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MassageTherapyforUpperBackPain

Massage Therapy for Upper Back Pain

PerfectAreaNo.11,theerectorspinaemusclegroupoftheupperback
updatedAugust302016(firstpublished2005)
byPaulIngraham

Triggerpoints(TrPs),ormuscleknots,areacommoncauseofstubbornandstrangeachesandpains,andyettheyareunder-diagnosed.The14PerfectSpots(jumptolistbelow)aretriggerpointsthatarecommonandyetfairlyeasyto
massageyourselfthemostsatisfyingandusefulplacestoapplypressuretomuscle.Fortoughcases,seetheadvancedtriggerpointstreatmentguide.

Pain Location
anywhereintheupperback,mainlybetweentheshoulderblades
BigRedBooksReference:Volume1,Chapters18&27

https://www.painscience.com/articles/spot11erectorspinaeupper.php

Problems
scoliosis

Related Muscles
erectorspinaemusclegroup
seechartofallspotsbelow

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Thisspotistoolargetoreallybecalledaspotitsmoreofanarea.Thethickcolumnsofmusclebesidethespineareoftenlitteredwithmuscleknotsfromtoptobottom.
Nevertheless,thereisonesectionofthegroupwheremassageisparticularlyappreciated:fromthethickmuscleatthebaseoftheneck,downthroughtheregionbetweenthe
shoulderblades,taperingoaroundtheirlowertips.Thereisnodoubtthatthispartofabackmassagefeelsevenbetterthantheresteventhelowback,despiteitsownquite
perfectspots,cannotcompete.AreaNo.11belongsinthisserieseventhoughitisnot,strictlyspeaking,asinglespot.

WhyisAreano.11perfect?
ManypeoplesuerfromwhatIcallbrickbackthatis,theirupperbackfeelslikeabrick,specicallybetweentheshoulderblades.Itisdense,rigid,andsometimesseemingly
impervioustopressure,asthoughthespineisheldsotightlybythemusclesthatithasbeenfused.
Thisstateismostlytheworkoftheerectorspinaemusclegroup.Theerectorspinaearethethickcolumnsofmuscleoneithersideofyourspine.Theyoftenfeelropyandhard,
andareanaturaltargetformassage.Triggerpointsintheerectorspinaeareoftennumerous,likeastringfullofknots.UnlikemanyoftheotherPerfectSpots,whichare
unfamiliar,mostpeoplearewellawarethattheyhaveknotsintheupperback:theironlyquestionis,HowdoIgetridofthem?Evenpeoplewhodonothaveobvioustrigger
pointsinthisareawillusuallyndthatmassageherefeelsespeciallygood.
Thereisnogoodexplanationforwhythesemusclesaccumulatesomanytriggerpoints.Alongwiththeshoulders,lowerback,andhips,itsanothercommonspotforstressand
anxietytoexpressitself.
Itmayberelatedtothesheeramountofmusclethatattachestotheupperthoracicvertebrae,like
riggingonasailingshipconvergingonthemasts.Theareaisastablefoundationtosupportthe
movementsofneckandshoulderaction.Forinstance,theneckishighlymobilebutcanstillbe
stabilizedstronglybecauseithasthesolidmassoftheupperbacktoclingto.Thisregionof
unusuallthickmusclemaygetmoreTrPssimplybecauseithasmoremuscle.

Evolutiondoesntcareifwerecomfortable,aslongaswe
survive.

And,ofcourse,stressandevolutionaside,theupperbackandshouldersbothoftensuerfrom
commonactivitiessuchassitting,slouchingandcomputerwork.Althoughpoor
posture/UnconventionalErgonomicsaregenerallyoverratedasacauseofpain,theyprobablyareassociatedwithalotofminordiscomforthere.

HowdoyoufindAreaNo.11?
Findingthisareaiseasy,becauseitsbigandthelandmarksareobvious.Startbyndingthespine.Nowmovejusttoonesideofthespine.Thereisagrooveherebetweenthe
spineandthebulkycolumnoftheerectorspinae.
https://www.painscience.com/articles/spot11erectorspinaeupper.php

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Youwillndsensitiveknotsatthebottomofthegroove,ontheinneredgesoftheerectorspinae,andontopofthem.Thisistruefortheentireback,butthemostusefularea
rangesfromthebaseofthenecktoabouttwothirdsofthewaydownbetweentheshoulderblades.
LikeanyoftheotherPerfectSpots,youcanndaknotandpressonituntilthetensioneases.However,becausetherearesomanyknotsinthesemuscles,acoupleofother
approachesproduceevenmoresatisfyingresults.
Therstiscalledstripping,inwhichyoulubricatetheskinandslideslowlyandstronglyalongthelengthofthegroove,usingathumb,ngertips,theheelofyourhand,
knuckles,orevenanelbow.Theamountofpressureyouusedependscompletelyonthepersonyouaremassaging.Keepitmanageable!Thistechniquewilltreatmanytrigger
pointsinsteadofjustone:morebangforyourbuck.
Anotherwayoftreatingseveraltriggerpointsatonceiscalledstrummingorfrictions.(Notthe
sameideaasfrictionmassage,butthesamemovement.)Theerectorspinaeareoftenquiteropy,
andsometimesfeelsurprisinglylikeguitarstrings.Especiallywhenthisisthecase,youcancreate
adelicioussensationofreleasebyrubbingbackandforth(sidetoside)acrossthebreswith
yourngertips.Thisdoesnotrequirelubrication,astheskinmoveswiththengers.

