Upper back problems: doctor answers patient questions

The following explanations, insights, and advice about upper back problems are provided by Douglas J. Hendricks, MD, a physical medicine and rehabilitation specialist and a contributing author for Spine-health.com.

Patients frequently e-mail us questions about upper back problems, exercises and other treatments, and while we don’t provide individual responses, periodically, Dr. Hendricks and other contributors to Spine-health.com will take time to respond to the themes from more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about upper back problems represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Upper back problem questions and physician responses

Question:

I’m having some seriously bad back pains. I’m 16 years old and recently (over the last few months) my back has been hurting quite badly. Usually during the morning its fine, but by about 5:00 it gets really bad, especially right at the spine in the middle towards my upper back, just in between my shoulder blades. When I come home and sit in a chair or even try to go to sleep, it’s awful. Sitting on a chair makes it feel really bad and I’ve resorted to slouching and moving around to make it bearable. Also when I stand and do simple things, like ironing or drawing or even just picking something up, it’s become really, really bad. When I go to sleep, it takes about 30 minutes before the pain calms down.

The pain started when I used to review for exams. I would lean against the backboard on my bed or I would sit up on my chair for long periods of time doing work, sometimes really early into the morning. However I’ve stopped doing this and I’ve been working on a chair or sofa and I’ve quit weightlifting for the last 2 months, but things just seem to be getting worse. Sitting on a chair in school is fine, and I feel no pain there, it’s only when I get home when the problems occur. Can you give me any information about what I could do to prevent or stop the pain?

Doctor’s response:

Given your young age and the severity of your pain, I suggest you go see your regular doctor, a physiatrist or other spine specialist. A physiatrist is a Medical Doctor (MD) or Doctor of Osteopathy (DO) who specializes in a wide variety of non-surgical treatments for the musculoskeletal system, such as physical therapy, medications, massage and interventional medicine (i.e. injections). You need a thorough spine examination with x-rays. You may just have muscular pain due to the poor posture often assumed during long hours of studying.

Until you are seen by a physician, I recommend avoiding those positions/postures that cause the back pain to flare up. You may try Tylenol, low-dose Aleve, or ibuprofen and ice/heat. Seeing a chiropractor may also be beneficial.

Question:

I am a newly commissioned military officer. While conducting morning physical training six months ago, our unit did a motivational pushup exercise where we placed our legs onto a partner’s upper back/neck. Each in turn had someone else's legs (from about the knee) on top of their neck/back. My partner weighed in excess of 200 pounds while I weigh all of 122 and while attempting to push myself back to the up position, I felt something release in my upper back/neck...Almost like pressure was being relieved and then a very sore neck area incurred. I attempted to do a few more repetitions but couldn't.

After "PT" that morning, I had severe neck and joint pain, and to this day I have numbness/tingling in my right arm and shoulder after waking and the same symptoms immediately following any type of physical activity. This includes sit-ups, pushups, lifting and anything over the head. I am scheduled to have exploratory surgery done on my right shoulder because the doctors think it's in the shoulder but haven't found anything on MRIs… It has been 6 months since this injury occurred and I can do absolutely no exercises without having this numbing sensation in my right arm that remains there until I crack my neck. I know something isn't right. X-rays and MRIs were negative on the shoulder. What can you recommend for me?

Doctor’s response:

You need a cervical MRI (image of the neck) and an appointment with a spine specialist to discuss the results and potential avenues of treatment. I suspect you have a pinched nerve in your neck, possibly from a herniated disc. The herniated disc material can press on a cervical nerve, causing arm pain, numbness and tingling, and even muscle weakness along the nerve pathway down the arm. The MRI scan should detect the presence of any disc bulge, herniated disc or similar pathology.

In the short term, over-the-counter ibuprofen or Aleve may be helpful. A short course of oral steroids, about one week, may provide pain relief as well until a definitive diagnosis can be made. All treatments for a cervical herniated disc are essentially designed to help resolve the arm pain, and usually the weakness and numbness/tingling will resolve with time. Most symptoms can be successfully treated with conservative treatments, such as physical therapy and exercise, chiropractic manipulation, bracing, activity modification, and other pain medications or injections.

