Upper Back Stiffness: The Hidden Cause of Persistent Shoulder Pain
Key insights: 60-second read
- Shoulder pain may involve more than the shoulder - In my clinical experience, some people with persistent shoulder symptoms also have meaningful restrictions around the upper back and thoracic spine.
- The test-retest is important - If shoulder movement or symptoms change after addressing the thoracic region, I consider this a useful clinical clue.
- The key question is what changes - Rather than assuming the painful area is the only problem, I want to see whether changing the upper back or shoulder blade changes the shoulder.
If you've had persistent shoulder pain, it's natural to focus on the shoulder itself. But in my clinical practice, I have found that there can sometimes be a bigger picture to consider.
My clinical perspective
When someone has shoulder pain, I want to know whether improving thoracic spine mobility or shoulder blade function changes their movement or symptoms. When it does, I consider that clinically meaningful information and a reason to look beyond the shoulder alone.
On this page
Can Upper Back Stiffness Contribute to Shoulder Pain?
The shoulder and upper back work together. The shoulder blade moves across the rib cage, while the thoracic spine forms part of the framework around which that movement occurs.
What interests me clinically is what happens when we test this relationship.
If someone has painful or restricted shoulder movement, I may first assess that movement and then address a specific restriction around the thoracic spine. If the shoulder movement or symptoms immediately change, that provides useful information.
Why the test-retest matters
If shoulder movement or symptoms consistently change when the upper back is addressed, I consider this a useful clue that the thoracic region may be contributing to the presentation.
What Clinical Clues Suggest the Upper Back May Be Involved?
There is no single symptom that proves the upper back is responsible for shoulder pain. However, certain findings make it more important to assess the thoracic region.
Examples include:
- A band of pain across the shoulder
- Pain that is difficult to localise to one specific shoulder structure
- Symptoms that change with sustained positions or activities
- A feeling of tightness or restriction around the neck or shoulder blades
- Restricted thoracic or neck rotation, or extension during assessment
- Shoulder movement that changes after thoracic mobility work
- Shoulder symptoms that temporarily change following treatment directed at the upper back
How Can You Test Whether the Upper Back Is Affecting Shoulder Movement?
One of the most useful principles in my clinical reasoning is simple: change something, then re-test the problematic movement.
The following exercise is a simple way of doing this:
If the movement feels easier or your shoulder symptoms change, you've found something important.
What Exercises Can Improve Upper Back Mobility?
If thoracic stiffness appears relevant to your shoulder movement, improving mobility in this region may be a useful part of a broader rehabilitation program.
These are three simple exercises I commonly use to work on thoracic mobility and shoulder blade movement.
1. Thoracic Extension Over a Foam Roller
How to perform: Place a foam roller perpendicular to your spine at mid-back level. Support your head with your hands and gently extend backwards over the roller. Perform 10-15 slow repetitions, moving the roller slightly to work through different areas of the upper back.
Purpose: A simple way to work on thoracic extension mobility.
2. Open Book Rotation
How to perform: Lie on your side with your knees bent and arms straight ahead. Slowly rotate your top arm across your body, following your hand with your eyes, until you reach a comfortable range. Return slowly. Perform 8-12 repetitions on each side.
Purpose: To work on thoracic rotation and comfortable movement through the upper back.
3. Scapular Wall Slides
How to perform: Stand against a wall and place your arms in a comfortable goalpost position. Slowly slide your arms upwards, allowing your shoulder blades to move naturally, then return to the starting position. Perform 10-15 repetitions.
Purpose: To combine shoulder movement with scapular control and complement thoracic mobility work.
These exercises are not intended to replace assessment of the shoulder itself. If symptoms are persistent, significant or worsening, the most appropriate exercises will depend on the individual presentation.
When Should You Seek Professional Help for Shoulder Pain?
If shoulder pain is severe, persistent or interfering with normal activities, a professional assessment can help determine what may be contributing to it.
Seek assessment particularly if you experience:
- Severe or rapidly worsening pain
- Significant weakness or an inability to lift the arm
- Numbness, tingling or symptoms extending into the arm or hand
- Significant loss of shoulder movement
- Shoulder pain following significant trauma
- Persistent symptoms that are not improving with appropriate self-management
A physiotherapy assessment can consider the shoulder, shoulder blade, thoracic spine, neck and other relevant regions together rather than assuming the painful area is the only area that matters.
Frequently Asked Questions
Can upper back stiffness contribute to shoulder pain?
In my clinical experience, upper back/neck restrictions can be the underlying cause of why a shoulder has become dysfunctional in the first place.
How can I tell if my upper back is contributing to my shoulder pain?
One useful clinical approach is to compare a shoulder movement before and after addressing a restriction around the thoracic spine. If the movement or symptoms change, this may suggest that the upper back is contributing.
What exercises can improve upper back mobility?
Thoracic extension over a foam roller, open book rotations and scapular wall slides are simple options for working on thoracic mobility and shoulder blade movement. The most appropriate exercises depend on the individual presentation.
When should I see a physiotherapist for shoulder pain?
Consider professional assessment if shoulder pain is severe, persistent, worsening, associated with significant weakness or loss of movement, follows significant trauma, or involves numbness or tingling. A physiotherapist can assess the shoulder together with the thoracic spine and other relevant regions.
The key takeaway
Shoulder pain should never be viewed in isolation. In my clinical experience, changes in the upper back (and neck) can produce meaningful changes in shoulder movement or symptoms. For me, that makes the thoracic region worth considering as part of a broader shoulder assessment.
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
I genuinely hope this article offers a fresh perspective - or at least one useful takeaway. If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you'd like me to cover next.
- Grant
