🤔 What Is It?

Postural strain in the upper back occurs when the muscles and joints between the shoulder blades, neck, and thoracic spine become overworked, tight, or fatigued from sustained poor posture — usually from long hours sitting at a desk, driving, or using a phone.

This often fits the pattern of Upper Crossed Syndrome, a common muscular imbalance where:

• The pecs and upper traps are tight

• The deep neck flexors and lower traps are weak

• The head shifts forward, and the shoulders round in

The result is upper back tension, aching between the shoulder blades, and fatigue that builds throughout the day.

💡 Common Physiotherapy-Related Causes:

• Slouched sitting posture at work or study

• Forward head and rounded shoulders (tech neck)

• Weakness in postural muscles (lower traps, deep neck flexors)

• Imbalance from training push-heavy in the gym

• Inadequate thoracic spine or scapular mobility

🛠️ What You Can Do:

• ✅ Take posture breaks every 30–45 minutes when working at a desk

• ✅ Perform simple mobility drills (chin tucks, thoracic extensions, wall slides)

• ✅ Use ergonomic desk setups — screen at eye level, supported elbows

• ✅ Avoid overtraining push movements without pull-focused strength

• ✅ Apply heat or massage to relieve muscular tension at the end of the day

👩‍⚕️ How Physio Can Help:

• Assess your posture, movement control, and muscle imbalances

• Release tight muscles with hands-on therapy, dry needling, or cupping

• Restore strength in postural stabilisers and scapular muscles

• Prescribe a targeted mobility and activation program

• Guide desk and lifestyle changes to prevent recurring overload

• Help you return to the gym or work pain-free with stronger posture

🙋‍♀️ Answers to Common Questions

1. What does postural strain feel like?

• A dull, aching or tight feeling between the shoulder blades

• Often worse at the end of the day or after prolonged sitting

• May cause tension headaches or stiffness in the neck

• Can feel better temporarily with stretching or movement

2. Is this the same as poor posture?
Postural strain is the result of poor posture over time, where muscles become overloaded trying to support a suboptimal position. It's not a permanent issue — with the right treatment, your body can relearn efficient movement and support.

3. Can physio help even if there’s no injury?
Yes — physiotherapy is highly effective for non-traumatic pain, especially when it comes from lifestyle or movement patterns. We specialise in fixing the root cause, not just the symptoms.

4. Should I try to sit perfectly upright all day?
No — the best posture is your next posture. Staying rigid or upright for too long can cause its own problems. Movement and variety are more important than being “perfectly straight.”

5. How long does it take to improve?
Many people notice relief in just a few sessions, especially with hands-on treatment and mobility work. Long-term change takes consistent strengthening and posture awareness, but the results are sustainable.

6. Can I still work out with postural pain?
Yes — and in most cases, exercise is part of the solution. We’ll help you adjust technique, balance your training, and build strength in the areas you need most.

7. What exercises help postural strain?

• Chin tucks and wall slides

• Band pull-aparts or face pulls

• Thoracic mobility (foam rolling, extensions)

• Prone Y/T/Ws or lower trap activation
  We’ll build you a custom plan to match your posture and activity level.

🤔 What Is It?

Facet joints are small stabilising joints at the back of your spine. In the thoracic region (upper to mid-back), these joints help you bend, twist, and extend. When irritated or overloaded, they can cause localised pain and stiffness, usually near the spine.

This irritation can result from:

• Poor posture

• Repetitive or sustained extension/rotation

• Joint stiffness and lack of movement

• Sudden loading (e.g. during sport, gym, or awkward lifting)

💡 Common Physiotherapy-Related Causes:

• Repetitive twisting or arching of the back

• Sitting or slouching for long periods

• Thoracic stiffness causing joint compression during movement

• Overhead lifting or forceful rotation in sport or gym

• Poor control of scapular or spinal movement patterns

🛠️ What You Can Do:

• ✅ Avoid extreme twisting or extension movements temporarily

• ✅ Try gentle thoracic mobility drills (e.g. cat-cow, open book stretches)

• ✅ Apply heat or use a foam roller to ease stiffness

• ✅ Improve your sitting posture and movement patterns

• ✅ Strengthen postural and spinal support muscles under physio guidance

👩‍⚕️ How Physio Can Help:

