Common Issues: Upper Back Issues & Causes

Here we go deeper into some of the common issues that your students may be experiencing. (For more on the anatomy and potential injuries such as fractures and tears, see Anatomy of the Shoulders.)

These issues are related and may be experienced together:

  1. Forward Head
  2. Excessive Curvature of the Thoracic Spine
  3. Tight & Weak Serratus Anterior Muscles
  4. Winged Scapula

For a more formal description of the state of the muscles when we are experiencing such conditions, please see Functions & Issues: The Anatomy of Slumping.

1) Forward Head

A common postural misalignment leading to neck and upper back pain is the head protruding in front of shoulders:

  • With a forward head, muscles in the neck and front body become tight and short.
  • Muscles in the upper and mid-back become overstretched and weak.
  • To keep the gaze forward, the chin juts, creating further compression in the neck. (Carol Krucoff).

2) Excessive Curvature of the Thoracic Spine

  • Rounding in the upper back and shoulders is a common cause of upper back pain.
  • The rounding causes the shoulder blades to move away from the spine, causing muscle overstretching and weakness.
  • When thoracic spine curvature is greater than 50 degrees, it is clinically defined as kyphosis.
  • Potential symptoms include an appearance of hunching forward, mild to severe back pain, loss of height, difficulty standing upright, and fatigue.
  • Although yoga teachers may see students with kyphosis due to postural causes, there are also structural causes unrelated to posture, such as with Scheuermann’s Kyphosis.
  • See also: Anatomy of the Spine: Function & Issues

How Slumping Leads to Pain

Slumping causes the shoulder blades to slide away from the spine, chronically overstretching and weakening the muscles around them. Eventually these muscles harden into tough bands to protect themselves from this constant strain. As they tire, these weakened fibrous muscles go into spasm, creating hot, persistent pains along the edges of the shoulder blades and the sides of the neck. – Doug Keller

3) Tight & Weak Serratus Anterior Muscles

  • A repetitive forward-head position leads to a rounded upper back and constantly protracted shoulder blades; this in turn causes the serratus muscles to be always “on” and therefore to become both tight and weak.
  • Tension or pain in the neck, upper trapezius or rhomboids may be referred pain from a weak serratus anterior.
  • Weak serratus muscles “can even contribute to shallow breathing.” (Nishita Morris)
  • See also: Anatomy: The Shoulders

4) Winged Scapula

  • When the medial edge of the shoulder blade (the side closest to the spine) visibly protrudes, it is called a winged scapula.
  • This often indicates a weak serratus anterior muscle.