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Physical Therapy to Relieve Upper Back Pain

Peer Reviewed

Many cases of upper back pain are caused by muscle strain, particularly from poor posture. Going to physical therapy can help you address the underlying causes of your pain; a physical therapist will work with you to restore full, pain-free movement and help your body heal. You can also learn about how to minimize or avoid pain in the future.

Most importantly for many upper back pain sufferers, a physical therapist can teach you good posture, if you need to learn that. It can be difficult to "un-learn" years of bad posture, but a physical therapist can work with you to learn what good posture feels like and how to maintain it throughout the day.

Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They're called passive because you don't have to actively participate. Your physical therapy program may start with passive treatments as your body heals, but the goal is to get into active treatments. These are therapeutic exercises that strengthen your body and help prevent a recurrence of upper back pain.

Passive Treatments
Your physical therapist may give you passive treatments.

  • Deep tissue massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles). For upper back pain caused by soft tissue tension, massage is very beneficial.
  • Hot and cold therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.

    Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed on the target area or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.
  • Transcutaneous electrical nerve stimulation (TENS): A TENS machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body's production of endorphins (your natural painkillers). The TENS equipment your physical therapist uses is relatively large. However, a smaller machine for at at-home use is also available. Whether large or small, a TENS unit can be a helpful therapy.
  • Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Active Treatments
In the active part of physical therapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move—especially important if the joints in your thoracic spine are causing problems). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with back pain, especially since your pain might not even be caused by the same condition.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This is all part of the "self-care" or "self-treatment" aspect of physical therapy: Through physical therapy, you learn good habits and principles that enable you to take better care of your body.

We know: It's difficult to kick bad habits that lead to upper back pain, particularly posture. For many people with upper back pain caused by poor posture, bad posture actually feels right. The physical therapist can help you learn that good posture feels better.

Finally, the physical therapist may suggest a personalized exercise program because staying active is so important to spinal health. Working out—doing both cardio work and strength training—can reduce the likelihood of another upper back pain episode. Plus, of course, you'll be improving your overall health.

Updated on: 10/19/12
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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