• Identify which joints are restricted or irritated

• Apply joint mobilisation or manipulation techniques

• Use manual therapy, needling, or massage to ease surrounding tension

• Prescribe mobility and stability exercises to restore normal movement

• Help you modify sport, gym, or work activities to avoid flare-ups

• Prevent recurrence with a long-term movement strategy

🙋‍♀️ Answers to Common Questions

1. What does facet joint irritation feel like?

• Localised pain on one side of the spine, often described as a “pinch” or “stab”

• Worse with twisting, leaning, or arching the back

• May feel stiff or restricted when rotating or extending

• Not usually associated with numbness or tingling

2. Can it refer pain anywhere?
Sometimes — it may cause a dull ache into the shoulder blade or side of the ribs, but generally stays quite local. If pain radiates further, other causes like nerve involvement will be ruled out.

3. Is this a serious condition?
Not typically. It’s usually a mechanical irritation that responds well to treatment. Left untreated, it can lead to chronic stiffness, postural compensation, or referred discomfort, but it's not dangerous.

4. Do I need a scan?
Not usually. We can clinically diagnose and treat facet joint issues with movement and palpation tests. Imaging is only considered if symptoms persist or suggest something more complex.

5. How long does it take to feel better?
You’ll often feel relief within 1–3 sessions with manual therapy and mobility work. Full resolution with strength and postural correction may take a few weeks, depending on your activity level and goals.

6. What movements should I avoid?
Avoid:

• Forceful twisting or arching

• Repetitive overhead lifts if aggravating

• Slouched or static postures
  We’ll guide you on when and how to reintroduce these safely.

7. What exercises help facet joint pain?

• Open book stretches and thoracic extensions

• Foam roller mobilisation

• Scapular retraction and postural drills

• Core and spinal stability work (especially mid-back control)
  These are progressed as pain settles and movement improves.

🤔 What Is It?

Costovertebral joints are where your ribs attach to your thoracic spine. Each rib connects to the spine via small joints that allow the ribcage to expand and move with breathing, rotation, and upper body movement.

When these joints become irritated, stiff, or misaligned, it can lead to:

• Sharp or stabbing pain near the spine or under the shoulder blade

• Pain that wraps around the rib cage or flares with breathing

• Discomfort with twisting, lifting, or certain sleeping positions

💡 Common Physiotherapy-Related Causes:

• Sudden twisting or awkward movement (e.g. reaching, turning in bed)

• Poor posture or thoracic stiffness

• Overuse from repetitive lifting, coughing, or sneezing

• Muscular imbalance or tightness around the thoracic spine and ribs

• Breathing dysfunction or shallow chest breathing patterns

🛠️ What You Can Do:

• ✅ Avoid forceful twisting or deep compressive postures temporarily

• ✅ Use heat and gentle thoracic mobility drills to ease stiffness

• ✅ Practice diaphragmatic breathing to reduce rib strain

• ✅ Try positions of comfort (lying on side, supported sitting)

• ✅ Begin rehab with physio to restore rib joint motion and control

👩‍⚕️ How Physio Can Help:

• Identify which costovertebral or costotransverse joint is restricted

• Release tension with manual therapy, dry needling, and mobilisation

• Improve thoracic spine and rib mobility

• Address breathing pattern dysfunction and core control

• Rebuild postural and shoulder stability to prevent recurrence

• Guide return to gym, sport, or work without flare-ups

🙋‍♀️ Answers to Common Questions

1. What does costovertebral joint pain feel like?

• Sharp, stabbing, or “catching” pain near the spine or inner shoulder blade

• Pain may wrap around the side or front of the rib cage

• Often worse with deep breaths, twisting, or lying flat

• May feel like a “rib out of place” (though it’s rarely dislocated)

2. Is this dangerous or heart-related?
It can feel alarming — especially if it wraps around the chest — but costovertebral pain is musculoskeletal in nature. If pain is accompanied by shortness of breath, chest tightness, or cardiovascular risk, we’ll advise urgent medical review. Most cases are benign and respond well to physio.

3. Can a rib “pop out” or get stuck?
Not exactly — but the joint can become stiff, irritated, or slightly shifted. This may feel like a rib is “out,” but it's more about joint mechanics and muscular imbalance, which we can treat effectively.

