Upper Back Pain

The upper back is composed of the ribs, the 12 thoracic spinal joints and discs and a multitude of muscles involved in trunk motion and shoulder control and power.

Pain in this area is most often caused by poor posture, particularly with our day to day desk and phone/tablet use.

The stiffness caused by this posture can lead to thoracic spinal facet joints becoming locked which is very painful. The ribs can also be impacted and effect rotation and cause breathing disorders.

Growth issues can cause scoliosis which is where the spine grows irregularly and leads to a twist of the thoracic spine. Careful treatment and monitoring of this are is essential to ensure that long term function is preserved.


  • Spinal (Thoracic) joint pain

    The 12 joints of the thoracic spine each have a disc between the bony body and a pair of facet joints at the back. The discs do not often cause problems, certainly not as often as in the low back. However, in more elderly patients or those with osteoporosis / osteopeania there is a risk of fracture in the bones leading to a change in the shape.

    The facet joints are the most common structure to be affected with stiffness causing these to stop sliding and gliding well and this leads to them becoming stuck on each other. This can be both acutely painful as well as creep up in a general ache and stiffness type pain.

    There is a lot we can do for you with this type of pain including mobilisation, manipulation and exercise.

  • Scoliosis

    This is where the spine has a sideways curve usually “S”- or “C”-shaped. Sometimes the curve is stable, occasionally it increases over time. Mild scoliosis does not typically cause problems with many of us having it without ever knowing. It is found in about 3% of people and mostly between the ages of 10 and 20. Girls more than boys. Typically, no pain is felt but there can be more postural aches and pains when sitting and sometimes issues with certain sports such as tennis or swimming.

    Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 49513

    We don’t really know why it happens but it is likely to be a combination of genetic and environmental factors. Diagnosis is confirmed with X-rays and is classified as either structural with a fixed curve, or functional where the underlying spine is normal but it moves oddly.

    Treatment depends on the degree of curve, location, and cause. Alongside the more traditional treatments of monitoring, braces and even surgery, there are benefits in manipulation, mobilisation, and exercises. Having the condition regularly monitored and mobilised to help the aches and pains that come from daily living, as well as strength work targeted at the imbalances and weaknesses.

    We are very used to treating youngsters with this and have seen many through their adolescent years as well as rehabilitated several people following surgical corrections.

  • Rib and breathing issues

    The ribs attach into the thoracic spine at the back and the sternum at the front. This direct relationship means that an issue in one invariably means an issue in the other.

    Posture is the pain problem for both, leading to stiffness and dysfunction. Further, things like a fractured rib mean a period of immobility and altered movement and inevitably leads to the same sort of stiffness. So even if the rib has healed please get yourself looked at to reduce the chance of a longer-term issue.

    Breathing is integral with the diaphragm and abdomen and we often find that issues lower down in the body originate in the thoracic spine and ribs.