Question:

I currently see a chiropractor for my upper back problem. In the past 5 months, I have been experiencing upper back pain during sleep, and I often awake in such pain that it is difficult to move around. My chiropractor had suggested a firmer mattress (I bought one), a body pillow (I bought one), a neck pillow (I bought one), ice and/or heat (have done that too), and so far there has been no pain relief. He now feels I have stress related back pain, since the pain seems to subside as the day wears on and I am moving around. But what can I do to alleviate this horrible pain? What would you advise me to do next? Should I see my regular physician and be thoroughly checked out?

Doctor’s response:

You definitely need to see your medical doctor for a checkup. I doubt this is stress related back pain, since stress-related back pain tends to get worse as the day progresses (not better, as in your case). The pain during sleep is concerning to me. Depending on your age and other medical problems, further imaging is necessary. At the very least, I would recommend a thoracic spine MRI. There may be a need for blood tests and other testing to look at your internal organs.

Question:

I desperately need help. It’s the thoracic pain that started over one year ago: burning and stabbing under the left shoulder blade, and if I move, walk or do any kind of movement, it gets worse. My MRI shows two small fatty tumors in the cervical area and two small bulged discs in the lumbar area, but my doctor says neither should be causing this pain. Nothing is showing in the thoracic area. I've done all the doctors have suggested. I've begged for a shot of some pain relief...just for a few days pain free...God would I be thankful. If I stay still, I am able to handle it, but I can't sit my life away. I’m 55 yrs old and don’t have insurance.

Doctor’s response:

I recommend getting in to see a physiatrist who specializes in diagnosing and treating back pain for a thorough history and physical examination. There may be effective yet affordable treatment alternatives for your upper back pain.

Question:

I have a 29 year old son who was recently involved in an accident. Since this, he has been experiencing thoracic pain which radiates to his lumbar region. A recent MRI report states "consider Scheuermann disease." I have researched this disease extensively and as my son has never had childhood or adolescent back pain, this diagnosis makes no sense. Please would you advise me on possible misdiagnosis of this condition or what else could be wrong with my son’s back.

Doctor’s response:

Scheuermann disease is a disease affecting the thoracic spine predominantly in teenagers. Many times there are no symptoms, but sometimes there can be mild pain. It can cause an exaggerated rounding of the midback, and over time it can be harder for the patient to extend (bend backward). There are very characteristic changes on x-rays that, when found, typically lead to mentioning Scheuermann disease in the report. For your son, however, it should be considered likely that he has a musculoligamentous strain of the midback muscles caused by the car accident. This pain is easily treated with analgesics (pain medications such as Tylenol or topical creams), physical therapy or chiropractic. This type of pain usually resolves within weeks to up to three months post-accident.

Question:

I'm having trouble finding specific exercises for preventing back pain caused by breast size. Losing weight won't help with breast size, and I would rather use exercise to handle the problem than breast reduction surgery. Are there any exercises designed specifically for large breasted women?

Doctor’s response:

Good question. There are some things that you can do to help with your pain. First is to stretch the latissimus dorsiflexion (the triangular, flat muscle found along the back of the ribs which covers the back of the lumbar region and the lower half of the thoracic region) and pectoralis (the thick, fan-shaped muscle, found along the upper front of the chest, which lies under the breast in the female) muscles. Second is to do strength training focused on the scapular region (muscles around the shoulder blades). A good place to start would be with a physio ball (also commonly called “swiss”, “stability”, “therapy” or “exercise” ball). While lying on your stomach on the ball, try spinal extensions (bending backwards), hip extensions (lifting a straight leg straight behind you), and raising your arms up in front of you. Third is to be aware of your posture and utilize good posture guidelines while standing, sitting, working, sleeping, etc. (Answered by Jason G. Schomburg, MPT)

What next?

If you have questions about upper back problems, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “Search” box located in the upper left hand corner of each page and type in keywords that represent the topic you are interested in. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with upper back problems, please go to the Spine Forum Message Boards or the Back-to-Back sections.

March 20, 2006

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.