4. Will I need a scan?
Not usually. Diagnosis is made through movement tests, palpation, and pattern recognition. Scans are only needed if symptoms persist or trauma is involved.

5. How long does it take to improve?
Mild to moderate cases often improve within 2–4 sessions. More chronic or movement-related dysfunctions may take a few weeks with progressive rehab.

6. Can it cause pain with breathing?
Yes — especially during deep inhalation or sneezing, since the ribs expand and move. Once joint movement and muscular tension improve, this symptom usually resolves.

7. What exercises help rib joint dysfunction?

• Open book thoracic rotations

• Foam roller extensions

• Breathing drills (diaphragmatic + lateral rib expansion)

• Shoulder and scapular mobility to offload thoracic strain
  All exercises are adapted to pain level and function.

🤔 What Is It?

The thoracic spine (mid to upper back) is designed for rotation, extension, and flexion — but in many people, it becomes stiff or restricted due to poor posture, repetitive tasks, or lack of movement.

This stiffness doesn’t just affect the upper back — it can also place strain on the neck, shoulders, and lower back, leading to pain, poor mobility, and reduced performance.

💡 Common Physiotherapy-Related Causes:

• Prolonged sitting with rounded posture

• Inadequate thoracic mobility from inactivity or training imbalance

• Excessive focus on chest/shoulder strength without thoracic mobility

• Poor breathing patterns and rib immobility

• Overreliance on lumbar or cervical movement to compensate for thoracic stiffness

🛠️ What You Can Do:

• ✅ Take regular posture breaks during desk work or long drives

• ✅ Use a foam roller or peanut to mobilise the upper spine

• ✅ Perform daily thoracic rotation and extension drills

• ✅ Strengthen your postural muscles to maintain better positioning

• ✅ Seek physio guidance to target the right joints and movement patterns

👩‍⚕️ How Physio Can Help:

• Assess which thoracic segments are restricted and contributing to symptoms

• Mobilise stiff joints with manual therapy, cupping, or dry needling

• Re-train proper movement through mobility and spinal control drills

• Address linked issues in the neck, shoulders, or rib cage

• Tailor your rehab for sport, work, or gym performance goals

🙋‍♀️ Answers to Common Questions

1. What are signs of thoracic stiffness?

• Feeling tight, locked, or restricted in the upper/mid back

• Difficulty rotating your torso (e.g. reversing the car or swinging in sport)

• Trouble with overhead movements (e.g. presses, snatches)

• Compensations like neck strain or low back tightness

• Reduced breath expansion or shallow breathing

2. Why is thoracic mobility important?
The thoracic spine is crucial for:

• Rotating the torso (e.g. sports, driving)

• Allowing overhead shoulder movement

• Supporting deep, efficient breathing

• Reducing strain on the neck and lower back

3. How long does it take to improve?
Some mobility gains can be seen within a few sessions, but lasting results come from consistent mobility and postural strengthening — often over 4–6 weeks depending on severity.

4. Can this cause shoulder or neck pain?
Yes — lack of thoracic motion can cause compensatory stress in the neck and shoulders. Improving thoracic mobility often reduces pain and improves performance in these areas.

5. What exercises improve thoracic mobility?

• Open book and thread-the-needle drills

• Foam roller extensions over mid-back

• Wall angels and scapular mobility work

• Breathing drills to expand the ribs
  We’ll personalise your program based on how your spine moves.

6. Should I stretch or strengthen?
Both! First, we improve joint mobility and release restriction. Then we build strength and control to maintain better posture and movement long-term.

7. Do I need to get adjusted or cracked?
Manual mobilisation or manipulation may help, but lasting change requires movement and strength. We combine hands-on work with active rehab for the best results.

🤔 What Is It?

Sometimes, upper back pain isn’t coming from the back itself. Instead, it’s referred from other regions — most commonly the neck (cervical spine) or the shoulder/scapular complex.

This means the pain you feel between the shoulder blades or near the spine is actually caused by dysfunction, nerve irritation, or muscular overload higher up the chain. Treating only the upper back in these cases often misses the root cause.

