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Episode 254: Midback Pain Relief Redeux

Video Highlights

- Quick pain rationale
- Neuromechanic basics
- Powerful drill demonstrations

Everyone talks about low back issues, what about mid-back issues?!

In our last few blogs we’ve been looking at easy solutions for kind of common issues.

We did a blog recently on low back issues and then also improving shoulder function.

What I want to go over with you today is based off a question that came in on the blog that said, “Hey, everyone talks about low back issues, what about mid-back issues?” A very, very common complaint that we see a lot of times.

Now, I’m going to give you some background information first. Then, we’re going to look at two different basic exercise ideas that you can start to incorporate if you have a lot of issues in these troublesome upper trap areas or mid-back areas around your scapula, the ribs or around the spine.

One thing I want you to be aware of is that a lot of issues that occur here in what’s called the periscapular or infrascapular area, in other words in the middle of the shoulder blade or underneath the shoulder blade, are often related to referral from the visceral system. If you’re having breathing issues, you’re having gut issues of some kind, maybe stomach inflammation, gallbladder, liver issues, in some cases those can actually cause referred pain into the mid-back and upper trapezius region.

I always want to recommend to people if you try exercises, you’ve been doing lots and lots of mobility work and strengthening and you continually have these issues make sure that you talk to a healthcare provider about that. Maybe you need some testing or you just need to work on your breathing to improve that. It is super common, we see it all the time so I want you to be aware of it.

Now, usually once we know that people are safe to do things we then start to focus on how can we improve the conversation between the brain and the musculature. The musculature isn’t tight on its own, it’s actually causing you issues because of some kind of improper communication between the brain/body system.

In our system we do a lot of what we call neuromechanic drills, some people call these nerve flosses or nerve glides. We’re going to look at one that’s very specific to what’s called the accessory nerve. Now, the accessory nerve is actually called the cranial nerve coming out of the brain stem. It’s cranial nerve 11 and it basically handles this muscle right here called your sternocleidomastoid and also your upper trapezius.

If you have some issues in that nerve you may have either excess tension or even weakness with tension in the neck or shoulder region so this is often a very fast fix. To work on this particular nerve, it’s kind of a strange exercise, our basic rules when we teach neuromechanic drills, go slow, don’t overdo the tension. I want you to work on a level three out of 10 tension in the beginning which means you may just feel an odd stretch. It will feel a little bit strange but I don’t want you to go any deeper or more intensely into it. All right, so let’s get started.

We’re going to start off nice and tall. Let’s assume that I’m having some issues on my right upper trap or maybe my right upper back. To focus on the right side here’s what we’re going to do. We’re going to take our right arm, we’re going to relax it, maybe a little bit of elbow bend. We’re going to retract the right shoulder blade. In other words we’re going to pull the shoulder blade back toward the spine. We’re then going to depress it or pull it down. Step one, pull the shoulder blade back. Step two, pull the shoulder blade down. Now, take your neck, tilt away. Since I am working my right side I tilted my head to the left.

Now, from here you can do a little chicken exercise, you’re going to push the head forward. That should start to build up some significant tension. Then, finally flex your whole head forward and then do a little additional chicken movement. In this position you should feel kind of this weird stretching sensation in that upper trap. Then you can just do a little variation of that chicken movement forward and back or just flex and extend the head and neck. That should again impact the nerve that’s going into that upper trap muscle in a good way.

Woman sitting on couch with laptop and holding her lower back in pain using both hands.

Now, this is a hard one to feel for some people. The number one mistake people make is they do this. They retract, they depress the scapula, tilt, and do this. As soon as they make this motion happen they let the shoulder pop up again.

The shoulder must stay down and back the entire time. Then you’re going to use the head and neck motions as the primary driver for the stretch. That’s called an accessory nerve neuromechanic drill. Don’t need to know that. You just need to know that it will make your neck and shoulder function better and your upper back. Again, you can do it on both sides but I tend to have people focus first on the side with less tension so that you can learn it there and then perform the exercise on the side with more tension.

