be that they are transferable to other patients with upper back pain – especially since the exact cause and joint dysfunction may be very different in origin.
As mentioned earlier, posture and ergonomic changes is the crux of upper back physical therapy. The biggest activator of this is the patient and needs full cooperation for success in rehabilitation and future prevention. Though staying with bad posture may seem more comfortable at its present injury, it is only a result of weakened deconditioned muscles staying in their laziest form. Though strengthening and posture retraining may feel and sound difficult, the goal is to create muscles in the back and core that do not require being lazy and inactive to feel comfortable and pain-free.
Staying strong, stable and flexible is the mainstay of recovering from upper back pain. It starts with passive methods by a physical therapist, but adherence of the home exercise program that they prescribe will guide you to a healthier and more pain-free habit of living. Come visit one of our convenient Portland area clinics and have one of our therapists help you with your upper back injury treatment today!