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Mid Back Pain and How to Manage It

Physiotherapy Back Pain

Mid back pain is the pain you experience between the top of your back, from the junction with your neck, to the bottom of the rib cage. My friends and family in St John’s, Mount Pearl and Conception Bay South, throughout Newfoundland, really …as a group, complain a lot of mid back pain; mostly bearable, but frequently present, and sometimes really annoying and painful. There can be many reasons for it, some of them indicating serious pathology; but the most frequent reason for pain in the mid-back relates to an increased mid back slump, or poor posture. Uncorrected, poor posture can slide into significant pain conditions, like costochondritis,  disc protrusion and related nerve pain; and arthritis, etc. It can also cause or contribute to degenerative or lifestyle diseases of the major organ systems, like GERD and irritable bowel conditions; incontinence; late onset asthma; and diabetes, etc.

Two of the most serious reasons for pain in the mid back are cancer and osteoporosis fracture. Cancer pain that radiates to your back will likely be associated with other, non-back symptoms; and will not improve with conservative treatment measures. Osteoporosis fractures cause sudden, severe pain which is worse when standing, walking, twisting and bending; and which eases when you lie down. Most people who are at risk for osteoporotic fractures know they have osteoporosis, and are aware of the risk. It is always wise to consult your doctor if you have questions or concerns about your pain; both to keep your doctor aware of your health status, and to screen for the more serious pathologies, if warranted.

Most of the time mid back pain, with all its downstream pain conditions, is the result primarily of weakness of the back muscles, which changes how associated muscles work. It is aggravated by activities which allow your back to slump, notably prolonged sitting. It is strongly associated with head forward position and the ‘tech neck’ position. Two of the most provocative activities are texting and driving. It must be acknowledged that there can be other contributors to your mid-back pain, such as stress and actual changes in muscle texture (stiffness, trigger points etc). That said, the mid-back area wouldn’t be so influenced by stress, and wouldn’t develop trigger points, if there wasn’t first an issue with muscle strength and posture.

Mid-back pain is first described as an achy, tired sensation that increases with time on task. Sometimes it’s a one-off, following unaccustomed activity; and other times it’s a regular and recurring occurrence that has the annoying tendency to worsen over time. It’s never nice when it slides into a named pain condition, such as one of those mentioned above.

The purpose of this blog is to introduce you to some exercises that you can include in your daily activities to bring your focus to your mid-back, to stimulate the righting reflex that automatically straightens your back, and to mobilize and strengthen your back. We have selected the following exercises with an office worker in mind, but with no particular thought to exercise intensity. With the exception of one exercise, there are no seated exercises, as we find that exercising in place can exaggerate the prevailing muscle imbalances. We explain three issues which complicate exercise for the mid-back region; stretch weakness, inherent stiffness, and unnoticed rotation.

Weakness of back muscles is not as straightforward as it may appear. It is intuitive, and true, that it refers to strength; but it is also influenced by time on task. The first concept is easy; being less active  and doing less exercise, sets up a situation of decreasing muscle strength. The second concept is not so clear; it has been termed stretch weakness…the longer the time in slump, the weaker a muscle will test. This aspect of strength is sneaky because strength appears to rebound when the provocative activity is stopped. An example of stretch weakness occurs when you notice it feels difficult to stand straight after sitting for a while; but you are able, or sort of able, to perform a superman exercise at the gym. The risk of a pain condition with stretch weakness relates to the degree of the slump, not your ability to reverse the slump.

If you try strengthening your back, but the achy pain persists, it may be that your back weakness is not so simple. Within the clinic, we often notice that the weak back muscles are not equally weak, for example the right back extensors are weaker than the left. This allows the upper back to rotate, and this can be a difficult imbalance to correct. Two examples of how this occurs, quite beneath your notice, are a sloppy sitting habit and poor eyesight. For myself, I notice when I’m leaning forward to see the computer screen that I have an elbow on the table; this resting elbow creates a  rotation in my upper back. For those with vision issues, including a dominant eye, there is an unconscious rotation to accommodate sight. How subtle the contributing issues can be! But identifying and correcting these subtle factors is important to effectively strengthen your back and chase the achy pain away.

