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Massage Today
December, 2007, Vol. 07, Issue 12

Upper Back Pain

By Ben Benjamin, PhD

Rotation of the thorax. - Copyright – Stock Photo / Register Mark Fig 5. Rotation of the thorax. Question: True or false: While upper back pain may be caused by an injury to the thorax, it is just as likely to be caused by a cervical injury.

Answer: True.

It's common for injuries to the cervical ligaments to refer pain into the upper thorax. The pattern of pain often is shaped like a coat hanger, encompassing most of the upper back region. The person experiences an uncomfortable tension or ache that might feel like muscle strain, but that goes away except for short periods after rest or a massage. The culprits usually are microtear injuries to the 5th, 6th or 7th nuchal or supraspinous ligaments. One particular injury - damage to the anterior portion of the intertransverse ligament running from the 6th to the 7th cervical vertebra - often refers pain to the chest.

When the pain originates in the thoracic ligaments, there is a constant or frequent ache in the middle of the back, especially when sitting for extended periods of time. Sometimes the pain from a thoracic ligament sprain goes through the thorax to the chest. Microtears in the thoracic ligaments may result from an accident or years of poor posture in a kyphotic slump.

Extension of the neck. - Copyright – Stock Photo / Register Mark Fig 1. Extension of the neck. Flexion of the neck. - Copyright – Stock Photo / Register Mark Fig 2. Flexion of the neck.
Side-flexion of the neck. - Copyright – Stock Photo / Register Mark
Fig 3. Side-flexion of the neck.
Rotation of the neck. - Copyright – Stock Photo / Register Mark
Fig 4. Rotation of the neck.

To determine whether pain in the thoracic region is originating in the thorax or in the neck, perform orthopedic assessment tests on both areas. When the pain originates in the neck ligaments, one or more of the passive neck tests - passive rotation, passive side-flexion, passive flexion and passive extension - will usually cause discomfort or pain in the thorax. When the pain originates in the thoracic ligaments, passive rotation of the thorax usually will be painful to one side. (Often the person will be hesitant to rotate the torso to reach for something, fearing either consciously or unconsciously that it will cause pain.) Pain also might originate in one of the muscles of rotation, in which case, resisted rotation of the thorax will reproduce the discomfort. However, in my experience this is rarely the case. Identifying and treating the ligaments usually will diminish and often eliminate the pain.


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