💡 Common Physiotherapy-Related Causes:

• Cervical facet joint irritation or disc issues

• Neck postural strain from prolonged computer or phone use

• Scapular dyskinesis or shoulder instability

• Thoracic outlet syndrome or nerve tension

• Poor movement patterns that overload the thoracic region

🛠️ What You Can Do:

• ✅ Notice whether pain changes with neck or shoulder movement

• ✅ Try gentle neck retraction (chin tuck) drills

• ✅ Improve postural awareness, especially at work or driving

• ✅ Avoid deep massage over the pain site if it’s not helping

• ✅ Get a physio assessment to trace the true source of your symptoms

👩‍⚕️ How Physio Can Help:

• Determine whether your pain is referred or local

• Assess cervical and scapular mechanics

• Treat the source using manual therapy, neural glides, and mobility drills

• Re-train posture, scapular stability, and deep neck control

• Build a movement plan that addresses the whole upper quadrant

🙋‍♀️ Answers to Common Questions

1. What are signs my upper back pain is referred?

• Pain that feels deep, vague, or hard to pinpoint

• Discomfort that changes with neck or arm movements

• Little relief from local massage or foam rolling

• Accompanied by neck stiffness, arm weakness, or pins and needles

• Onset after prolonged desk work or posture strain

2. How does referred pain actually work?
Referred pain happens when nerve pathways overlap, and the brain can’t easily distinguish the source. Irritation in the neck or shoulder can activate pain-sensitive structures in the upper back, even if those tissues are healthy.

3. Is this a nerve problem?
Not always — referred pain can come from joints, muscles, or nerves. We'll test for neural tension, joint referral patterns, and muscular triggers to identify the cause.

4. Do I need imaging?
Usually not — we can often diagnose referred pain with clinical tests. Imaging may be considered if symptoms are severe, persistent, or not responding as expected.

5. Can physio still help even if the pain isn’t coming from the back?
Absolutely. Physio is often more effective in these cases, because we treat the true cause rather than chasing symptoms. You’ll likely feel better faster and reduce future flare-ups.

6. How long until it improves?
It depends on the source and how long the issue has been present, but many people feel improvement within 1–3 sessions, especially once the right area is being treated.

7. What exercises help referred upper back pain?

• Chin tucks and deep neck flexor work

• Scapular retraction and control drills

• Thoracic mobility (open books, foam roller)

• Nerve glides if tension is present
  Your physio will tailor exercises based on your exact referral pattern.

🤔 What Is It?

Trigger points are small, hyperirritable spots in muscle tissue — often described as “knots” — that can cause local pain, referred discomfort, or a sense of tightness. In the upper back, they’re commonly found in muscles like the:

• Upper trapezius

• Levator scapulae

• Rhomboids

• Infraspinatus

These trigger points can build up over time from poor posture, stress, overuse, or training load — and often lead to a persistent tightness or ache that massage alone won’t fix.

💡 Common Physiotherapy-Related Causes:

• Prolonged postural loading (e.g. desk work, phone use, driving)

• Repetitive movements or overload in training (especially upper body push/pull)

• Weakness or underuse of postural muscles (lower traps, deep neck flexors)

• Poor scapular control and shoulder blade mechanics

• Emotional or mental stress (muscle guarding)

🛠️ What You Can Do:

• ✅ Avoid repetitive or sustained positions that overload the area

• ✅ Use heat, foam rolling, or gentle stretching for short-term relief

• ✅ Incorporate regular postural breaks and mobility work

• ✅ Learn basic trigger point release or ball-based self-massage techniques

• ✅ Get a physio assessment to treat the underlying source — not just the symptoms

👩‍⚕️ How Physio Can Help:

• Identify which muscles are carrying trigger points and why

• Use dry needling, cupping, massage, or active release to reduce tension

• Assess and correct posture, movement control, and breathing patterns

• Rebuild muscular balance with a tailored strength and mobility plan

• Address contributing areas like the neck, shoulders, and thoracic spine

🙋‍♀️ Answers to Common Questions

1. What does a trigger point feel like?

• A “knot” in the muscle that feels tender to touch

• Pain may be local or refer to nearby areas (e.g. neck, shoulder, arm)

• May cause restricted movement or tension that lingers after rest

• Some people report headaches or tingling when pressing a certain spot

2. Why do I keep getting the same knot?
Because the underlying cause hasn’t been addressed — usually poor posture, stress, or muscular imbalance. Releasing the trigger point provides relief, but if you don’t fix what’s driving the overload, it’ll come back.

