Muscle injury of the upper back Thoracic muscle injury

The upper back is the area from the base of the neck to the waist. There are several muscles that work together here to facilitate a number of movements.

It is difficult to distinguish between a muscle tear or another injury of the upper back. The pain can also come from the spinal column. The physiotherapist can help to track down the cause of the symptoms.

Tearing or spraining of muscles is a common cause of back pain. This can happen when the muscle fibres in a muscle are stretched excessively. The severity of the injury depends on the number of muscle fibres that tear. In the case of a slight sprain, only a few fibres are torn. In more severe cases a larger section of the muscle is torn.

Muscles that can be affected include: the erector spinae, the trapezius, the rhomboideus, the latissimus dorsi, the levator scapulae and the muscles that are located between the ribs (intercostal muscles).

The symptoms usually occur at a clearly defined time or through severe physical exertion. Sometimes the symptoms develop gradually as a result of prolonged overloading.

The diagnosis is made based on the patient's story, the physical examination and an MRI when surgery is considered. Instead of an MRI, a CT scan may sometimes be chosen. An EMG (electromyography) clarifies how well the nerve is still functioning, but does not indicate the cause of the complaints.

The goal of the treatment is to reduce the pressure on the nerve root. This is more easily achieved with a soft cervical hernia than with a hard one. The treatment first consists of posture instructions. For example, the patient is advised not to look down for prolonged periods, such as when reading. In addition, the therapy is aimed at training the neck and shoulder muscles, improving mobility, and giving the nerve more space.

Wearing a semi-rigid neck collar can have a beneficial effect on recovery in the acute phase but should never be used indiscriminately.

With a hard cervical hernia, there is less scientific evidence for effective physiotherapeutic treatment. Often, physiotherapy is used to try to alleviate the complaints because, apart from surgical intervention, there is a lack of alternatives. An anti-inflammatory injection can provide temporary pain relief. Keep in mind that this is not always without risk.

Take a look here at the online exercise programme with exercises for muscular injuries in the upper back.

Fruth, S.J. (2006) Differential diagnosis and treatment in a patient with posterior upper thoracic pain Phys Ther. 2006; 86:254-268.