14 Exercises for Upper Back Pain
By Caroline Jones, Physiotherapist
Ever feel as though you’re carrying the weight of the world on your shoulders? Stress and tension often accumulate in the muscles of the shoulders and upper back. This can result in neck and shoulder pain and potentially headaches. People often ignore the upper back during workouts however it’s important that you don’t neglect this area. It plays an integral part in controlling your posture and core strength as well as movement. If it’s not working to its optimal function, poor lifting technique can cause you injuries and pain.
The upper back originates at the base of your neck, incorporates both shoulders and extends down to mid spine, including your ribs. The complexity of this region means that dysfunction can occur either due to injury or progressive pain and degeneration.
Why stretching and strengthening the upper back muscles is so important
Your priority should be finding the balance of muscle length and strength. If muscles are too strong without adequate stretching, they can shorten and tighten. Less commonly, if they are too flexible without adequate stability, your joints can become too lax and you won’t be able to control your movement properly.
The muscles of the upper back are often overlooked during a workout for stronger, more impressive muscles that contribute more to your aesthetics. However, they are the cornerstone of the body’s posture and by ignoring them you are opening yourself up to injuries. By spending time working on the muscles of the upper back, you’ll find you’ll be able to lift more weight, with better muscle patterning and prevent unwanted injuries.
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
- 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.
- 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.
- 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.
- 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.
Strengthening exercises for the upper back muscles
1. External rotators of the shoulder
The external rotators of the shoulder are important for posture as they keep the shoulder blades in a “down and back” posture, preventing against rounded shoulders. This is a useful exercise to do even if you don’t have shoulder pain as by strengthening these muscles you will be able to lift heavier in a safer and stronger shoulder position.
2. Latissimus dorsi — shoulder extension
The “lats” as they’re more commonly known are the large “wing shaped” muscles that spread out from the back in body builders and are also prominent in swimmers. They are used to make a pulling downwards motion, the action used in pull ups but also in shoulder extension where the arm is pulled backwards.
3. High plank with thoracic rotation
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.
4. Deep neck flexion
The most important set of muscles to control neck and upper shoulder posture, the deep neck flexors act to hold your head in correct alignment on your neck and shoulders. These muscles are usually found to not be activating properly in patients who suffer from neck pain and they are the first port of call in neck and posture rehabilitation.
5. 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.
6. Side plank
This is an effective variation of the plank which targets your core muscles on the side of your trunk, the obliques as well as the muscles around the shoulder girdle of the planted elbow. To progress this exercise, you can rise up unto your hand and feet.
7. Rows
These target the muscles of your upper back and back of your shoulder. For optimum maximum muscle contraction, squeeze the shoulder blades together at the end of each pull, before releasing back to the front.
8. 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.
9. Shoulder pull — retractions
This is perfect for people who are trying to improve their posture, or it can be done by desk workers at regular intervals throughout the day. The shoulder blades shoulder slide down and backwards, hold for a few seconds and then relax.
10. 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.
Stretches for the upper back muscles
1. Pectorals
It’s important that the pectoral muscles aren’t tight as they can anteriorly rotate your shoulders causing rounded posture. This is especially important for desk workers who spend long periods of time hunched over a computer keyboard.
2. Trapezius stretches
One of the easiest stretches for you to do but it can also be the most effective. Gently tilt your ear down to your shoulder. For an added stretch you can apply gentle overpressure and sit on your opposite hand to ensure shoulders stay away from the ear.
3. Stretch between shoulder blades — rhomboids
The muscles between the shoulder blades can become quite tight and this gentle stretch is an effective way of lengthening them.
4.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 at the end of a workout and often yoga classes will finish with this stretch.
Other techniques for managing upper back pain
Other techniques for stretching and lengthening the muscles of the upper back are foam rolling, trigger pointing and massage. While these are great for short term relief, the initial problem e.g. muscle imbalance or incorrect activation may still remain and if not addressed, your tightness will simply reoccur. For example, if you were to get a massage to loosen your shoulder muscles but did nothing to address your poor posture, they would simply tighten up again. These techniques are very useful however for muscle recovery after a heavy workout or an event.
Desk workers should ensure that they maintain correct posture while using their computer and other tech devices, even having an ergonomic assessment of their work station to make sure that the monitor, mouse and keyboard are all at a suitable position to avoid over reaching and aggravating sustained postures. Regular breaks whilst sitting at their desk to stretch neck and roll shoulders are also beneficial.
By looking after your upper back you’re setting yourself up with a strong foundation for great posture and movement. Good luck with these exercises and stretches and hopefully it helps prevent any back pain and injuries!
About the author
Caroline Jones is a physiotherapist, personal trainer and qualified lymphoedema therapist. Having sustained a serious back injury herself and undergoing spinal surgery and rehab, she understands firsthand the benefits of using exercise as medicine and is passionate about getting patients moving.
Originally published at https://www.injurymap.com.
