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Understanding and Treating Upper Back Pain with Physiotherapy

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Understanding and Treating Upper Back Pain with Physiotherapy

Upper back pain, particularly in the thoracic spine region, can significantly impact one's quality of life. Whether it's caused by postural associated pain, muscle strain, or underlying conditions, finding effective treatment is crucial for relief and prevention. Physiotherapy offers a holistic approach to managing upper back pain, addressing its various causes and symptoms through tailored exercises and techniques.

Types of Upper Back Pain:

Upper back pain can stem from various sources, including muscle strains, muscle spasms, postural related pain, and other underlying conditions. 

It can manifest as dull, achy discomfort, sharp pain, or stiffness in the thoracic spine region. Understanding the underlying cause is crucial for effective treatment.

Considerations for Referred Pain:

Referred pain from the neck or cervical spine can often masquerade as upper back pain. Conditions such as cervical spondylosis, disc herniation, or nerve compression in the neck can radiate pain to the upper back region. Physiotherapists can assess and differentiate between local upper back pain and referred pain from the cervical spine to tailor treatment accordingly.

Referred Pain to Lateral Trunk and Chest Region:

In some cases, upper back pain may radiate to the flank or chest region. This referred pain can be due to thoracic spine dysfunction and rib dysfunction. Physiotherapists conduct thorough assessments to identify the source of referred pain and develop targeted treatment plans. It is also crucial that other causes of trunk and chest pain is ruled out, therefore an assessment to eliminate visceral causes involving the heat and lungs should be undertaken.  

Physiotherapy Treatment:

Physiotherapy plays a vital role in managing upper back pain by addressing its underlying causes and symptoms. Treatment typically involves a combination of manual therapy, therapeutic exercises, postural advice, and education. 

Manual Therapy:

Physiotherapists may use manual techniques such as massage, joint mobilization, and manipulation to alleviate muscle tension, improve joint mobility, and reduce pain.

Therapeutic Exercises:

A person performing physiotherapy exercises designed to relieve upper back pain

Specific exercises targeting the thoracic spine and surrounding muscles are crucial for strengthening and restoring mobility. These exercises may include:

    • Thoracic spine mobilization exercises to improve flexibility and range of motion.
    • Strengthening exercises for the muscles supporting the thoracic spine, including the rhomboids, trapezius, and erector spinae.

Postural Correction myth:

  • There is a common misconception that good and bad posture can either improve or worsen back pain. This fallacy is in-fact contrary to the best evidence and literature, which indicates that poor posture does not lead to back pain, similarly good posture does not prevent pain. 
  • Being in a static position for an extended period of time will eventually lead to pain, therefore regular movement and changes towards postural positioning is recommended to mitigate against postural related pain. 

Vertebrae Myth buster: 

Understanding the Difference between Thoracic, Cervical, and Lumbar Spine:

It's essential to differentiate between the thoracic, cervical, and lumbar spine to understand the source of upper back pain accurately.

  • The thoracic spine refers to the middle portion of the vertebral column, comprising twelve vertebrae attached to the rib cage.
  • The cervical spine encompasses the neck region.
  • The lumbar spine supports the lower back.


Physiotherapy offers a comprehensive approach to managing upper back pain, addressing its root causes, and treating the pain effectively through manual therapy, therapeutic exercises, and postural advice. By understanding the types of upper back pain and debunking common myths, individuals can take proactive steps towards relieving pain, improving mobility, and enhancing overall well-being.


  • Lee DG, Chung SH, Jung HS. The efficacy of thoracic spine manipulation for patients with chronic neck pain: a randomized controlled trial. Phys Ther Sport. 2019;40:10-17.
  • Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14(5):531-538.
  • Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. Elsevier Health Sciences; 2002.
  • The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review: 

The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.

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