3. Do I need dry needling or massage?
Both can be helpful. Dry needling works well for deeper or more persistent trigger points, while manual therapy is great for reducing surface tension. Your physio will guide the best approach for your body and goals.

4. Can I release it myself?
Yes — using a trigger ball, lacrosse ball, or massage cane, you can perform self-release. However, this should be paired with mobility and strengthening to make changes last.

5. Is it dangerous to have trigger points?
Not at all — but they can be frustrating and draining, especially if they keep returning. Identifying the root cause will give you more permanent relief and help prevent future flare-ups.

6. How long until it gets better?
Some people feel immediate relief after release work. For long-standing tension, it may take a few weeks of consistent treatment, mobility, and re-training to correct.

7. What exercises help prevent trigger points?

• Foam roller or ball-based thoracic release

• Wall slides, band pull-aparts, scapular stability drills

• Deep breathing and stress management

• Strengthening of the lower traps, rotator cuff, and neck flexors
  Your physio will help you find the right balance for long-term change.

🤔 What Is It?

Scapular dyskinesis refers to abnormal or inefficient movement of the shoulder blade (scapula). The scapula plays a critical role in upper back and shoulder function — it provides a stable base for arm movement, supports posture, and protects the thoracic spine.

When scapular movement is imbalanced, weak, or poorly timed, it can lead to:

• Pain in the upper back or shoulder blade region

• Reduced shoulder range or performance

• Clicking, catching, or a feeling of weakness with overhead movement

• Increased strain on the neck, thoracic spine, and rotator cuff

💡 Common Physiotherapy-Related Causes:

• Poor posture or prolonged desk work

• Previous shoulder or neck injury altering movement patterns

• Overtraining push movements (e.g. bench press) with undertrained pulling

• Weakness or inhibition in stabilising muscles like lower traps and serratus anterior

• Muscle timing issues from fatigue, tension, or poor motor control

🛠️ What You Can Do:

• ✅ Improve posture with scapular retraction and thoracic mobility drills

• ✅ Reduce repetitive overhead or pushing movements short-term

• ✅ Incorporate rowing, pulling, and lower trap activation exercises

• ✅ Perform scapular control drills with mirrors or band resistance

• ✅ Get a physio assessment to build a balanced strength plan

👩‍⚕️ How Physio Can Help:

• Assess your scapular rhythm, muscle activation, and thoracic posture

• Treat contributing factors (e.g. tight pecs, weak traps, stiff thoracic spine)

• Restore shoulder mechanics with neuromuscular control and strengthening

• Improve scapular stability for sport, gym, or work demands

• Reduce compensation in the neck, upper back, and rotator cuff

• Provide long-term strategies to keep the shoulder complex resilient

🙋‍♀️ Answers to Common Questions

1. What are signs of scapular dyskinesis?

• A feeling that the shoulder blade “wings,” moves unevenly, or is unstable

• Clicking or catching during overhead or pulling movements

• Upper back or shoulder fatigue even during low-load activities

• One shoulder that always feels tighter, weaker, or awkward

• Pain that worsens with repetitive upper body training or desk work

2. Can this cause upper back pain?
Yes — the scapula anchors to several upper back muscles. Poor control can overload the rhomboids, traps, and thoracic joints, leading to local pain or referred symptoms.

3. Do I need surgery or imaging?
No — scapular dyskinesis is a movement issue, not a structural one. Physio is the gold standard for restoring correct muscle timing and movement control.

4. Can I fix this on my own?
Some improvement is possible with good exercise, but physio helps you correct movement patterns and prevent reinforcing poor habits. Supervision often speeds up results.

5. How long does it take to improve?
Mild cases may feel better in 2–4 weeks. Chronic or performance-related cases may take 6–12+ weeks to fully retrain movement and build strength.

6. What exercises help with scapular control?

• Wall slides and scapular clocks

• Prone Y’s, T’s, W’s for lower trap and mid-back strength

• Serratus activation drills (e.g. push-up plus, wall punches)

• Thoracic mobility + postural alignment

• Band pulls, face pulls, and unilateral rows
  Your physio will tailor this based on your specific movement pattern.

7. Can I keep training?
Yes — and training is often part of the solution. We’ll adjust your program to reduce compensation and rebuild control, without derailing your goals.