Upper Back Pain

Upper Back Pain

A self help strategy for desk workers suffering upper back pain

Sitting ultimately leads to slouching which can irritate the ligaments that hold your spinal joints together. After a period of time, discomfort is felt in your back as the ligaments tire from being constantly stretched, and start to whinge at you.

If you’ve fallen victim to prolonged slouching, your body will most likely appreciate movements in the opposite direction – extension. If you suspect your upper back pain and stiffness is largely due to prolonged sitting, you can try this series of thoracic mobilisation exercises for relief.

1. Cat camel stretch

Start with all fours on the ground. As you lower your spine, curling it towards the floor, arch your neck backwards as if to look to the sky, resembling a typical cat stretch. Then arch your spine upwards from this position, forming a camel’s hump, whilst simultaneously lowering the neck to look between your arms and legs.

Oscillate between the two positions about five to six times.

2. Greet the sun stretch

Whilst standing, have your arms fully stretched out to the sides of your body, parallel to the ground, with your thumbs pointing to the ground. Look straight ahead, then extend your neck backwards as far as possible. As you do this, rotate your arms backwards so that your thumbs attempt to complete between 270-360 rotation. Note that in the photo below, the subject is in the final position of this stretch.

3. Lat pull over stretch

This exercise usually features in weight training programs, where the aim is to increase the strength of the latissimus dorsi. You could perform this stretch on a gym bench or even the arm section of your couch at home. It can be useful to use added weight in the form of a dumbbell [as pictured] or alternatively, interlock your hands together. It helps to make small pulsating motions with your arms at the end range of this stretch for added “burst” of extension through your thoracic spine.

4. Foam roller exercise

A foam roller is a fantastic tool where you can make excellent use of your body weight to relieve spinal stiffness. Choose a space on the floor where you can lie your upper back on top of the roller. Use your legs to push and pull your body up and down the floor. The weight of your body overlying the roller will cause intersegmental extension across the length of your thoracic spine as you travel up and down the floor.

5. McKenzie push-up

Typically used to address lower back pain, the McKenzie push-up is a must inclusion for thoracic mobility due to the global spine extension achieved in this exercise. Place your hands beneath your chest about shoulder width apart. Using your triceps muscles, push into the floor raising your upper body once again, whilst keeping your pelvis on the floor. Come up all the way until both arms lock out. Aim for up to ten repetitions.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Shoulder pain exercises

Shoulder pain exercises

Exercises for rotator cuff problems, shoulder impingements, shoulder instability and SLAP tears

The shoulder is an incredibly complex joint. It has a large degree of freedom at the expense of reduced stability. For this reason it is subject to a wider range of injuries, most of which involve damage to the rotator cuff.

The following exercises are designed to rehabilitate the rotator cuff muscles. They will be particularly useful for injuries such as shoulder impingement, tears in the rotator cuff, shoulder instability and SLAP lesions. The information has been adapted from the book, The Shoulder Made Simple (Version 6.0), by Dale J Buchberger.

Due to the volume of information surrounding this rehabilitation program, this article is only a summary of the exercises. It is strongly recommended that before attempting these exercises that you consult a physical therapist for a proper diagnosis of your shoulder condition, and any other information pertinent to the rehabilitation of your particular shoulder injury.

Rotator cuff & scapular strengthening – Day 1

1. Side lying abduction

Keep the humerus (upper arm) in the scapular plane.

Lift the humerus in the scapular plane. This is a linear movement. Only raise the arm to the height of the knee. Approximately 30 degree arc.

2. Push-up Plus

Keep elbows fully extended with scapulae retracted. Ensure your torso, spine and back muscles are all firmly activated.

Protract the scapulae (do not flex thoracic spine) whilst keeping the elbows extended. Progress from using a Dyna-Disc to doing the exercise with your feet on a physio ball and vary the lever length (start with the physio ball under your knees first and progress to using it under your feet).

3. Field goal

Place the Dyna-Disc under your chest while your arms hang relaxed off the bench. The first progression is to retract the scapulae (pinch the shoulder blades together).

While maintaining scapular retraction, extend the shoulders to 90 degrees. Keep the elbows flexed at 90 degrees.

Maintain 90 degrees of shoulder extension and scapular retraction. From this position, externally rotate the shoulder with the thumbs pointed up as pictured. Be sure to reverse each motion, but do so SLOWLY!

4. Concentric/Eccentric

Side lying external rotation, pointing the thumb backwards. Elbow tucked into the front of your hip (the part part).

From the externally rotated position, press up to the ceiling, extending the elbow. In the next photo, keep the elbow fully extended while you perform horizontal adduction with internal rotation (turning the thumb to the floor while crossing the chest). If there is anterior shoulder pain, lower the arm to a comfortable level of adduction.

5. Modified empty can

Start in the thumbs down or “empty can” position. Retract the scapulae. In the next photo, elevate the humerus with the thumbs pointed downward in the scapular plane. At approximately 45 degrees of scapular plane elevation, start externally rotating the arm whilst continuing to elevate the humerus. You must maintain the scapular plane throughout the motion.

