Anatomy, Pathology and Treatment of the Upper Back


Upper Back Anatomy

The Upper Back is made up of the Thoracic section of the Spine. The Thoracic Spine comprises 12 vertebrae (spinal bones). Each of these 12 Thoracic vertebrae act as an attachment for the ribs, helping to form the rib cage. The rib cage works as the strong protective cover over many of our vital organs including the heart and the lungs.

thoracic spine anatomy

Each Thoracic vertebrae sit one on top of each and are separated by Intervertebral Discs. These Intervertebral Discs act as the ‘shock absorbers’ of the Upper Back. The Upper Back is supported by a magnitude of soft tissues including muscles, ligaments, and fascial tissues.

Thoracic vertebrae

The robust and strong nature of these structures listed above (vertebral bones, muscles, ligaments, and fascial tissue) are there to protect the Spinal Cord as it sits within the Spinal Column of the Spine.

At each level of the Upper Back and Thoracic Spine, a nerve feeds off the Spine and passes into specifics areas of the thorax, acting as the ‘power’ supply for all thorax function. These nerves are called Intercostal Nerves.

Intercostal Nerves

Upper Back Pathology

Pathology within the Upper Back is much less common than pathology in the Neck and Lower Back. This is due to the robust nature of this area of our spine due to the ribs forming a solid/rounded encasing, as well as there being much less movement in our Upper Back compared to other areas of our Spine. Less movement typically means less chance of injury or overload.

There are however some common Pathologies that we see in the Upper Back. These are:

  1. Non-specific Upper Back Pain
  2. Radicular Syndromes
  3. Specific Spinal Pathology

Non-Specific Upper Back Pain

This type of Upper Back Pathology accounts for around 90-95% of Upper Back Pain and it includes pathologies caused by:

  • Issues/injury to Soft Tissues supporting the Upper Back e.g. muscle strains, ligament sprains
  • Issues with Posture
  • Issues with ‘Overloading’ the Spine
  • Stress
  • Underlying joint changes- wear and tear of the Spine
  • Upper Back muscle weakness/instability

All these Pathologies can be managed and treated with Physiotherapy and symptoms will settle with conservative treatment usually within a 6-week period.

Radicular Syndromes

This type of Upper Back Pathology accounts for around 5-10% of Upper Back Pain and it includes pathologies caused by:

  • Neural irritation (radicular)
  • Neural compression (radiculopathy)
  • Spinal Stenosis

Most of these Pathologies can be managed and treated with Physiotherapy and symptoms will settle with conservative treatment usually within a 12-week period.

Specific Spinal Pathology

This type of Upper Back Pathology accounts for <1% of Upper Back Pain and it includes more serious pathologies caused by more:

  • Cancers
  • Spinal Infections
  • Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • Spinal Fractures
  • Shingles

These types of Upper Back Spinal Pathology are serious and require urgent and immediate medical attention.

Upper Back Pathology Risk Factors

It is worth noting that there are several Risk Factors which leave you more at risk of developing any of the above Upper Back Pathologies. These are:

  • Age- the effects of degenerate change with aging
  • Fitness Level- poor fitness levels and global muscle weakness = higher risk of developing pathology
  • Weight Gain- increased weight=increased stress on structures supporting the Upper Back
  • Genetics- we are all unique but can mean some of us are more inclined to suffer with Upper Back Pathology
  • Occupational Risk Factors- Sedentary job/Manual jobs will have an impact on your Upper Back in different ways
  • Mental Health Factors- Anxiety and depression can have a direct impact on the Upper Back
  • Pregnancy- The Upper Back is at greater risk of Pathology due to weight gain and hormonal changes with pregnancy

Upper Back Pathology Treatment

The White House Clinic is much more than just a regular physiotherapy clinic. We can facilitate any intervention that is needed to help manage and rehabilitate any type of Upper Back Pathology or issue. The information below outlines all the services available at the clinic.

Physiotherapy Assessment and Treatment

We have a group of highly experienced physiotherapists who will be able to provide a thorough assessment and diagnosis of your Upper Back issue. Following this they will be able to provide you with the best evidence-based treatment to ensure improvement and hopefully resolution of your symptoms. Treatment for Upper Back pathology could include Manual Therapies, progressive Exercise Prescription or Acupuncture depending on your symptoms.

State-of-the-art gym and rehabilitation facilities

Several of our clinics are equipped with both a gym and a studio. These are filled with modern equipment enabling our physiotherapists to have the best facilities to provide your rehabilitation. Working with one of our professionals to strengthen your Upper Back is one of the best ways to prevent pathology.

Workspace and Ergonomic Assessment

If it is determined that your working position or setup is causing or contributing to your Upper Back issue, we have physiotherapists who are highly experienced in Workspace or Ergonomic Assessments. They will be able to assess and advise on the best setup of your workspace and desk to ensure symptoms are resolved and prevent the risk of reoccurrence in the future.

Rapid access to investigative and scanning facilities and direct referral links to the top orthopaedic specialists in the area

If you require further investigation such as an x-ray or MRI scan, we have the clinical pathways to refer you quickly. We also have long-standing professional relationships with the top orthopaedic specialists in the area, so in the scenario where referral to a specialist is required, we can refer you swiftly and directly.


At the White House Clinic, we can help you with any form of Upper Back issue at any stage of the process to recovery.

The Upper Back can be a source of pain and decreased function for many people.  There is, however, almost never a situation where you should ‘just have to live with it’.

If you have any questions about your Upper Back or any of the services that we provide, then get it contact with us today and we will be happy to help.

Gregg Roberts

Operations Director & Senior Physiotherapist

Gregg is the Operations Director and a Senior Physiotherapist at the White House Clinic. He qualified with a BSc (hons) in Physiotherapy from Sheffield Hallam University in 2009.

Gregg Roberts

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