Treatment decision6 min read
Upper back pain: which route to take, and the decision criteria
The most frequent question from people with upper back pain is whether to see a doctor or a physiotherapist first. The decision rests on the features of the pain and any accompanying findings; the same route is not taken in every case.
When waiting is appropriate
Waiting two to four weeks is appropriate for pain that started with a particular movement, eases with a change of position and does not affect general health.
Staying mobile within pain limits is advised over complete rest in this period. Immobility rapidly weakens the back muscles and delays recovery.
Warmth, gentle mobility work and over-the-counter pain relief where needed are usually enough. If symptoms do not recede in that time, assessment is advised.
When physiotherapy assessment is appropriate
Physiotherapy assessment is appropriate for mechanical upper back pain that does not recede in two to four weeks, recurs, or limits daily tasks.
Assessment is also useful for thoracic stiffness accompanying neck or shoulder symptoms; the result does not last unless these regions are worked together.
Where the picture relates to prolonged desk work and increases in the week while easing at weekends, the programme serves both treatment and prevention.
When medical review is required
Urgent assessment is needed for pain increasing with exertion, radiating to the chest or left arm, with sweating and breathlessness.
Upper back pain with fever, night sweats, unexplained weight loss or a history of cancer requires medical review.
Leg weakness, unsteady walking or sensory loss below a level on the trunk are urgent findings; physiotherapy is not started in that picture.
Key points
- Absent warning signs, waiting two to four weeks is appropriate.
- Movement within pain limits is advised over complete rest.
- Physiotherapy assessment suits pain that does not recede or that recurs.
- Thoracic stiffness with neck or shoulder symptoms must be worked together.
- Pain increasing with exertion with sweating is urgent.
Frequently asked questions
Should I have an X-ray first?
Usually not, absent warning signs, and it does not change treatment. Imaging becomes a priority with a history of trauma, in older age, or where osteoporosis is suspected.
How many sessions will I need?
Four to eight sessions usually suffice in mechanical upper back pain. The programme is somewhat longer where neck or shoulder symptoms accompany it; an estimate is given at the first assessment.
How do I prevent recurrence?
Regular use of the range gained is decisive. A few minutes of mobility work a day and maintaining the working setup markedly reduce recurrence.
Related articles
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- Treatment course· 6 min readManual therapy and thoracic mobilisation for upper back pain
- Exercise· 6 min readThoracic mobility exercises: a programme you can do at home
- Daily living· 6 min readPreserving thoracic mobility: what can be done during the day
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.