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Whether it's postural pain from desk work, facet dysfunction limiting your rotation, or rib pain affecting your breathing — our fellowship-trained Doctors of PT diagnose the source and build a movement-based plan to eliminate upper back pain.
Common Diagnoses
Thoracic spine pain has different causes — postural overload, joint restrictions, or rib dysfunction. Click each section below to learn about the three most common diagnoses we treat.
Postural syndrome (also called Upper Crossed Syndrome) is pain caused by prolonged poor posture — typically forward head, rounded shoulders, and upper back hunching over. It's driven by muscle imbalances: tight pecs and weak mid-back muscles. This is the most common cause of upper back pain in desk workers and athletes with poor posture.
Postural syndrome is caused by sustained poor posture leading to muscle imbalances and overload. Contributing factors include:
We retrain posture through thoracic extension mobility work, mid-back strengthening (rows, Y/T/W exercises), and pec stretching. Most patients see significant improvement within 4-6 weeks by addressing the root cause: muscle imbalances and sustained poor posture.
Upper back facet dysfunction is stiffness or irritation in the small joints of your upper back that guide how you twist and extend. When they become restricted or inflamed, they cause localized pain and reduced mobility. This is common in athletes who demand high thoracic rotation (golfers, throwers).
Facet dysfunction is caused by joint stiffness, trauma, or repetitive strain. Common triggers include:
We use manual therapy (thoracic mobilizations, dry needling) to restore facet joint mobility, then retrain thoracic rotation patterns. Most patients see significant pain reduction within 4-6 sessions.
Rib dysfunction happens when one of your ribs becomes restricted or slightly misaligned where it attaches to your upper back. This causes sharp, localized pain and can make deep breathing painful. It's often mistaken for a muscle strain but is actually a joint issue.
Rib dysfunction is caused by sudden movement, trauma, or repetitive strain affecting the rib-spine articulation. Common triggers include:
We use manual therapy (rib mobilizations) to restore proper rib mechanics, then teach breathing exercises and thoracic mobility drills to prevent recurrence. Most patients experience immediate relief after the first session, with full resolution within 2-4 weeks.