It is important to understand however, a number of serious diseases such as heart attack, dissecting aneurysm of the aorta, lung cancer etc can cause upper back pain.

A medical checkup is essential, if passage of time has not already proven your pain's cause is benign.

Your pain here, may be coming from an internal organ ( in some cases, due to the serious diseases alluded to and needing very urgent medical attention.) Usually however it is from the spine between your shoulder blades, your rhomboid muscles or referred from your neck.

The other side of the coin is that mechanical disturbance of your thoracic spine can produce symptoms other than pain, such as breathing difficulty or palpitations.

This can mimic or aggravate symptoms of diseases of internal organs, such as asthma or angina.

Referred upper back pain

Pain is often felt at a distance from it's source.You will find it described as “referred” pain, here referred from the neck to the back.

It isn't always one or the other however. Two or more causes for the one pain, can co-exist. This is particularly likely if a pain is frequent or persistent.

Your pain may be partly referred and partly from a local problem in your thoracic spine.

Multifactorial pain management approach

Pain is often accompanied by various changes in our body. Some such as depressed mood, are obvious. Other changes include reduced breathing, adrenal hormone changes and muscle spasm. Our brain mechanisms for experiencing pain, can get "wound up" and do the job better.

This last condition of "wind up" can be treated with the little known modality "neural therapy." Look up Dr. Dietrich Klinghardt and the  Huneke brothers for details.

Each of these processes can then contribute to the pain (and disability.) Holistic pain management deals with them all at the same time.

Back to upper back pain and posture.

ergonomics of sitting at a computor

The pelvis has rotated in the position of the person on the left, straightening out the normal curve of the small of the back.

Your hip joint can bend up to more than 90 degrees, but it doesn't normally without also rotating the pelvis. The curvature of the low back is maintained in the person on the right.

The ergonomic kneeling chair on the right, combined with the sloping working surface and elevated screen, is the way to go.

Good posture looks wonderful too! You don't see models slouching on catwalks. It also gives one a good feeling. The Alexander technique is one method for changing habits of posture and thereby states of mind.

See more on the postural and deportment page.

Test yourself for your relaxed head posture

You can easily test yourself to find the head posture when your neck muscles are most relaxed.

Dig the fingers of one hand, under the inside edge of the Sterno-mastoid muscle on that side, which runs down the front of your neck beside your voice box.

Now look up at the ceiling. You will notice that with your head as far back as it can go, this muscle has tightened up. Now slowly bring your head forward, until this muscle suddenly relaxes.

This is the position.

How to improve posture

My mother used to tell us to "reach for the sky with the back of your head."

One simple exercise to improve posture, is to get into the habit of trying to look over things to see what is behind them.

Another is to have some cheap adhesive tape remind you every time you start to bend over. You need someone to apply it, starting inside your breast, then up and over your shoulder and down your back, on each side.

Stand up as straight as you can, as the tape is applied. Now hold that posture. Every time you start to sag, the tape will tighten up and remind you. You can leave it on for progressively longer periods, as you get stronger.

Yoga can also fix your posture and help you to relieve a back pain problem.

The BackTone, TruPosture and iPosture devices are more upmarket products which remind one when one slouches, so one can practice straightening up.

Large breasts can aggravate upper back pain by placing a continual strain on the muscles here, especially if one has less than perfect posture. Breast reduction surgery can greatly help upper back pain.

You don't have to bend with osteoporosis

Osteoporosis does not have to result in a person bending over with a hump back, suffering upper back pain from wedged vertebrae. Maintain good posture and the only result is that you get shorter.

A very simple exercise to help maintain the strength of your upper back muscles, is done watching TV. This wouldn't work at our house as a couple of boisterous golden retrievers would join in. Update 2017 : make that one equally boisterous rescue greyhound.

Lay on your front facing the TV. Lift your head and shoulders so that you can see the TV. Stay there.

This isn't easy. Nothing worthwhile is. I can't do it for long - they say we teach what we have to learn.

Here the spine has not bent over as the bone gives way.
The discs have pushed into the bone as it weakened.

Here the bone at the front has broken, as the bent posture has placed more pressure here.
The spine is now permanently bent forward here.

Osteopenia (mild bone loss) and osteoporosis are avoidable, treatable.

Have you already been given one of these diagnoses, or had a

broken hip or other fracture?

Are you concerned to avoid these?

Lots of good information for you is available at...

Kate's www.osteopenia3.com website

Vitamins K25 and D are really important for bone strength. Tests for these vitamins are available, but levels in test are not something to focus on too much.7

Tests are also available to try and predict who is at risk of fracture.

A single measurement of type 1 collagen cross-linked N-telopeptide (NTx) — a urinary marker of bone resorption — was sufficient to determine which premenopausal women were more likely to later suffer a fracture, in a recent study.4

The anabolic (muscle and bone building) steroids have a place in medicine. I have given nandrolone injections for many years, and found them useful and well tolerated.