Now, once we have the musculature calm down, maybe we are a little bit more stable, we have a little bit more relaxation in the upper trapezius muscles, we then can start to focus on some of the mobility exercises for the upper spine. Now in general, any time we’re working on the spine we talk about conjoined movements. If you watched our little back video we did things like we would glide left and then tilt and then turn. Really, the same thing in the upper body. The biggest issue here is that most people that haven’t done a lot of mobility training have a difficult time isolating the thoracic spine or mid-back in order to do mobility work.

Usually what happens, we say, “Hey, I want you to do some lateral tilting in your mid-back,” and they instead do this. They bend from the waist, they don’t actually bend from the ribs. When we focus on these exercises you’re going to be thinking about moving your ribs and the space between your shoulder blades. We’re going to follow a very similar model to what we did with the low back. The way that we tend to teach this is by using a resistance band because a resistance band often will help guide your brain to know how to make the movements best occur.

You want to take a fairly heavy resistance band, fix it on something that’s not going to slide or move towards you. You’re then going to climb inside the band. You actually want it underneath both arms around your rib cage. Now, you can always hold it in front to make it comfortable for you. Now, once you have that positioning you need to step out until you feel some resistance from the band, particularly in the lateral side of your rib cage. From this position all we’re going to focus on is first gliding our rib cage to the side. This is just called a thoracic lateral glide. Your low back is going to be involved to some degree but we’re trying to isolate again the motion to that rib cage. Once I can do that lateral glide I’m going to glide and hold and flex and extend, and then relax.

Again glide, hold, flex, and extend. The way that you’ll know that you’re doing it correctly is if you again feel this kind of strange mobilization or stretching sensation on the side closest to the band. As I’m sliding to my left flexing and extending I’m feeling most of the work happen in that left rib cage and left spinal area. Once we again have that lateral glide flex extension we now want to add some additional movements to it so we’re going to add rotation. We’ll set, do a lateral glide, flex, rotate left, rotate right, reset. Glide, extend, rotate left, rotate right.

You can see that the rotations are actually quite small. It’s not a fully body rotation, I’m not trying to move the band that much. The band is there to guide me into how to make the movements happen. The cool thing is you will quickly be able to identify what combination of movement patterns actually will help reduce your tension because usually what will happen is this. You find a good direction, you do this, glide, flex, left rotate, it feels good. Glide, flex, ugh. If you get the ugh sensation from one direction you know you need to slow that down, make it smaller and easier or maybe even avoid it at first, and just focus on more the lateral glide and the flexion component or extension component.

Now, we can also incorporate into this a lateral glide with a lateral bend, flex, extend, rotate, rotate. Ultimately, we have to think about the mid-back going forward and back, flexion, extension, gliding right and left, bending right and left, rotating right and left. It is again a three-dimensional look at how to create mobility in that upper back region. Now, the way that you target areas is important. In general, you want to start with the band relatively level. If I, let’s say, felt more tension in my mid-back but in my lower mid-back I may want to elevate the band, put it on a higher attachment point so that it’s coming down on an angle. That will allow me to focus on that lower rib cage, lower thoracic spine area to do my exercises.

Conversely, if I want to work on the upper section which is where lots of people have issues, move the band lower so that I now have this upward angle. I have to secure the band a little bit more in order to do that but then as I start to work directly against the resistance to the band it allows me to focus higher up in the thoracic region. The basic idea behind all this, prep the musculature and nervous system by doing the accessory nerve first that we did originally. Then begin exploring the small controlled three-dimensional motions utilizing a band to help guide you into how to create the movement.

Most mid-back issues that we run into, again, are related to breathing, maybe something going on in the abdomen. If you do have very specific movement restrictions that can also cause you lots of issues.

Give this exercise a try. If you have questions about it let us know.

Also, to help understand the process please check out some of the previous blogs, particularly on the low back.

Thanks guys, enjoy.

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