Upper back pain, the pain between the shoulder blades, is one of the most common complaints I hear as a massage therapist. For some it is a persistent and debilitating problem, for others it is an annoyance that disappears on its own after a few days. There are several ways to address upper back pain, such as seeking out a massage therapist, physiatrist, personal trainer, physical therapist, or chiropractor, but in today's post we will be focusing on ways to manage self-care, and so we will be focusing on the muscles that cause or assist with this problem.
To see what to do to help fix it, visit my second post in the series.
Usually posture is given the blame for the pain one gets in the upper back, but for most people "sitting up straight" is not a fix for this problem. Generally instead of referring to correct posture, I will instead refer to staying in one position for a long period of time. In the first part of this post we will get into some of the muscles of this group, theories for why this pain occurs, and the second part we will cover some ways to manage or fix the problem. Knowing why/how it occurs is useful for correcting the problem, so we will cover that first.
The muscles of the upper back and shoulder attachments are going to be our focus here for one simple reason: they are what you can control and work on yourself at home, or with limited assistance. Some of this pain may be explained by something called the Upper Crossed Syndrome which I encourage you to click and take a look at.
Yes, I want you to really look at the picture of the muscles here, to get some insight into what's going on in the back. Also, because how the muscles lay and how they work is really really cool. First, look at the direction of the lines. This is showing the direction the muscles will contract (I covered this topic in my muscle function post for more information). The mid back pain you feel is probably somewhere around the rhomboids muscles (major and minor, but I will simply call them rhomboids), so find that in the picture and take note that the fibers run from the shoulder blade to the spine. This means the rhomboids pull the shoulder blade toward the spine, that's their job. More importantly you should note that this also means that the lines of the fibers do not pull the shoulder in any other direction. Notice also that the Trapezius muscle has a similar fiber direction, so it also pulls the shoulder blade toward the spine. Take note of the muscles of the rotator cuff (which I have written a separate post about if you want to review it). You'll recognize them when we get to 'fixes' in the second post on this topic.
The antagonist of the rhomboids is the serratus anterior. Just stick that in the back of your mind for now, we will visit it again in the second post.
Now the front side of the shoulder blade is going to be noteworthy as well. One of the main reasons that 'posture' is blamed on upper back pain is because when the shoulders round forward on the front of the body, the back of the body becomes elongated. Essentially, that means your rhomboids have to maintain constant tension, which may be one of the reasons they start to get sore.
The powerful pectoralis major muscle of the chest (your 'pecs') pull strongly on the shoulder in the forward motion, and the rhomboids must oppose this action to keep the shoulder blade in place.
Also remember that sometimes the problem is not necessarily where you feel the pain. For a review on that topic, read my post on "What are Trigger Points?"
The second post will cover tips on how to help relieve some of the discomfort.
What's going on with me, research articles, interesting little blurbs. This blog is an attempt to consolidate research into an easily digestible format.
Alex Moon has been a Licensed Massage Therapist since 2012, did his undergraduate studies at Utah State, and is currently working on his Doctorate in Physical Therapy.