Theerectorspinaeareoftenquiteropy,andsometimesfeel
surprisinglylikeguitarstrings.

Forthebestresultsfromstrumming,carefullyfeelaroundinthegroovebetweenthespineand
thebulkiestcolumnoftheerectorspinaeforasingleclearlyidentiablestringofmuscle.You
mayneedtopressquitermlytodoso.Youcanusethesametechniquequitebroadlyandlightlyacrosstheentiregroup,butitdoesntfeelnearlyasdramaticasdeepstrumming
ofindividualstrands.

HowdoesAreano.11feel?
Heavenly!Inmyexperience,strummingintheveryuppermostpartofthebackisoneofthemostvividsensationsinallofmassage.However,thiscombinesbothalocationanda
specictechniquewhichdoesntaecteveryonethesameway.Atitsbest,though,thesensationisdeeplypenetratingandpeopleoftenspeakoffeelingitinmychest.
Nowhereistheideaofgoodpainorasweetachemoreobviousthanitishere.Whilemanytriggerpointreleaseshaveasatisfyingquality,thesemusclesproducethegold
standardofgoodpainbywhichallothergoodpainsarejudged.Onlyexcessivepressureonthemostunhappybackswillfeelsharporburning.Mostpeoplewillexperienceadeep,
spreading,warmingache.
Thesemusclesalsooftenproducevividanddiversereferredsensations.Mostcommonly,feelings
of(good)painorpressurewillspreaddownandoutwards.Theshouldersoftenrespond,asdothe
chestandthroat.Withseveraltriggerpointsbeingreleasedatonce,somepeoplesometimes
reportawidespreadfeelingofbeingpleasantlyparalyzedthroughouttheentiretorso!The
sensationmaybebreathtaking,whichcanbealarmingifitstoostrong,orwonderfulifthe
pressureistolerable.

https://www.painscience.com/articles/spot11erectorspinaeupper.php

Whilemanytriggerpointreleaseshaveasatisfyingquality,
thesemusclesarethegoldstandardbywhichallothersare
judged.
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MassageTherapyforUpperBackPain

Althoughthearchofthefoot(SpotNo.10)maybethenicestsinglespotformassageinthebody,itisjustamerespot,andfarfromthecore.Bycontrast,thesummedeectofall
thetriggerpointsinthisareaissopotentandusefulthatIalwaysrequesttreatmentforiteverytimeIseeamassagetherapistmyself.

AboutPaulIngraham
Iamasciencewriter,formermassagetherapist,andIwastheassistanteditoratScienceBasedMedicine.orgforseveralyears.Ihavehadmyshareofinjuriesandpainchallengesasarunnerand
ultimateplayer.MywifeandIliveindowntownVancouver,Canada.Seemyfullbioandqualifications,ormyblog,Writerly.YoumightrunintomeonFacebookorTwitter.

Whatsnewinthisarticle?
Aug30,2016Miscellaneousediting,andinparticularreplacedparagraphabouttheevolutionaryperspectiveonbackpainwithsomemorerelevantexplanationoftheanatomyofthisarea.
NewimageshowingthelocationofSpot11.

AppendixA:Istriggerpointtherapytoogoodtobetrue?
Triggerpointtherapyisnttoogoodtobetrue:itsjustordinarygood.Itcanprobablyrelievesomepaincheaplyandsafelyinmanycases.Goodbangforbuck,andlittlerisk.Inthe
worldofpaintreatments,thatsagoodmix.
Butpainisdicultandcomplex,notreatmentisperfect,andthereislegitimatecontroversyaboutthescienceoftriggerpoints.Theirnatureremainssomewhatpuzzling,andthe
classicimageofatightlycontractedpatchofmuscletissuemaywellbewrong.Whatwedoknowisthatpeoplehurt,anditcanoftenbehelped.

https://www.painscience.com/articles/spot11erectorspinaeupper.php

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ThePerfectSpotsarebasedonadecadeofmyownclinicalexperienceasamassagetherapist,andyearsofextensivesciencejournalismonthetopic.Wanttoknowmore?Thisis
thetipoftheiceberg.Ivewrittenawholebookaboutit

Nottoogoodtobetrue.
Justordinarygood.Triggerpointtherapyisntamiraclecure,
butitisavaluablelifeskill.Practicallyanyonecanbenefitat
leastalittle,andmanywillexperiencesignificantrelieffrom
stubbornachesandpains.Thefirstseveralsectionsarefree.

