Painful Conditions Of The Upper Back


Weakness of the upper back erector spinae develops as the shoulders slump forward and the upper back rounds. If the back has not become fixed in the faulty position, exercises are indicated to help strengthen the upper back extensors and to stretch the opposing anterior trunk muscles if they have begun to shorten. Proper shoulder supports are indicated while the muscles are very weak.

The middle and lower portions of the trapezius muscles reinforce the upper back extensors and help to hold the shoulders back. The manner in which these muscles are exercised is very important. (The wall-sitting and wallstanding exercises are illustrated on pp. 116 and 357.)

It is necessary to check whether opposing tightness limits the range of motion before attempting the exercises. Tests for length of the latissimus dorsi and teres major, pectoralis major, and pectoralis minor should be performed. (See pp. 306 and 309.) Tightness in the upper anterior abdominal muscles and restriction of chest expansion will also interfere with efforts to straighten the upper back.

As a general rule, exercises for the rhomboid muscles are not indicated. Although these muscles pull the shoulders back, they do so in a manner that elevates the shoulder girdle and tends to tip it forward in a faulty postural position. Besides, the rhomboids are usually strong.


Rhomboids may shorten as a result of forceful exercises in the direction of adduction, elevation and downward rotation of the scapula. They also may shorten as a result of weakness or paralysis of the serratus anterior, which is a direct opponent of the rhomboids. Treatment by massage and stretching of the rhomboids is indicated. Placing the arm forward in flexion of the shoulder normally brings the scapula in the direction of abduction. When the rhomboids are contracted, it is difficult to obtain an abducted position merely by positioning the arm. To stretch the rhomboids, it is necessary to apply some pressure against the vertebral border of the scapula, in the direction of abduction.


Middle and lower trapezius strain refers to the painful upper back condition that results from gradual and continuous tension on the middle and lower trapezius muscles. This condition is rather prevalent, and it usually is chronic. It does not have an acute onset unless associated with injury, but chronic symptoms may reach a point of being very painful.

Symptoms of pain do not appear early. The weakness may be present for some time without many complaints. It appears, however, that complaints of pain are associated with traction by the muscle on its bony attachments along the spine. Patients may complain of a sore spot, or palpation may elicit pain or acute tenderness in the areas of vertebral or scapular attachments of the middle and lower trapezius.

The stretch weakness of the muscles that precedes the chronic muscle strain may result from a habitual position of forward shoulders, round upper back, or the combination of these two faults. It also may result from the shoulders being pulled forward by overdeveloped, short anterior shoulder-girdle muscles. Repetitive movements associated with some sports, such as baseball, may contribute to overdevelopment of shoulder adductor muscles. Occupations that require continuous movement with the arms in a forward position, such as piano playing, contribute to stretching of the trapezius muscles.

Some occupations require held positions for extended periods of time. An example is the dentist bending forward over the patient, putting strain on the upper back muscles and stress on the anterior surfaces of the bodies of the thoracic vertebrae.

For some individuals, recumbency or change of sitting posture may remove the element of continuous tension on the trapezius, but in individuals with tight shoulder adductors and coracoclavicular fascia, tension is continuously present. Change of position does not change the alignment of the part when such tightness exists. Pain is relieved very little—if at all—by recumbency.

Tests for length of the shoulder adductors and internal rotators should be done to determine whether tightness exists. (See pp. 309 and 310.) If tightness is present, gradual stretching of the tight muscles and fascia is indicated. Some effective relief of pain should be achieved in a short time if gentle treatment is given daily.

With marked weakness of the middle and lower trapezius, regardless of whether opposing tightness exists, a shoulder support is often indicated. Such a support can effectively assist in the effort to hold the shoulders back in a position that relieves tension on the muscles.

Shoulder support with An elastic, vest-type stays in the back to help support to help hold support the upper back the shoulders back, and hold the shoulders back.

Note: Avoid applying heat and massage to the upper back over the area of muscle stretch. Such measures merely relax the already stretched muscles. After a support has been applied, and along with treatment to correct opposing muscle tightness, exercises should be given to strengthen the lower and middle trapezius muscles. (See pp. 116 and 357.)

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