Another issue which complicates exercise prescription for the mid back is that the area is quite rigid. As slump deepens, there is a loss of tissue extensibility around the vertebrae and rib joints, which restricts the ability to straighten. As this occurs, effort to straighten requires compensatory movement from the low back and/or neck.

So, how do you manage an achy, painful back; especially one that seems to be more bothersome over time? Our advice is:

  • Incorporate exercises which target the mid back area. Use the exercises we provide, supplement or change them, as best suits your routine. There are a great many good exercises.

Posture Exercise Tree Balance Pose

Posture Exercise Tree Balance Pose

TO PERFORM TREE POSE

  1. Stand on one leg
  2. Bring your other foot to your knee that you balancing on, opening your hip with your other knee out to the side
  3. If you feel unstable or off balance perform this balance exercise by a wall or something to hold on to
  4. Begin with your hands on your hips, if you feel balanced, you can make the pose more challenging by raising your arms overhead
  5. Focus on balancing upright with proper posture
  6. Hold the balance pose for 30 seconds on each leg
  7. If you begin to wobble or get off balance, put your leg down, re-center your balance, and then continue performing Tree Pose
  8. Please Note: this is a challenging exercise, make sure there are no obstacles that you could run into or trip over. Be safe and aware of your surroundings while performing this exercise.

Posture Exercise Chair Pose

Posture Exercise Chair Pose

TO PERFORM CHAIR POSE:

  1. Stand up straight in proper posture
  2. Bend your knees and position your lower body as if sitting in a chair
  3. Bring your arms up extended overhead
  4. Keep your head up and your eyes parallel with the ground
  5. Keep your back straight and avoid collapsing your body forward
  6. Hold the Chair Pose Position for 30 seconds
  7. Please note: This is a difficult exercise. Make sure you have strong balance before attempting to perform it. If you feel off balance, have something nearby to grab onto for support

Posture Exercise Posture Break Standing

Posture Exercise Posture Break Standing

TO PERFORM A POSTURE BREAK STANDING:

  1. Stand up straight in proper posture
  2. Bring your arms out wide to the sides
  3. Drop your head back
  4. Push your chest forward
  5. Open your chest cavity and feel “anti-gravity”
  6. Hold this position for 30 seconds while taking deep breaths
  7. Perform one Posture Break for 30 seconds every hour of your workday
  • Full-body exercise, either independently or coached…whatever exercise interests you and you believe you can stick to. Walking is great, but generally not enough if the rest of your daily activities are sedentary.
  • Consider the ergonomics of your most common activities, like your computer and television set-ups; and incorporate exercise breaks during long computer sessions.
  • Have a posture pic taken; it may identify a problem, and will serve as an indicator of changing alignment and strength over time. It is not necessary for effective treatment, but it is informative and can be motivating!
Physiotherapy Back Pain
  • If you’ve tried to improve things on your own, but the achy pain persists, get help; either your physician if you have medical concerns; or your physiotherapist to identify imbalances and recommend adapted exercise.
  • Sometimes, when long time issues have created stiff, scarred muscles and/or pain is overwhelming, you just need more help. Low intensity laser is a great modality to restart or speed healing, reduce requirement for medication and reduce scarring. It’s also a great complement to massage therapy, acupuncture and physiotherapy.

We hope we have been able to contribute to your understanding of mid-back pain; and that we can help some of you avoid its more serious consequences. Please know we are here to help you. We can advise on a more comprehensive prevention strategy; and we can certainly help when mid-back pain goes beyond the achy. While we can provide the physiotherapy, massage therapy, acupuncture and bioflex laser services you want, we offer as well a collaborative treatment plan. This plan coordinates  the services you need, both in terms of timeliness and cost; and helps you optimize personal health insurance.

Our goal for you is…

To Feel Better, Move Better and Look Better

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