Upper Back Exercises: How to Fix Your Tired Thoracic Spine

Easy to do upper back exercises fro improving the thoracic spine and neckYou might not know but pain in the upper back,  neck and even the mid-back region can all be connected together. You probably know the feeling of wanting your shoulders rubbed or having someone ask you to please rub their tired shoulder muscles. It is such a common complaint that I hear from people who sit all day using a computer at work. They all know that sitting still for too long is not a good thing for them, but it is what they have to do to get their work done.

Well I want to help you find what you can do to help those aches and pains in the joints of your thoracic and cervical spine and to finally relax those tired neck muscles. There is a big back muscle that is heavily involved in this pain that comes from sitting at a computer all day. This muscle is called the trapezius or you can say ‘traps‘. Then there are are a couple of syndromes that might need to be fixed. These are the upper crossed syndrome and T4 syndrome. I’ll be helping you through all this new lingo below. So if you have chronically tense muscles on the top of your shoulders, headaches or neck pain then this information is for you.

Trapezius Myalgia

When the trapezuis muscle is fatigued and overworked it can become knotted, stiff and painful. You could be diagnosed (ICD 10 code M79.1) with a condition called trapezuis myalgia. This basically means you have to many muscle knots in your traps.

Muscle Trigger Points

In the youtube video below you’ll be able to see where the common trigger points can be found in the trapezius muscle. A trigger point basically means a muscle knot.

Dr Janet Travell and Dr David Simons discussed these common sources of muscle pain in their famous book, “Myofascial Pain and Dysfunction – The Trigger Point Manuals”. You’ve probably seen these muscle charts hanging in your chiropractors, osteopaths or physiotherapists rooms.

Did you see in the video how far a muscle knot in the trapezius can refer pain?

You get active and latent trigger points. An active trigger point in the trapezius muscle can send pain signals all the way into the back of head or jaw area.

Myofascial trigger point chart showing referral pain patterns for the trapezius muscle

This is why there can be times when you think you have a pinched nerve in the neck problem or you are suffering a bad headache, it could actually all be coming from this type of referred pain in the trap muscle.

Now I’ll explain the two common syndromes you need to know about.

Upper Crossed Syndrome

This condition was coined by Dr Vladimir Janda in 1979. It is one of the trio of crossed syndromes. The other two being lower crossed syndrome and layered syndrome.

What happens in upper crossed syndrome is a combination of muscle inhibition and shortening of muscles.

  1. Inhibited muscles: deep neck flexors and lower scapula stabilizors
  2. Shortened muscles: upper fibres of the trapezius & the levator scapulae, sternocleidomastoid, pectoralis major

Dynamic neuromuscular stabilization chart showing the crossed syndromes discovered by Dr Janda

Here is an example of what anterior head carriage looks like in real life. You can see the solider on the left and Justin Bieber the teen pop star on the right. Even celebrities have bad posture. Image source: craigliebenson.com


So when your head drifts to far in front of your spine that’s a problem. You ideally want the head to be over the cervical spine so that all the joints and discs can do there job properly and that muscles don’t overwork, underwork and turn off.

This abnormal posture will cause pain in the cervical spine, C-T junction and upper to mid-thoracic’s.

This type of neck posture will lead to a dowager’s hump like you might see in an old grandparent. It can also be a reason you think you have a large lump at the back of your neck. That area is called vertebrae prominens which is the most spinous process of the C7 bone which is the most prominent vertebra. It is normal, but can become bigger which is then a “Buffulo hump” found with Cushing’s syndrome.

Deteriorion of the thoracic kyphosis into a dowager's hump in an old lady

If you look in the mirror do you have this type of posture?

T4 Syndrome

I believe the 4th thoracic vertebra is one of the most important areas to treat when dealing with any neck, upper back or shoulder injuries.

The reasons are:

  • The T4 spinous process is tender to touch and stiff to move in most people with a problem
  • baby prone with good head and thoracic spine extension whilst resting on elbowsWe start neck extension at this level not in the cervical spine. You see this in babies laying on their stomachs lifting their heads up.

T4 Syndrome (a.k.a upper thoracic syndrome) was coined by Australian physiotherapist, Geoffery Maitland, back in the 1950’s.

The description of some of the symptoms you can experience:

  • Feelings of tingling parasthesia or numbness, and altered perception of hot and cold in the glove distribution of both the left and right hands
  • Patient has a history of intermittent, posterior thoracic pain or pain around the scapula region
  • Headache at the base of the skull or frontal like a tension type headache
  • Symptoms are worse at night or with activities involving thoracic flexion/slumping (e.g sitting at a computer/desk for long periods, laying with pillows under your head)
  • The best position of for relief is normally laying completely flat.
  • Women more than men can suffer this problem.

The exact cause is unknown, but the theory is a lack of movement (hypomobility) between T2-T7 vertebra can irritate the nerve roots and sympathetic nervous system that leads to the discomfort feelings and pain.

I personally think so many people have a dysfunction at the area of their spines. So many people don’t move this area and so it is locked and tight.

Neck and Upper Back Exercises Research

Your sitting at your computer reading this thinking what to do now to help your aching upper back and neck pain.

They did a study in Denmark to test if general exercise or specific exercises were better for trapezius myalgia. You can read the full research paper for free if you click here.

A review of what they found was:

  1. Specific exercises help control chronic pain in the long-term
  2. General exercise helped acute pain in the short-term

So movement is important to help yourself get pain relief.

Seven Upper Back Pain Tips

When you have a strong posture muscles and good control of your head then you can do like this guy and balance 22 bricks on his head for work. Hopefully when you master some of the exercises you’ll do that 🙂

Here are my 5 self-treatment tips and exercises for upper back, neck pain and shoulder muscle stress:

  1. Just Start Moving
    Sitting for too long causes muscle problems. Stimulate them by just going for a walk, general stretching, cycling etc…
  2. Relax Your Shoulders
    It is amazing how just consciously allowing our shoulders muscle to drop down can relax the muscle. Don’t keep them up by your ears all the time.
  3. Shoulder Stabilisers Exercises
    Doing strength training exercises for the neck and upper back can help in the long-term. I have included a video of how to do from beginners exercises (isometrics) to advanced strength training exercises (isotonics using pulleys and theraband). You can also get a complete shoulder exercise pdf with more shoulder rehabilitation movements from a physiotherapist.
  4. Shoulder Blade Push-Ups
    I love these. They are a great way to exercise your upper back muscles like the rhomboids, subscapularis, lower latissimus dorsi and traps properly. Check out how to do three difficulty levels from beginner to advanced shoulder blade push-ups exercises here.
  5. Chin Tucks
    These types of movements are apart of my basic rehab exercises for neck problems. Again you can use them the upper to mid-back. Pull your chin in to create a double chin. This stops you from sticking your head out to far from spine when sitting at a computer creating bad neck and upper back posture. See the complete movement here.
  6. The Praying Stretch
  7. The T4 Sphinx Exercise

The above upper back and neck pain self-treatment list is a basic start. Hopefully it will get you some pain relief today and help in the long-term. Remember if the pain persists to see a healthcare professional for a diagnosis.

What do think of the above moves? Anything you like doing specifically to help your upper back and neck muscles?

Further Reading:

  1. Andersen LL, Kjaer M, Søgaard K, Hansen L, Kryger AI, Sjøgaard G. Effect of two contrasting types of physical exercise on chronic neck muscle pain. Arthritis Rheum. 2008 Jan 15;59(1):84-91.