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86 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 2 0 technique CLINICAL EXPLORATIONS Managing Upper Back Pain By Whitney Lowe TSP is more common in women than men, 1 and TSP also appears to be occurring with increasing frequency among adolescents. It is correlated with heavy load, like a backpack full of books. Other factors that play a prominent role in adolescent TSP include the frequency of physical activity, daily time spent watching television, studying in bed, sitting postures when writing, and computer usage. 2 Ergonomics literature and research offers insights into developing workstations that help decrease back pain, yet rarely discuss good ergonomic workstations for adolescents. Young people often get last picks on work locations for their studies at home. In this article, I will focus on the soft-tissue elements of TSP that don't get as much attention in the research literature but are common for our clients. We'll review some of the key anatomical issues in this region and then explore how anatomy, biomechanics, and other factors contribute to upper back pain. Then, we'll look at some key treatment strategies. ANATOMICAL BACKGROUND The upper back is the area between the lowest cervical vertebra and the uppermost lumbar vertebra. Essentially this area of the back corresponds with everything adjacent to the 12 thoracic vertebrae. The majority of soft-tissue TSP complaints seem to be within about the T1–T7 region. One of the main reasons for the high incidence of upper back pain is the mechanical stress in this region from sedentary postures. There are layers of muscles in this region that must manage these loads. Some of these muscles are quite deep, so it is easy to gloss over them when working on the thoracic region. For that reason, it is helpful to use a specifically targeted technique, most likely with a small contact surface (fingertip, thumb, or pressure tool). Another key anatomical factor to consider in the upper back is the costovertebral articulations where the ribs connect with the thoracic vertebrae. The costovertebral articulations are not very stable joints. And, like other synovial joints, the articulation is surrounded by a richly innervated joint capsule, so Upper back pain is common—especially for people who spend long hours in front of a desk or computer screen. Interestingly, there is a great deal of research published on lumbar and cervical pain complaints, but nowhere near as much focusing on thoracic spine pain (TSP). The orthopedic literature that does focus on TSP emphasizes structural issues associated with the spine and doesn't put as much emphasis on soft-tissue problems. The emphasis on bony, structural causes of TSP is common in orthopedics; however, massage therapists often find that clients report soft-tissue pain in the upper thoracic region with this condition. 1 Trapezius and latissimus in the most superficial layer of the upper back. Image from 3D4Medical's Complete Anatomy application.

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