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The upper back is at a crossroads between the lower back, neck and shoulder blades and is therefore a common place to have pain and dysfunction in runners. Upper back pain between the shoulder blades is a frequent location as is upper back pain with breathing. It can be hard to take in a deep breath and it can be extremely painful. The pain can also occur off to the sides, which may make it seem like it is under the shoulder blades. It can feel like a general tightness but is often a sharp and stabbing pain. Thoracic spine pain can also lead to pain in the anterior chest wall.

Studies have reported up to 22-65% of adults will experience pain in the upper back each year and about half of these cases are related to muscle and joint pain. While upper back pain is not as common as lower back pain, pain in the upper back is just as disabling as having low back pain. It is very common for people that have had chest and upper back pain to have the problem recur repeatedly considering that about half of these people still have pain after 2 years. Pain in the upper back seems be even more prevalent in younger patients, including adolescents, compared to older adults. It is concerning that preliminary evidence suggests upper back pain is occurring more frequently in adolescents now compared to the past, which may predict more problems for adults in the future.

What Causes Upper Back Pain in Runners?

Mid and upper back pain in runners is extremely common due to the normal stresses placed on the area being amplified by the impact of running. The actual pain can be from the thoracic spine, the associated musculature and/or the posterior rib joints. Ribs in the body have joints in the front and in the back which can become dysfunctional and extremely sensitive to movement and pain. Often, pain that is located off to the side and is worse with deep breathing is due to rib restrictions and dysfunction. These pains can be so bad that a significant number of people actually go to the hospital to be checked out for a heart attack, only to find out that their heart is completely fine and the pain was from the muscles and joints in their chest or upper back.

Problems with posture dominate the reasons for having upper back pain in runners. Slouching is something that people do now on a regular basis, especially when much of the population sits for most of the day at a desk. Sitting at a desk and then sitting in traffic and then slouching when you watch TV or play video games all has an adverse effect on the health of your thoracic spine. Over time, it leads to muscle imbalance and asymmetry where the muscles in the front part of your chest begin to tighten up and the muscles in the upper back begin to weaken and lengthen. This could cause a decrease in the mobility of your ribs and your spine and can directly lead to problems with your capacity to breathe. This decrease in your ability to breathe can be further exacerbated by dysfunctional breathing patterns. Overall, it becomes harder for someone to straighten up, extend their back and take a deep breath in.

The repeated pounding of running takes a toll on your legs, but the legs are meant to withstand repeated impact. Proper running mechanics are needed to ensure the legs do not break down and develop pain and the same is true of how improper running mechanics are related to upper back pain. The thoracic spine will also become painful when excessive loading places undue stress on the spine due to slouched structures. As I have mentioned in previous articles, the type of foot strike that a person uses can affect the forces and loads in the body, including the spine.

Lack of strength and endurance in the muscles of upper back means that the ability to compensate will be compromised. Overtraining will decrease your ability to train / perform, increase muscle soreness and increase your perceived level of exertion. Proper running form and proper programming will be less likely to have upper back pain as a result, which can make it a good idea to use a running coach.

Something that can occasionally be an issue with upper back pain is indigestion. Eating too soon or too much before a run can contribute to indigestion.

Bra Fit, Running and Upper Back Pain in Women

Another issue that can cause upper back pain in women is when a woman’s bra is not fit properly. Up to 75% of women do not wear the appropriate sportswear and do not know how to correctly choose a sports bra, let alone a regular bra according to the medical literature. There are obviously multiple factors that contribute but it is best for you to go someone who has attended a nationally recognized fitting school and not just on-the-job training in the national chain store. I would recommend that women go to “That Special Woman” for a proper bra fitting. “That Special Woman” is located in Toledo and carries mastectomy bras and regular bras, which can include plus-size and nursing bras. A woman should be refit if she has lost or gained around 10 to 15 pounds. Often, women will tighten the strap more than is needed or buy a sports bra that is too small. Squeezing the thoracic spine too tight can cause restrictions that result in problems and pain in the upper back and ribs. 

Upper Back Pain Treatment

As always, you need to find out what the actual problem is before you try treatment on a person. A proper evaluation including history and a complete exam is appropriate when someone is having pain in the upper back. There are several reasons to be evaluated and treated by a healthcare professional, such as a chiropractic physician specializing in sports medicine, when you are experiencing upper back pain. This is especially the case if an issue lasts for a couple of days or is getting worse. Obviously, anyone that has extreme pain in the chest and/or upper back or any other medical emergency should be seen in the emergency room.

