Upper Back Pain

Updated: Oct 5


anatomical illustration of the back and muscles

Pain or aching felt between the shoulder blades that can be worse with sustained postures or develop sharper pains on certain movements and deeper breathing. This can affect shoulder strength and stability, neck comfort and ability to hold your position on the bike.

What causes Upper back pain?

In most cases the main source of the problem is muscular ache due to sustained position, lack of conditioning to the back (posterior chain) muscle groups, or adopting a new riding position that the body has not accommodated to yet. Persistent problems in this area may also be associated with irritation of the facet joints or the discs in between each vertebrae.


Risk Factors

  • Previous back pain / injury

  • Weakness in upper back muscles

  • Stiffness in thoracic (mid back) spine joints

  • Unsuitable bike fit - generally too long and low or excessive forward shift of balance

  • Large increase in riding volume

  • New bike / new bike set up, increasing ride distances from no previous riding


What are the symptoms?

  • It is most commonly described as a gradual ache that comes on during a ride - it can occur after 30-45 minutes in newer cyclists or after around 2-3 hours in more experienced cyclists.

  • Once aggravated it can come on much more quickly or even limit riding altogether.

  • In mild cases it is often completely pain free when not in a riding or sitting position.

  • Cyclists will often describe either pain or restriction of movement, particularly with rotation (turning) from side to side.

  • Cyclists adopt a position which requires the mid-back (thoracic spine) to be held in a moderate or high degree of flexion for sustained periods. If the position is a challenge for you to maintain or you hold the position for longer than you have optimal muscle strength to do so then it will often lead to strain and spasm in the muscles.

  • The easiest way to test these muscles is to have it assessed by a physiotherapist (or osteopath, chiropractor etc). This will often reveal excessive tension or sensitivity in the muscles highlighted in the picture above.


How can I manage Upper back pain?

Activity Modification

  • Switching to shorter ride durations that do not aggravate your symptoms is a good first step.

  • If your work is desk based, take regular breaks from sitting, find a chair with higher back support (and sit back into it), or opt for a variable height work station if possible.

  • Heavy lifting with your arms out in front of your body places moderate to high loads on these back muscles so may be aggravating in more acute cases.


Physiotherapy

  • Soft tissue or sports massage is particularly helpful in alleviating tension and pain felt across this area of the back.

  • Joint mobilisation can encourage reduced tension and better movement.

  • Taping strategies can help to improve postural awareness and take some pressure off the working muscles.

Person's back with tape to relieve upper back pain

  • Mobility exercises are a great way to gradually regain and encourage full functional range of motion through the thoracic spine and shoulder blades

  • Strength training is vital for longer term management and unlocking some performance benefits if you are looking to work on a more aerodynamic or low racing position. They need to cover a wide variety of muscles including - erector spinae, latissimus dorsi, rhomboids, trapezius, scapular stabilisers etc.

Book a Physiotherapy consultation

Bike Fit

  • Reach and drop to the handlebars are the most common areas where a rider will need to make some changes to reduce pressure or workload on their upper back. Long reach and a large amount of ‘drop’ from the handlebars to the saddle will force more joints towards end of range and increase the muscular effort to hold this position.

illustration of a bike highlighting distance between handle bar, saddle and pedals