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C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p 87 mechanical stresses, subluxations, or dislocations of rib heads can produce significant acute thoracic pain. A former rib injury can also set the individual up to have recurrent pain in this region long after the initial injury has resolved. In the next section, we'll explore some of the key biomechanical stresses that overload these muscles and lead to pain in the upper thoracic region. CAUSES OF UPPER-BACK PAIN A key cause of upper back pain is biomechanical overload. There is a limited amount of movement between adjacent vertebrae in the thoracic region. The structure of the rib cage allows very little torso flexion, as this motion would compress the rib cage. There is also minimal spinal extension in this region. The majority of flexion and extension movement in the back is in the lumbar region. More of the rotational movement of the spine occurs in the thoracic region. A primary role of the muscles in this region is to maintain and stabilize the torso or scapula so the upper extremity can generate large forces. Also, many of these muscles must hold the head and upper back in static positions for long periods. Frequent sedentary postures and forward-head tilt to look at monitor screens puts a significant biomechanical strain on the thoracic extensor muscles. These postures require the muscles to work with long periods of isometric contraction to offset the pull of gravity on the head. When attempting to determine a cause of pain with TSP, it is helpful to consider key theories about posture and pain that have developed from both research and clinical experience. One of the most prevalent Primary Layers in the Upper Back Starting superficially, the upper back is dominated by the trapezius and latissimus dorsi muscles (Image 1). Deep to the trapezius in the upper back lie the rhomboid major and minor (Image 2). These muscles frequently hold myofascial trigger points that refer pain to other regions. Rhomboid pain is probably one of the most frequent complaints that brings people to see their massage therapist. The next layer down holds the serratus posterior superior running parallel beneath the rhomboids. In addition, the long expanse of thoracic erector spinae muscles lie against the rib cage as they extend toward the cervical region (Image 3). At the deepest level are the intrinsic spinal extensor and rotator muscles that lie close to the spine, the multifidus, and rotatores (Image 4). 2 3 4 The deepest intrinsic spinal muscles in the thoracic region. Image from 3D4Medical's Complete Anatomy application. Rhomboid major and minor in next layer. Image from 3D4Medical's Complete Anatomy application. Erector spinae in the thoracic region. Image from 3D4Medical's Complete Anatomy application.