Upper Back Pain
That spot between your shoulder blades that you cannot reach, cannot stretch, and cannot get rid of. It is almost never the problem. Dr. Andrew Allen treats the mid back as the hinge it actually is, not as a knot to dig at.
Over 20 years of experience · Wheat Ridge, Arvada, Lakewood, Golden & West DenverYou have been chasing this knot for years
A lacrosse ball against the wall. A massage gun in the closet. Asking your spouse to dig a thumb into it while you make a noise you are not proud of. Two hours of relief, then it is back by morning. The mid back is the most persistently misunderstood region of the spine because the place that hurts and the place that failed are almost never the same place. If digging at it worked, it would have worked by now. At Lakeside Spine & Injury Center, the first visit is about finding out what that knot is actually protecting.
How upper back pain actually shows up
The thoracic spine has ribs attached to every level, which gives it a symptom vocabulary nothing else in the body has:
The unreachable knot
Right at the inside edge of the shoulder blade. Constant, dull, and completely immune to every tool you have bought for it.
Cannot take a full breath
A catch when you inhale deeply. Ribs are joints, and when one stops gliding it makes breathing feel restricted on that side.
The stab under the shoulder blade
Sharp, specific, and often reproducible by turning a certain way. Usually a rib or facet joint rather than muscle.
Wrapping pain around the ribs
An ache that follows the rib line around toward the front. Thoracic nerve irritation follows the rib, and the pattern is diagnostic.
The desk burn
Fine at 9 a.m., burning by 3 p.m. between the blades. That is postural endurance failing, not tissue damage.
Cannot get relief from stretching
You stretch it constantly and it never changes. Stretching a muscle that is working overtime as a stabilizer does not help it.
Stiff and creaky in the morning
You need a few rotations and a coffee before your mid back agrees to participate in the day.
Headaches on top of it
Mid back stiffness drives cervical compensation, which drives headaches. See headaches and migraines.
It came with neck or shoulder pain
Rarely arrives alone. It usually travels with neck pain or shoulder pain, which is a clue in itself.
The knot is the smoke. We are looking for the fire.
Your rhomboids and mid traps are not tight because they are strong. They are tight because they have been asked to hold a position for eight hours a day that they were never designed to hold. These are the root causes Dr. Allen is actively ruling in or out:
Thoracic joint restriction
The mid back is supposed to be your primary source of rotation and extension. When those segments lock down, everything above and below compensates, and the muscles across the region go into permanent guard. This is the most common finding we make here.
Rib joint dysfunction
Every thoracic vertebra has a rib attached, and each rib has its own joints. When one stops gliding, it produces a sharp, breath-related pain that no amount of massage touches, because it is a joint problem wearing a muscle costume.
Scapular control
If your shoulder blade does not glide, tilt, and rotate correctly, the rhomboids and mid traps get drafted into being static stabilizers. That is your knot, and it will exist for as long as the scapula needs it. See shoulder pain.
A locked-down front side
Pecs and lats that have shortened from years of sitting and reaching forward will pull your shoulders around the front no matter how much you stretch the back. You cannot fix a front-side problem from behind.
Breathing pattern
If you breathe with your chest and neck instead of your diaphragm, your ribs never get the movement they need. Twenty thousand shallow breaths a day is a mobility problem in disguise.
Hip and low back compensation
When the lumbar spine loses rotation, the thoracic spine either overworks or shuts down to protect it. The mid back and low back are on the same team. See lower back pain and sciatica.
Neck compensation from below
Cervical and thoracic problems generate each other in a loop. Treating one without the other is why relief tends not to last.
Sustained load, not bad posture
There is no perfect posture. There is only too much of one position. A laptop on a kitchen counter, a monitor too low, ninety minutes on I-70, then a couch.
Old rib or collision injury
Ribs remember. A crash, a fall on the slopes, or a hard landing can leave rib joints restricted for years. See our car accident injury care.
Training imbalance
A lot of pressing, not much pulling. Common in athletes and active adults, and one of the more satisfying things to correct.
How Dr. Allen figures out what is actually wrong
You get evaluated and treated on day one. Not a clipboard and a handshake and a see-you-next-week.
We listen to the whole story
When it started, what makes it better, what makes it worse, what you have already tried on it, and what you are actually trying to get back to. The list of things that have not worked is genuinely useful information.
We watch you move
Thoracic rotation and extension, overhead reach, shoulder blade control, and how your ribs move when you breathe. Pain tells you where. Movement tells you why.
We test the ribs and the breath
Rib springing and breathing mechanics, because a restricted rib is one of the most commonly missed findings in the entire body and one of the most satisfying to resolve.
Segment-by-segment hands-on assessment
Dr. Allen palpates each thoracic level and rib articulation directly to find which specific joints are stuck and which tissue is guarding them. Twenty years of hands find what a form does not.
We connect it to your life
Your desk, your commute, your training split, your bike fit, your sleep position. The cause is usually sitting in your calendar.