Dietary protein intake has only a small effect. From a meta-analysis6 on this,
"it is disappointing that a significant association of protein and fracture risk was not found here. Indeed, the lack of an association with fracture risk may weaken the theory that protein intake influences bone health. "

Vertebral crush fracture - treatments for this upper back pain

Intranasal salmon calcitonin is effective¹ for the acute pain of recent osteoporotic vertebral compression fractures in both men and women.

Intravenous calcium as a single bolus injection, two weeks after a fracture occurs, can I believe, speed up healing.

New bone formation is sufficient even 4 days after a fracture, to allow a positive radionucleotide nuclear medicine bone scan (which detects new bone formation.)
Much of the action in the first two weeks after a fracture however, is dissolving of old bone - that which had it's blood supply disrupted, along the line of the fracture.

The calcium injection, given after this necessary phase of dissolving of bone, inhibits the secretion of parathyroid hormone² and I believe, speeds up net accumulation of new bone.

Percutaneous vertebroplasty

reduced pain more than just optimum analgesia in patients with acute vertebral fractures, in a trial³ in the Netherlands and Belgium.

The osteopathic lesion, when you have put a joint "out"

The thoracic spine (upper back) is the easiest place to see osteopathic lesions. These are the bread and butter of osteopathy (and chiropractic,) hence the name.

I treat such lesions in most people who come with upper back pain.

They involve blocked movement at the little paired posterior spinal joints (zygapophyseal joints or facet joints.)

Thoracic subluxation before treatment
Thoracic subluxation after mobilization

Before and after treatment of a mid thoracic subluxation. The upper spinous process started positioned to the left, and after treatment was directly on top of the bone below.

The factors underlying a tendency to such osteopathic lesions may include temporomandibular (jaw) joint problems, excess foot pronation and lots of things in between, as well as posture, posture, posture.

These causal factors operate on the whole spine. Gelb's book Temporomandibular Joint Dysfunction has X-rays of the spine showing improvement in scoliosis from before to after orthodontic treatment

It is the rule rather than the exception therefore, to find multiple osteopathic lesions, in the cervical, thoracic and lumbar spines.

It pays to examine the entire spine, even if the complaint is only of upper back pain.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.

Unexpected tenderness even without pain here.

People are often quite surprised by the tenderness over their thoracic spinous processes.

The old clinicians who mostly had to rely on listening and feeling, described tenderness over the T 1 and 2 spinous processes in active duodenal ulcers, without spontaneous pain here.

The tenderness is often more extensive than just over the "hitched" (buckled and stuck) posterior joints.

Interscapular itch rather than pain

Itch here even without obvious rash, is probably more commonly a skin problem - possibly from not rinsing shampoo and conditioner off adequately.

Our family shifted from Melbourne to Adelaide for a year when I was 16. Melbourne has soft water, Adelaide has hard water.

In Adelaide, it was very difficult to get any lather with soap. Arriving back in Melbourne, it was quite striking that one couldn't readily get the soapy feeling off one's skin. Soap sticks.

You have probably had the experience of still smelling of chlorine at the end of the day, despite showering after having a swim earlier in the day.

My naturopath mentor used to get people to soak in baths containing various nutrients, to efficiently get them into the body through the skin.

Various drugs are now administered via patches stuck on the skin.

Be careful what you get in contact with. Some of it goes into your body.

Midline thoracic itch can be from mechanical disorder, instead of upper back pain.

Itch and pain are both from messages transmitted to the brain via small unmyelinated c nerve fibres, and the difference is probably quantitative rather than qualitative. That is, itch is a milder form of pain.

How to examine for these blocked joints causing upper back pain

Your rhomboid muscles contribute to upper back pain

Home study course available

If you are interested in a home study course on this type of examination, please send me your e-mail address by the contact form.

Need help or have a helpful tip to share, or an experience others can learn from?

You can have your own page on this site, be anonymous if you prefer, and help other people or get useful opinions.

It's very quick and easy

References for upper back pain

1. Knopp JA et al Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int. 2005 16(10) pp.1281–1290.

2. A good page on calcitonin and parathormone is at... http://www.becomehealthynow.com/article/bodyendocrine/736

3. Caroline AH Klazen, The Lancet, published online 10 August 2010

4. American Society for Bone and Mineral Research (ASBMR) 2010 Annual Meeting: Abstract 1093. Presented October 17, 2010, from the University of Pittsburgh Graduate School of Public Health in Pennsylvania.

5. Go to http://www.naturalmedicinejournal.com/ and search on this site for vitamin K.

6.  http://ajcn.nutrition.org/content/90/6/1674.long

7. Serum 25-Hydroxyvitamin D Insufficiency in Search of a Bone Disease
Sonali Shah Cherie Chiang Ken Sikaris Zhong Lu Minh Bui Roger Zebaze Ego Seeman
The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 7, 1 July 2017, Pages 2321–2328


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If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.