Upper Back Pain: posture modification and exercises for pain in the area around the shoulder blades

Upper back pain (or pain in the thoracic spine) is a very common issue.   As physicians we often pay a more attention to lumbar or cervical pain issues.  I am not sure why this is, but the lumbar and cervical spines generally receive more attention in terms of clinical and epidemiologic research.  However, pain in the thoracic spine can be equally disabling and can impose similar burdens on the individual and community.   

There are a lot of factors that can cause pain in the region between the shoulder blades. The most common cause, especially in a younger person is overload to the muscles that support our necks.   There certainly are other causes worth considering.  In older individuals compression fractures are one common cause.  Dysfunction in ribs and joints can be a significant component of pain in this area.  However, the most common overriding cause of pain in the area between and around the shoulder blades is myofascial pain, or pain in the muscles that support our neck and hold us upright.

One analogy that I use to consider the stress that we put on our upper backs is comparing our head to a bowling ball.  That is, our head weighs about as much as a bowling ball. If we have a posture with forward rounded shoulders and a forward flexed neck (or the slouched posture we all lapse into without our mothers around), then we are putting a lot of strain on those muscles that keep our head from falling forward. We overload these muscles by maintaining this slouched posture for extended periods of time with imbalances and bad habits.

Alarmingly, there is evidence to suggest that the incidence of spinal pain among otherwise healthy adolescents is increasing, which may suggest a new and expanding condition burden for future adults.  (Brit Med J 2002, 325:743-745)  In children and adolescents, pain in the thoracic region has been associated with postural changes associated with backpack use, backpack weight, other musculoskeletal symptoms. (BMC Musculoskeletal Disorders 2009, 10:77)

It takes a long time to change postural habits and address some of the issues that feed into the source of pain in the thoracic region.  There are a number of things, though, that can be done in the short and long term to address these issues.

• We can work to develop postural awareness. Just by being aware of when we slouch we can begin to make changes.  Postural awareness applies to both standing and sitting postures.  Just as we can slouch when standing, sitting with a slumped posture (as we are all want to do) has been “shown to  increase disc pressure even more, and to aggravate chronic low back pain” as well as pain in the thoracic region.   (Electromyogr Clin Neurophysiol. 2007 Sep;47(6):273-8.)

• We can work on exercises to correct imbalances.   
  • I have some of my favorite exercises for neck pain  posted in an article on neck pain issues (http://www.backexercisedoctor.com/journal/2009/12/7/neck-pain-generalities-and-my-favorite-neck-exercises.html).  A lot of these same exercises are helpful for pain in the thoracic region. 
  • In addition, studies have shown that abdominal bracing done while sitting, or “co-contraction of the trunk muscles during sitting while doing desk work could bring about the correct lumbar curvature, and effectively stabilize the lumbopelvic region, and decrease focal stress on passive structures.” (Electromyogr Clin Neurophysiol. 2007 Sep;47(6):273-8.) Refer to my article on Abdominal Bracing Exercises (http://www.backexercisedoctor.com/journal/2009/12/28/abdominal-bracing-exercises-and-back-pain.html ) for more detailed information on these exercises which can be applied to activities for sitting and standing.
• Posture braces can help with posture re-education. There are a lot of braces that can be found out there on the internet. I do not have any that I specifically endorse but amazon.com has several under the heading of posture brace or clavicle brace.
• Ergonomic modification. Reviewing our workspace, computer set-up, monitor height, chair height, etc. can make a dramatic difference both in terms of pain and the repetitive overloading that we can do to tissues in this region.  I intend to post a separate article at some point specifically on ergonomic issues.