14 Exercises for Upper Back Pain

Anatomy of the upper back muscles

The neck consists of seven cervical vertebrae, the building blocks of the spine. Each block is separated by a disc that sits in between and each vertebra has a facet joint on either side. The seventh cervical vertebra, referred to as C7, meets the first of 12 thoracic vertebrae T1 at the base of the neck, a point known as the cervicothoracic (CT) junction. This can be a common source of pain as the spinal curves transition from lordotic (concave) to kyphotic (convex.) An increased kyphotic thoracic curve can result in you developing a prominent hunchback posture.

Each level of vertebra has a pair of nerve roots, one coming from each side of the spine. These nerve roots trail down to supply their corresponding portion on the arm. This is how referred pain can occur, if a nerve root is irritated or inflamed at the spine, symptoms can be felt in the corresponding region e.g. in the forearm or fingers. For instance, if you injure C7, you may feel pain in your index and middle fingers.

The shoulder blades, known as scapula, are responsible for the stability of the shoulder and forearm movement. They rotate, retract and protract and their movement patterning and stability can greatly affect your posture and arm function. If the muscles surrounding the shoulder blades aren’t functioning properly, you can end up with “scapula winging” where the shoulder blades stick out.

The muscles of the upper back and how they work:

• Trapezius (upper, middle, lower) – a diamond shape muscle divided into three sections. They are not designed to be heavy lifters but are often used inappropriately when incorrect lifting technique is used

• Rhomboids – connect the shoulder blades to the spine

• Erector spinae – these long, superficial muscles run down the length of your spine like train tracks on either side of the vertebral column. The erector spinae are not designed for heavy lifting or stability and are intended to extend the spine only however they can go into spasm during episodes of back pain

• Latissimus dorsi – the large wing-shaped muscles of the back that are one of the prime movers in shoulder function. These are the muscles that you use in exercises like pull ups and lat pull downs

• Rotator cuff – this group of four muscles (infraspinatus, supraspinatus, subscapularis and teres minor) provide stability around the shoulder joint. The ligaments of the shoulders are quite weak and lax compared to other parts of the body. This means they rely on the muscle strength of the rotator cuff for stability

• Deltoids – the muscles that provide the cap on the top of the shoulder. They are important in lifting actions as they initiate the movement of the arm coming up

• Pectorals (pec major and pec minor) these muscles sit across the front of the chest, however, have a large impact on the upper back. If the pecs are tight, they pull the shoulder joint forward resulting in hunched shoulders.

• Serratus anterior – wraps around the side of your rib cage on each side and acts to pull your shoulder blade forward

The upper back also includes 12 pairs of ribs, each that have muscles positioned between them, known as intercostal muscles. These muscles can become painful with excessive amounts of coughing or being out of breath for long periods of time.

What can go wrong

1. One of the most common causes of upper back pain is muscle tension causing tightening of your upper traps and impingement of the nerve in the space above the shoulder blade (the suprascapular space.) Referred neck pain can occur due to compressed nerves that pass above the scapula and can also cause pain in the arm or numbness and pins and needles.

2. You can also suffer from degeneration of the facet joints of the vertebra, closing down the space meaning there isn’t as much room for the nerve roots to pass and they can become compressed.

3. Disc herniation can sometimes be referred to as a “slipped disc” however the disc doesn’t actually slip but bulges. This can cause compression or irritation of the exiting nerve root. Due to degeneration and drying out of the discs with age causing decreased height of the intervertebral disc, the nerve roots can be compressed even without a disc herniation.

4. Posture is one of the biggest causes of upper back pain and weakness. Desk working and increased use of tech devices amongst the entire population is resulting in higher rates of poor posture and back and neck injuries. Anteriorly rotated shoulders can result in your external rotators becoming weak and tight pectorals and hunchback posture.

14 great exercises for upper back pain

Plank

Core strength is incredibly important for the prevention of back pain, ensuring adequate posture and also postural endurance. The plank is the perfect exercise for you to target the muscles of the core as well as the shoulder stabilisers. It has many variations for all levels and can be performed on your hands or elbows and knees or toes. To further progress the exercise, lift one hand off the ground and rotate the arm and trunk towards the roof before returning and repeating on the opposite side.

Push ups – wall push ups

Although it predominantly targets your pectorals, push ups also work your shoulder stabilisers as well. These can be done on your toes, knees or even with hands on a bench or the wall to make them slightly easier. Slowly bend your arms to lower your chest towards the floor or bench. Pause for a second and then push back to straight arms. It’s important that you maintain a tight core throughout.

Reverse fly

Use an anchored resistance band in standing, or two that are linked together. Keep your elbows straight and pull your arms back, keeping your hands level at shoulder height. This exercise is effective for strengthening the muscles at the back of your shoulder.

Shrugs

Shoulder shrugs target the trapezius muscles and can be done either holding light dumbbells or hand weights or without any weight. Gently bring your shoulders directly up to your ears, hold for 3-5 seconds and then slowly relax.

Child's pose

This is a great all-rounder stretch as it lengthens out the spine and stretches out your shoulders. It’s the perfect choice for the end of a workout and often yoga classes will finish with this stretch. Spread your knees as wide as your mat. Lean forwards to let your belly rest between your thighs and let your forehead ligthly touch the mat. For stability, place your hands flat on the floor in front of you.