NHS explain the best ways to treat back pain
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Upper back pain is less common than lower back pain, but it can still be chronic and impact your life. It’s easier to know how to treat upper back pain if you understand its causes. Express.co.uk chatted to Dr Deborah Lee from Dr Fox Online Pharmacy to find out everything you need to know about upper back pain.
Upper back pain occurs when the muscles or joints in your thoracic vertebrae or the discs and spinal column in this area are stressed.
Dr Lee explained: “There are 12 bones in your mid and upper back numbered T1 to T12, and they’re known as your thoracic vertebrae.
“The top bone (TI) attaches to your neck and is made up of the cervical vertebrae, and the bottom one (T12) attaches to your lower back – these are your lumbar vertebrae.
“Each vertebra fits onto the next one via a series of small spiny protrusions called facet joints, and the vertebrae are all held together with muscles and ligaments.
“Lying between each vertebra is a soft pad of tissue – the intervertebral disc – that cushions the spinal movements.”
According to Dr Lee, anything that stresses the muscles and joints, squeezes the intervertebral discs, or pulls the spinal column out of alignment, can result in pain.
She said: “This is often due to impingement of the nerve tissue.
“The thoracic spine is relatively protected when compared to the lumbar spine which takes most of the body weight.
“Hence thoracic spinal problems are less common than those affecting the lumbar spine.”
Risk factors for developing upper back pain include:
- More common in younger adults
- More common in females
- Associated with weak body core muscles
- More common in those who have a history of musculoskeletal pain
- Linked to anxiety and depression
What causes upper back pain?
Thoracic back pain, more commonly known as upper back pain, is normally due to functional issues such as poor posture or trauma.
However, it can also be down to medical conditions like arthritis and fibromyalgia.
It is more unusual to get medical conditions affecting the thoracic vertebrae, but it does happen.
Dr Lee lists the following 13 things as the most common causes of upper back pain.
Sitting hunched forwards brings the cervical spine and shoulders forwards and means the thoracic spine is rounded.
Dr Lee said: “If you do this regularly, your back muscles will become weak and this can mean the vertebrae do not easily sit in proper alignment especially when stressed by movement.
“This will be worse if you constantly do something repetitively using only one side of your body.”
Not lifting properly
If you hold a heavy object perhaps over your head, or to one side or the other, without lifting from the knees and using your lumbar spine, this can result in upper back pain, according to Dr Lee.
Sometimes you might do something out of the ordinary, like doing some DIY, such that you are constantly stressing your spine in an unusual position, Dr Lee pointed out.
You can injure your upper back in a collision, such as an RTA, or a sports injury, or perhaps from falling downstairs.
Dr Lee explained: “This can cause fractures, muscle and ligament sprains, tears and bruises.”
Most commonly osteoarthritis (OA) but other types such as Rheumatoid arthritis, or ankylosing spondylitis, can also be a cause.
Dr Lee said: “The pain is often due to inflammation in the facet joints.”
Spinal fractures can occur in the thoracic vertebrae, most often due to osteoporosis, which causes loss of the normal architecture of the bone, Dr Lee said.
The doctor explained: “As the bone is weakened, any additional weight on the vertebra compresses it and can cause the bone to fracture.
“Fractures may also occur due to trauma such as an RTA.”
Herniation of a thoracic intervertebral disc
This is rare but can occur, and it’s often just due to age-related deterioration.
Dr Lee said: “Herniated discs are more common in the lumbar region.
“The disc is a bit like a jam doughnut – the outer portion is reasonably firm but the centred is soft and jelly-like.
“Pressure on the disc can cause the disc to rupture and the central part – the jam – oozes out, putting pressure on neighbouring structures such as nerves or the spinal cord itself.”
People born with a deformed spine, such as kyphosis (the spine is very hunched and curved forwards) or scoliosis (an S-shaped spine), may have severe thoracic pain.
Up to 70 percent of patients with fibromyalgia experience chest pain – which may be thoracic, or pain in the chest, rib cage, or shoulders.
Dr Lee said: “Sufferers tend to experience inflammation in their joint cartilage.
“In fibromyalgia, there is also abnormal pain signalling, meaning even light touch can be perceived as pain.”
Gall bladder disease
When the gall bladder is inflamed it presses on the phrenic nerve that runs from your abdomen, up through the chest and into the neck.
Hence gall bladder disease can cause pain in the back or the right shoulder.
Dissecting thoracic aneurysm
A rare acute, often fatal, medical emergency is dissecting a thoracic aneurysm.
Dr Lee said: “ This can cause excruciating thoracic back or chest pain.
“It occurs when there is a rupture in the wall of the aorta – the largest artery in the body that runs down the back, chest wall.”
Shingles are caused by the reactivation of the varicella-zoster virus (VZV) which causes chickenpox.
Dr Lee said: “It can occur in the intercostal nerves in the thoracic region, resulting In pain that travels around the ribs.
“The pain often proceeds with the development of the typical rash.”
Rarely spinal tumours can irritate the nerve roots and result in pain in the upper back, shoulders, chest or upper limbs.
When to see a doctor about thoracic back pain
Thoracic back pain is far less common than lumbar or cervical pain, so if you get it, and it’s severe or persistent, have a low threshold for going to see your GP.
It can be life-threatening, so if you have chest pain, or feel severely unwell, suffer collapse or confusion – phone 999 without delay.
Otherwise, seek prompt help from NHS 111 if you have thoracic pain and:
- You are generally unwell, with a fever and/or systemic symptoms such as nausea and vomiting
- You have had any recent trauma, such as a car accident
- The pain is severe and interfering with daily activities such as sleeping
- The pain is worse with coughing, sneezing, or emptying your bowels
- The pain is between your shoulder blades
- There is a swelling or a deformity of your back
- You have had any suspicious symptoms such as unintentional weight loss
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