You get treated the same day
You leave your first visit having actually been treated, and knowing in plain English what is going on and what the plan is. If we are not the right fit for your case, we will tell you and point you where to go.
Colorado is hard on a mid back
We would not live anywhere else. But the Front Range lifestyle has a signature, and after twenty years Dr. Allen can usually guess your hobby from your movement pattern.
The Denver commute
Wadsworth, Kipling, I-70, then eight hours at a desk downtown. Sustained thoracic flexion is the highest-volume exposure most people have, and the mid back pays for all of it.
Cycling on Clear Creek Trail
An hour in the drops is an hour of held thoracic flexion with the shoulder blades pinned. Beautiful ride, and one of the most reliable mid back generators we see.
Fourteeners with a pack
Twenty pounds pulling your shoulders back and down for eight hours, with your eyes on your feet. That is a full day of thoracic loading with a rib component.
Snow shoveling
Bend, twist, lift, throw, repeat, in the cold, before your ribs have warmed up. Rib joints get stuck on driveways every single winter.
Ski and snowboard falls
Landing on your back or catching an edge loads the rib cage directly. A rib restriction from a February fall can last until you finally get it looked at.
Climbing in Golden and Clear Creek Canyon
Overhanging routes are sustained pulling with the scapula in one position for a long time, and belaying is the exact opposite. Both find the mid back.
Gardening season
Wheat Ridge earned the Carnation City name honestly. Hours hunched over beds is hours of thoracic flexion, and spring is reliably busy here.
The remote work kitchen counter
A laptop on a counter is an ergonomic disaster performed daily, and it lands squarely between your shoulder blades.
Wadsworth and Kipling traffic
Fender benders load the rib cage and thoracic spine more than people expect, and those restrictions often surface weeks later.
How we treat upper back pain
There is no single technique that fixes a mid back. Dr. Allen builds care around what your evaluation actually found, which is why no two plans here look the same.
Chiropractic adjustments
Targeted manipulation of the specific restricted thoracic segments and rib articulations. Restoring a stuck rib is often the moment a patient takes their first full breath in months.
Soft tissue therapy
Hands-on work across the rhomboids, mid traps, serratus, and the pecs and lats on the front side that are pulling you forward in the first place.
Dry needling
Thin monofilament needles into trigger points hands cannot reach, including the deep layers beneath the shoulder blade. For that knot specifically, this is often what finally moves it.
Cupping therapy
Decompression-based soft tissue work that may help circulation and tissue mobility across the mid back and shoulder blade region.
Therapeutic exercise
Thoracic mobility, scapular control, and breathing mechanics. A short, specific set aimed at the deficit we found, not a photocopied sheet of twenty stretches.
Functional movement assessment
The reassessment loop. We re-test what we tested so you can see the change, and so we know whether the plan is working or needs to change.
Upper back pain FAQ
Why does massage only help for a day?
Because the muscle is not the problem. If your rhomboids are holding tension to stabilize a scapula that has no control, or to protect a thoracic segment that will not move, then relaxing them temporarily just removes the splint. The body puts it right back, usually within a day. Change the reason and the knot stops coming back.
Can a rib really go out?
Not in the dramatic sense, no. But rib joints can absolutely become restricted and stop gliding properly, and when that happens it produces a sharp, breath-related pain that feels far more alarming than it is. It is common, it is findable on examination, and it usually responds quickly.
Is my posture causing this?
Partly, but not the way you have been told. There is no single correct posture. The problem is volume, not shape. Any position held for eight hours will cause trouble, which is why the fix is rarely sitting up straighter and usually involves restoring the motion you have lost.
Why does my upper back pain come with headaches?
A stiff mid back forces the neck to supply the rotation and extension it can no longer provide. That raises load on the exact upper cervical segments that generate headaches. It is one of the most common patterns we see, and treating only the head never fixes it.
Do I need an X-ray or MRI first?
Usually not. Imaging is valuable when specific findings warrant it, and Dr. Allen will tell you if your case is one of them. Joint restriction and movement dysfunction do not show up on a scan anyway.
Will I have to come three times a week forever?
No. There are no long-term contracts and no forced treatment plans here. The goal is to get you out of pain, teach you what caused it, and send you back to your life.
Should I keep using my massage gun?
It is fine as symptom relief, and it is not going to hurt you. Just know it is a coping tool, not a treatment. If it were going to solve this, it would have already.
Do you take my insurance?
Coverage questions are best answered directly. Call or text (303) 351-0744, or check the FAQ.
Stop managing it. Start fixing it.
You have been digging at that knot for long enough. Get a real evaluation from a doctor with twenty years of hands, and find out what it is actually protecting.
Lakeside Spine & Injury Center · 6073 W 44th Ave #101, Wheat Ridge, CO 80033 · Proudly serving Wheat Ridge, Arvada, Lakewood, Golden, Edgewater, Applewood, and West Denver.