Mid and Upper Back Pain Treatment in Winter Park, FL | Sports Physical Therapy
Mid and upper back pain is often overlooked compared to the more commonly discussed neck and lower back conditions, but it is a significant source of discomfort and limitation for both athletes and active adults. The thoracic spine plays a central role in nearly every upper body movement, and restrictions or dysfunction in this region can contribute to problems not just in the mid and upper back itself but in the neck, shoulders, and lower back as well.
At Cross the Line Physical Therapy and Performance, thoracic spine assessment is a routine part of every upper body and spinal evaluation because of how significantly it influences the regions above and below it. Below is an overview of the most common mid and upper back conditions we treat in Winter Park and the greater Orlando area.
Thoracic Spine Pain and Upper Back Stiffness
Thoracic spine pain and upper back stiffness are among the most common mid and upper back presentations we see, and they are frequently underappreciated as a source of broader musculoskeletal problems. The thoracic spine is the most structurally rigid region of the spine, and when it becomes restricted in its movement, the regions above and below it are forced to compensate. This means that thoracic stiffness is a contributing factor not only in mid and upper back pain but also in neck pain, shoulder pain, and lower back pain in many patients.
Upper back stiffness often develops gradually from a combination of prolonged sitting, repetitive movement patterns, inadequate thoracic mobility work, and the natural tendency of the thoracic spine to stiffen with age and inactivity. For athletes, thoracic restrictions can meaningfully limit performance in activities requiring rotation, overhead reach, or full spinal extension.
Physical Therapy for thoracic spine pain and stiffness focuses on restoring normal segmental mobility through manual therapy and targeted mobility work, building the strength and endurance of the surrounding musculature, and addressing the postural and movement habits that have contributed to the restriction developing in the first place.
Muscle Strains and Postural Dysfunction
Muscle strains of the mid and upper back can occur from a sudden overexertion, an awkward movement, or a direct impact, and they typically present as localized pain and tenderness that worsens with certain movements or positions. Most upper back muscle strains resolve well with appropriate management including early movement, manual therapy, and a progressive return to full activity.
Postural dysfunction is one of the most common drivers of both acute and chronic upper back muscle strain. When the thoracic spine is held in a sustained rounded or forward flexed position for extended periods, whether at a desk, during training, or as a habitual resting posture, the muscles of the mid and upper back are placed under continuous low level load that can accumulate into significant discomfort over time.
For athletes this pattern often shows up in sports that involve prolonged forward trunk positioning, such as cycling, rowing, and swimming, or in gym athletes who spend significant time in pushing and pressing movements without balancing them with adequate pulling and thoracic extension work. Addressing postural dysfunction requires both improving thoracic mobility and building the strength and endurance of the muscles responsible for maintaining an upright and well-supported posture throughout daily activity and training. Our blog post on Does Strength Training Improve Flexibility touches on the broader role of strength work in improving posture and movement quality.
Thoracic Disc Dysfunction
Thoracic disc dysfunction, including disc bulges and herniations in the mid and upper back, is less common than in the cervical and lumbar spine due to the inherent stability of the thoracic region. However it does occur, particularly in individuals who have experienced significant spinal loading over time or following a traumatic injury.
Thoracic disc issues can present as localized mid back pain, sometimes with a band-like pattern of pain or tightness wrapping around the ribcage, and in more significant cases with neurological symptoms including numbness, tingling, or weakness in the trunk or lower extremities.
As with disc conditions in other regions of the spine, the presence of a thoracic disc finding on imaging does not automatically determine whether it is the source of symptoms, and many cases of thoracic disc dysfunction respond well to conservative Physical Therapy management. A thorough evaluation is essential for accurately identifying the contribution of the disc to the overall clinical picture and determining the most appropriate treatment approach.
Rib Dysfunction
Rib dysfunction involves abnormal movement or positioning of one or more ribs at either their thoracic spine or sternal attachments, and it is a frequently overlooked source of mid back, side, and chest pain. It can develop from a direct impact, a sudden forceful movement such as a heavy lift or a powerful cough or sneeze, or from repetitive strain in athletes who perform significant rotational movements.
Rib dysfunction typically presents as sharp, localized pain that worsens with deep breathing, trunk rotation, or sustained positions, and it can sometimes be mistaken for other conditions including pleuritis, costochondritis, or referred pain from the thoracic spine. An accurate clinical examination is essential for identifying rib dysfunction and distinguishing it from other causes of chest and mid back pain.
Physical Therapy for rib dysfunction involves manual therapy techniques directed at restoring normal rib mobility and joint mechanics, combined with addressing any thoracic spine stiffness or muscular imbalances that may have contributed to the dysfunction. Most cases respond quickly to treatment when accurately identified.
Scapular Dyskinesis
Scapular dyskinesis refers to abnormal movement or positioning of the shoulder blade during arm movements. It’s role as a contributor to shoulder symptoms is highly debated amongst some Physical Therapists.
Because the scapula serves as the foundation from which the shoulder joint moves, any disruption in how it functions directly affects the mechanics and load distribution of the entire shoulder complex.
Scapular dyskinesis is not a diagnosis in isolation. It is a movement finding that tells us something important about the neuromuscular control and strength of the muscles that position and stabilize the shoulder blade during activity, particularly the serratus anterior, lower and middle trapezius, and rhomboids. Weakness or poor coordination in these muscles allows the scapula to move in ways that increase stress on the rotator cuff, the labrum, and the acromioclavicular joint during overhead activity.
Treatment focuses on restoring normal scapular control through targeted strengthening of the scapular stabilizers, improving thoracic spine mobility to allow the scapula to move freely on a mobile thoracic base, and progressively reintegrating normal scapular mechanics into sport-specific and overhead movements. For a broader look at how scapular dyskinesis fits into shoulder injury and rehabilitation, visit our Shoulder Conditions page.
Post-Operative Thoracic Spine Rehabilitation
Thoracic spine surgeries are less common than cervical or lumbar procedures but do occur in cases of significant thoracic disc herniation with neurological compromise, spinal deformity correction, or thoracic fracture stabilization. As with all post-operative spinal rehabilitation, recovery timelines and restrictions vary considerably depending on the specific procedure and the extent of the surgery.
Physical Therapy following thoracic spine surgery focuses on restoring thoracic and overall spinal mobility within the parameters established by the surgical team, rebuilding core and spinal extensor strength, and progressively returning to the demands of daily activity and sport. The approach at Cross the Line Physical Therapy and Performance is consistent with how we manage all post-operative rehabilitation: your return to full function is the goal from the very beginning, and every stage of your program is designed with that end goal in mind.
Our Post-Surgical Physical Therapy FAQ covers our overall approach to post-operative rehabilitation in more detail.
Not Sure Which Category Fits Your Mid or Upper Back Pain?
If your mid or upper back pain does not fit neatly into one of these categories, or you are simply not sure what is going on, that is exactly what an evaluation is for. A thorough assessment gives us the objective information needed to identify exactly what is driving your symptoms and build a plan that addresses the actual cause.
Call, text, or fill out our contact form to schedule your evaluation at Cross the Line Physical Therapy and Performance in Winter Park, FL.