Getting Rid of Upper Back Pain

This is the first installment of what I'm going to call "The Posture Series".  The Posture Series is all about teaching others the basic self-care that I've taught my clients in my practice, so that they can enjoy the awesomeness of reducing their own pain and/or preventing injury.  I've been a massage therapist for about 8 years, trained by some very good, very experienced massage and physical therapists.  That doesn't mean I'm any kind of genius and I'm certainly no kind of doctor.  What I do have to offer are basic ideas that work wonders toward self-care that I've learned from experience and other people.

Most of what I believe in as far as the optimal function of the musculoskeletal system revolves around posture and alignment.  I consider this reasonable given that the skeleton has evolved to a very specific shape, which when aligned properly supports itself in a miracle of biological architecture.  The skeletal muscles create movement and add support to the joints.  Connective tissue such as tendons, ligaments and broad fascia also play key roles in this whole idea of posture, alignment and movement.  I'm not going to get too detailed with any of this.  What I will do is give my personal, specific opinion on how to deal with specific problem areas that are fairly common.  Again, I am not a doctor.  I just have practical knowledge that has been passed down and withstood the test of time.  So, here we go.

Common upper back pain (not from specific injury or other health condition) usually comes from poor posture.  This poor posture is typically a loop or cycle of slouching, muscular imbalance, poor circulation, muscle spasm, and weakness.  So, let's identify these things.

First, what does good posture look like?  It is surprising to me how few people know what good posture should look like.  What does "stand up straight" mean?  Shoulders back?  That's almost it.  The way I was taught in the first week of massage school was that this posture is not focused in the shoulders, but in the drooping of the rib cage.

Good Posture Checklist


1. (Stand up in front of a mirror.)  Place your feet shoulder or hip width apart.  Point your feet forward.  Distribute your weight evenly between from your heels to the balls or your feet and let your toes spread naturally.


2. Your legs should be straight but your knees should not be locked.


3. Your hips should be centered and your pelvis should neither be rotated forward nor backward.  Although a woman's sacrum does tilt backward more than a man's, neither one should look like they're sticking out their bum.  On the other hand, one's pelvis should not stick out further than the rest of the body, giving the effect of leaning backward.


4. Lift your ribcage.  This is key.  Imagine a string attached to the xyphoid process under the sternum that is pulling upward.  This should have the effect of opening up your chest.


5. Engage your latissimus dorsi muscles to pull your shoulders down and slightly back.  Once your ribcage is in the proper position, your shoulders won't need to be "pulled back" so much but should fall back into that position naturally.  Ideally, the collar bones should be visibly parallel to the floor viewing from the front.


6. Lift your head to make you as tall as possible.  This will most likely also retract your head backward a little.  Most people are used to having their head to far forward (think Mr. Burns).  Do not tilt your chin up or down.


Congratulations, you probably feel really awkward in this position.  That is only because you are not used to it.  You were actually built to stand like this.

Back to the point.  For the upper back pain, we are going to focus on steps 4-6.  You should practice this posture as many times daily as you can think of.  If you must set an alarm, do it.  You will probably be sore for a little while before your body starts to get used to it and then you will feel better.

Stretch out your pectoralis major and minor every time you notice your back starting to ache.  Most of the things you do involve having your arms in front of you.  Over time, your pec muscles tend to shorten, since their is little need to elongate, and they antagonist muscles on the back side of the body are put on a stretch.  These muscles begin to lose circulation and go into spasm, which causes upper back pain and the dreaded "knots" that never seem to go away.  By stretching out the pecs, the rhomboids get a chance to relax and the pain should start to go away on its own.  The best way I've found to do this is using a wall, corner, or door frame, which are all conveniently located in places like houses, schools and office buildings.

Pec Stretch:
Keeping your shoulder down (not letting it get closer to your ear) place your forearm against the wall so that your upper arm is parallel to the floor.  Keeping this relative position, using the wall to brace your arm in position, turn away from your arm until you feel the desired stretch.  Hold for ten to twenty seconds or until you feel satisfied.  Repeat this stretch on the same side with your arms placed slightly higher, and again slightly lower than the aforementioned position.  Repeat all three stretches on the other side.

Exercise your back and shoulders now and then.  You do much more pushing than pulling in your life.  You can help balance this out in the gym if you'd like.  A simple pull up bar in your door frame also does the trick, as do those pulling cords.  Any kind of rowing sport is excellent.  Look for creative ways to practice pulling from good posture, like vacuuming.  Position yourself in the proper posture and vacuum your house.  Next time you vacuum, use your other hand.  This is also good for your coordination.

Seated back exercise:
Next time you're sitting at your desk, on the couch, or at a stoplight, take a moment to squeeze your shoulder blades together and down while pushing your chest forward.  Hold for about five seconds.  Increased strength in your back and shoulders should help these poor overworked and under appreciated muscles keep you in the correct posture.  This is especially important for women, as we are naturally less muscular in the upper body and our breast weight exacerbates upper back pain.

No more Mr. Burns.  Bring that head up whenever you can remember it.  That exaggerated hump people get where their neck meets their back can become permanent.  Don't let it be you.

Back/neck stretch:
This last thing is my favorite back /neck stretch.  If you get that chronic, broad tightness in your back that makes you feel tired, this one should cover it.  Sit on the floor against the wall.  Let yourself slouch and let your head gently hang.  If that feels comfortable, lace your fingers behind your head and let your elbows hang, but do not pull.  Slowly turn your head from side to side.  When you feel your back start to loosen, slouch forward a little more, finding a comfortable place and rotating your neck and upper back slowly from side to side, reaching one elbow at a time gently toward the floor.  The goal is to get as close to your bellybutton as possible.  The whole stretch can take one minute or twenty minutes, depending on how tight your back is.  Make sure you do the whole thing slowly and when you are finished, come back up slowly.  You may feel a little light headed due to the sudden change in blood flow immediately afterward.  Take your time.  At no point during any stretch should you ever feel any sudden, sharp pains.  Back off the stretch if this happens.  Discontinue the stretch if it keeps happening as it may be a sign of an unknown injury.

I've been using these methods for eight years now and I feel great most of the time.  Whenever I start to get out of whack, I just remind myself to do these things and I'm back to normal.  These same tips have also reportedly reduced tension headaches in my clients.