Sit Up Straight! How to Manage Upper Back Pain
By Ehab Yasin DO and Susan Sorosky MD
As children, we all most likely heard the familiar words from our parents – “Sit up straight!” and “Don’t slouch!” Well…. they might have been on to something. It is true that poor posture and aches and pains do go hand-in-hand. In an effort to curb the spread of COVID-19, shelter-in-place orders and recommendations for social distancing have led to many adults working from home and children attending school on-line. These two populations share one thing in common: they hunch over their computers, attending “virtual” meetings and classes in less than ideal workspaces, ergonomically speaking. This is the perfect recipe for bringing on pain at any level of our spine, especially the upper back region.
We have transformed our kitchen tables, our couches, and even our bedrooms into “offices” without the proper modifications to help keep our bones, muscles, and ligaments in healthy and happy alignment. Over time, this sedentary existence leads to deconditioning of our muscles including our scapular stabilizers (the muscles that support the shoulder blade) and our core musculature. It also stresses the ligaments that help keep us aligned at each level of the spine. This extra stress leads to overworked and fatigued muscles, causing us to slouch further and create more aches and pains – a vicious cycle.
So now….When we find ourselves in an ergonomically deficient workspace, in a rut of inactivity, and we start to experience pain… what do we do?
- The first step is to try to prevent the pain from worsening and any new pain from occurring by addressing the ergonomics. Different types of jobs have different ergonomic recommendations, however in this digital age, we should all aim for optimal computer workstations both at the home and in the office, for ourselves and for our children. From how to sit to where to position hands and feet as well as monitors, keyboards and mice, there are copious recommendations for the optimal ergonomic set-up. Take a look at this checklist from the NIH to make sure you are doing it right.1 It even recommends rest breaks which are invaluable to spinal health.
- If your aches and pains are preventing you from participating in day-to-day tasks or recreational activities, consider an evaluation with one of our Board-Certified PM&R physicians who are specialists in Interventional Spine and Sports Medicine at Desert Spine and Sports Physicians. This evaluation includes a comprehensive history and examination of the musculoskeletal system, and in some cases, ordering and interpretation of imaging (i.e. x-rays or MRIs). Upper back pain is complex because this region of the spine consists of 12 vertebrae with 12 pairs of ribs and individual spinal joints connecting each level. Structures that cause pain in this region include muscles, bones, myofascial tissue, ligaments, joints, discs and nerves. Upper back pain can also be referred from the neck or the shoulder in some cases. In the vast majority of cases, however, upper back pain is triggered from improper muscle balance as a result of poor posture. 2
- So then what….? At Desert Spine and Sports Physicians, when we manage any pain complaint including upper back pain, our goal is to decrease pain and improve function. Our team specializes in nonsurgical treatments for musculoskeletal pain and injury. We create individualized physical therapy prescriptions for our patients which emphasize exercises to improve mobility and to stretch and strengthen affected muscles. In addition, manual therapies provided by physical therapists are also helpful in facilitating recovery and include soft tissue massage, trigger point release, thoracic spinal mobilizations and manipulation, dry needling and more. 3 In some cases, we also use non-opiate medications and targeted injections using ultrasound or fluoroscopic guidance to facilitate a patient’s participation in a healthy program of exercise.
If it was as easy as “just sitting up straight”… or “not slouching”… the vast majority of those working from home or attending virtual school would not suffer from aches and pains. But if we focus on the ergonomics and seek evaluation and treatment before the pain starts to interfere with our lives, then we can set ourselves up for success, especially as we attempt to return to a pre-COVID19 world. Contact us at Desert Spine and Sports Physicians – we are here to help!