The upper back is located between a multitude of areas that each need to be stable for the body to function properly. In the past, it was thought that the thoracic spine did not need to move very much because of how the ribs attach to it and this stability provided by the ribs is one of the reasons that disc problems are extremely rare in the upper back. The lower back, neck and shoulder blades all need to have stability provided through the local musculature to function properly and avoid injury in that area. This is one of the reasons why people do so much work on their core to avoid lower back injuries. But the upper back is in a different kind of position because the ribs provide stability and can cause the upper back to be too stiff, especially when combined with poor posture. The thoracic spine needs to be resilient, but it also must have a certain degree of mobility to ensure lack of pain and problems in the upper back.  It also needs to be flexible because the surrounding regions such as the low back, neck and shoulders rely on the mobility of the upper back. When the upper back has a problem with mobility, often one of the surrounding structures loses strength and stability to make up for the lack of mobility in the thoracic spine.

One of the ways to indirectly treat upper back pain in runners is to ensure strong and stable glutes as well as strengthening and improving the motor control of the hips and the core. It is essential that the core be strong to not transfer mobility into the lumbar spine. Strengthening the back and the posterior chain is often helpful for treating upper back pain. This can be accomplished through bird-dog exercises, deadlifts, shoulder retractions, single leg deadlifts, and kettle bell swings among a host of other exercises.

Just like it’s a good idea to brush your teeth twice a day, it’s a good idea to do certain activities every day as part of a general body maintenance plan. This would include stretching and foam rolling the areas that get tight, like hamstrings, glutes, piriformis and your tensor fascia lata. Exercises can be used to improve posture in the neck and upper back, as well as including mobility work for the thoracic spine. There is a whole host of exercises that can be helpful for thoracic spine extension and rotation which can include extending over a foam roller, stability/gym ball or a yoga wheel, as well as thoracic rotational exercises like the Brettzel 1.0 or 2.0.

We talked earlier about how decreased mobility combined with dysfunctional breathing patterns are some of the major issues relating to upper back pain. Breathing patterns are often incorporated into some of these thoracic extension and rotation mobility exercises and it is helpful to make sure that your breathing patterns are correct. For a demonstration on proper breathing patterns, please click here to see a video.

Rubbing the muscles in the upper back that are sore and tender is another treatment for upper back pain. Getting a massage from a licensed massage therapist can undeniably take stress out of the upper back. I personally recommend that people get regular massages whether or not they are in pain as part of that general body maintenance program mentioned earlier. Licensed massage therapists can be found in the offices of sports medicine chiropractors or independent massage therapy establishments. The state of Ohio requires a licensed massage therapist to charge sales tax on all massages unless the massage therapy session has been prescribed by a qualified healthcare provider, like a chiropractor or a medical doctor. Graston Technique is a advanced type of myofascial release treatment used to treat sore muscles and the resulting fibrosis and scar tissue from long standing muscle discomfort. Graston Technique can restore motion to stiff joints and decrease muscle tension in the upper back to get you back to having natural movement without pain.

Chiropractic adjustments are also extremely effective at relieving upper back pain. Restrictions in the motion of the thoracic spine and the associated ribs is often one of the main triggers for upper back pain. In fact, often massage therapist will find “knots” in the back that are actually painful ribs. I have a fair number of massage therapists as patients and I try to teach every one of them about these “knots” which are actually painful rib heads. They have the tendency to become more sore when they get repeatedly rubbed on. These dysfunctional rib heads are extremely painful but chiropractic adjustments restore their proper motion. This can be so much of a problem that the ribs can be painful in the front on the chest as well.

Treatment of upper back pain absolutely involves a multimodal approach. Chiropractic manipulation, postural exercises, strengthening and mobility exercises and soft tissue work to include massage therapy or Graston Technique are all excellent options for upper back pain treatment. Achieving upper back pain relief is possible and you do not have to suffer in pain.

Article Featured in Toledo Roadrunners Club Footprints – Volume 45, Issue 5 (May 2019)

MORE INFORMATION ABOUT DR. ROYER

Dr. Bryan D. Royer has been practicing chiropractic medicine in the Toledo area since 2005. He has a specialty in Sports Medicine and is a Certified Chiropractic Sports Physician® (CCSP®). Dr. Royer is certified as a Graston Technique® Specialist (GTS), a Certified Kinesio Taping Practitioner (CKTP) and a Corrective Exercise Specialist (CES). He is also a Board-Certified Chiropractic Neurologist and he has been voted “Best in Toledo” by readers of the Toledo City Paper five times. 

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