Ensure you continue to elevate the humerus whilst externally rotating. Notice the position of the elbow (100 degrees of abduction). The scapula should be reset before each repetition.

6. Elbow flexion with pronation and supination

It is difficult to see in this photo, but the subject has anchored a length of resistance tubing (with handle) at a distance from his right side. The right arm would have initially been fully straightened at 90 degrees from the body. We see in this photo, the subject has flexed the elbow (as in a bicep curl) whilst simultaneously supinating the forearm (he has turned the forearm/wrist so that the palm of the hand faces the ground at the end of the exercise)

Again, in this photo the right arm would have initially been fully straightened at 90 degrees from the body. We see in this photo, the subject has flexed the elbow (as in a bicep curl) whilst simultaneously pronating the forearm (he has turned the forearm/wrist so that the palm of the hand faces the ceiling at the end of the exercise). In both DO NOT drop the elbow! Maintain the elbow position during elbow flexion. This will also work the serratus anterior muscle.

Rotator cuff & scapular strengthening – Day 2

7. Subscapularis pull

Start with the elbow fully extended and the thumb up. Pull the tube behind the back (internal rotation) and touch the bottom tip of the opposite scapula with your thumb.

8. External rotation with scapular retraction

Keep the elbow tucked into your side as you externally rotate the humerus. As external rotation is completed retract the scapulae together.

9. Bilateral Blackburn 3 [BB3] – position 1 & 2

Use a Dyna-Disc under your chest, with your arms externally rotated. Retract the scapulae with elbows fully extended.

Lift thumbs to the ceiling with the elbows fully extended. Do not hyperextend the shoulders. Hyperextension of the shoulders will cause excess stress on the anterior shoulder capsule leading to shoulder instability.

10. Standing 3-way

Start with the arms lowered by the side of your body, with elbows extended. Retract the scapulae, and raise the arms forward keeping the thumbs up, elbows still extended. Perform this motion slowly.

As above, start with the arms lowered by the side of your body, with elbows extended. Retract the scapulae, and raise the arms in the scapular plane. Keeping the thumbs up and elbows fully extended.

11. Dynamic Blackburn

Merely place the hands on the buttocks, and retract the scapulae.

Depress the scapulae by reaching for your feet. Keep the hands together.

While keeping the hands together lift them off of your buttocks.

Slowly release hands. Begin to externally rotate the humerus while continuously abducting the humerus.

Continue externally rotating whilst abducting, thumbs should point upwards now, and the arm is at 90 degrees of abduction.

Continue externally rotating whilst abducting, thumbs should point upwards now, and the arm is at 100 degrees of abduction. This is the end range of motion for this exercise. Do not go higher! Reverse the motion slowly. Begin the next repetition from position 1.

12. Scapular retraction – End range

Lie face down with a dyna-disc under the chest. Shoulders and elbows are at 90 degrees. The first movement is to retract the scapulae. The forearms should not come off the floor.

Whilst maintaining scapular retraction, lift the elbows and thumbs to the ceiling. Maintain 90/90 degree position.

How many should I do?

The twelve exercises have been split into two days. There is no need to perform more than one day’s worth of exercises each day. You should perform two to three sets of each exercise. The advice Dale Buchberger suggests is to start each exercise with no weight and perform 10-15 repetitions. If this seems too easy, you can increase the number of repetitions by five until you can perform 30 repetitions pain free (eg. 15, 20, 25, 30). Before you can increase or add weight to an individual exercise, you must be able to perform 30 repetitions of that exercise. Some of the exercises will seem harder than others so expect to be using different weights across the twelve exercises.

Furthermore, you cannot increase repetitions until you have spent at least two weeks on the starting amount. For example, you must perform two to three sets of 15 repetitions of each of the twelve Buchberger exercises for two weeks. Only then, in the following two weeks may you increase to 20 repetitions of each exercise. Aim to do the Day 1 and Day 2 exercises four times each in the two week period.

If you do the maths, you’ll start to realise how long this rehabilitation program can take. Understand however, that it may well have taken longer than you realise to have damaged your rotator cuff in the first place. Whilst it might be a slow process to recover from your injury, know that Dale Buchberger has developed these exercises over a period of longer than 15 years and has assisted numerous professional baseballers (mostly pitchers) return to activity. The rotator cuff is a small muscle group and so you need only work up to a weight of four to five kilograms maximum. Overloading these small muscles is a frequent cause of rotator cuff damage.

The level of discomfort you may or may not feel after each exercise should help determine whether you can manage more, or whether you should reduce the repetitions. You should not feel pain during these exercises. If you do feel pain you may well be performing them incorrectly. It is acceptable to experience a degree of discomfort while performing some of the exercises. Your challenge is to determine the difference between damaging pain and rehabilitative discomfort. The emphasis must be on quality of performance, not quantity of weight.

You can access more information on tips to save your shoulders here. Ensure you have run through these exercises with a practitioner, and that you understand their purpose.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.