AppendixB:QuickReferenceGuidetothePerfectSpots

PerfectSpotNo.1MassageTherapyforTensionHeadaches

Underthebackoftheskullmustbethesinglemostpleasingandpopulartargetformassageinthehumanbody.Nootherpatchofmusclegetssuchravereviews.Ithaseverything:deeplyrelaxing
andsatisfyingsensations,andadramatictherapeuticrelevancetooneofthemostcommonofallhumanpains,thecommontensionheadache.Andnowonder:withoutthesemuscles,yourhead
wouldfallo.Theyfeeljustasimportantastheyare.(Click/tapheadingtoreadmore.)
forpain:almostanywhereinthehead,faceandneck,butespeciallythesideofthehead,behind
theear,thetemplesandforehead

relatedto:headache,neckpain,migraine

muscle(s):suboccipitalmuscles(recticapitisposterioresmajorandminor,
obliquiinferiorandsuperior)

PerfectSpotNo.2MassageTherapyforLowBackPain

https://www.painscience.com/articles/spot11erectorspinaeupper.php

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ThisPerfectSpotlivesinthethoracolumbarcorner,anookbetweenyourlowestribandyourspinerightwherethestabilityoftheribcageandthoracicvertebraegiveswaytotherelative
instabilityofthelumbarspine.Itconsistsoftriggerpointsintheuppercentralcornerofthequadratus(square)lumborummuscleandinthethickcolumnofmusclethatbracesthespine,the
erectorspinae.(Click/tapheadingtoreadmore.)
forpain:anywhereinthelowback,tailbone,lowerbuttock,abdomen,groin,sideofthehip

relatedto:lowbackpain,herniateddisc

muscle(s):quadratuslumborum,erectorspinae

PerfectSpotNo.3MassageTherapyforShinSplints

PerfectSpotNo.3isinyourshinsseeminglyanunlikelyplaceformuscleknots!Butthereismeatthere,andifyouveeverhadshinsplintsthenyouknowjusthowvulnerablethatmeatcanbe.
Evenifyouveneversueredsopainfully,yourshinsprobablystillsuerinsilencelatenttriggerpointsintheupperthirdoftheshinthatdontcausesymptoms,butareplentysensitiveifyou
pressonthem.(Click/tapheadingtoreadmore.)
forpain:intheshin,topofthefoot,andthebigtoe

relatedto:shinsplints,dropfoot,anteriorcompartmentsyndrome,
medialtibialstresssyndrome

muscle(s):tibialisanterior

PerfectSpotNo.4MassageTherapyforNeckPain,ChestPain,ArmPain,andUpperBackPain

DeepwithintheAnatomicalBermudaTriangle,atriangularregiononthesideoftheneck,isthecantankerousscalenemusclegroup.Massagetherapistshavevanishedwhileworkinginthis
mysteriousarea,nevertobeseenagain.Theregionanditsmusclesarecomplexandpeculiar,andmanylessertrainedmassagetherapistshavelowcondenceworkingwiththem.(Click/tap
headingtoreadmore.)
forpain:intheupperback(especiallyinneredgeoftheshoulderblade),neck,sideoftheface,
upperchest,shoulder,arm,hand

relatedto:thoracicoutletsyndrome,lumpinthethroat,hoarseness,
TMJsyndrome

muscle(s):thescalenes(anterior,middle,posterior)

PerfectSpotNo.5MassageTherapyforTennisElbowandWristPain

Justbeyondyourelbow,allthemusclesonthebackofyourforearmconvergeintoasinglethicktendon,thecommonextensortendon.Atthepointwherethemusclesconverge,inthemusclesthat
extendthewristandngers,liesoneofthemostinevitablemyofascialTrPsinmoderncivilization:PerfectSpotNo.5.Itisconstantlyandgreatlyaggravatedbothbycomputerusagetodayandby
theuseofapeninsimplertimesandbytheoccasionaltennismatch,thenandnow.(Click/tapheadingtoreadmore.)
forpain:intheelbow,arm,wrist,andhand

https://www.painscience.com/articles/spot11erectorspinaeupper.php

relatedto:carpaltunnelsyndrome,tenniselbow(lateralepicondylitis),
golferselbow(medialepicondylitis),thoracicoutletsyndrome,andseveral
more

muscle(s):extensormusclesoftheforearm,mobilewad(brachioradialis,
extensorcarpiradialislongusandbrevis),extensordigitorum,extensorcarpi
ulnaris
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PerfectSpotNo.6MassageTherapyforBackPain,HipPain,andSciatica

Whenyouhavebackpain,buttockpain,hippain,orlegpain,muchorevenallofyourtroublemaywellbecausedbytriggerpointsintheobscuregluteusmediusandminimusmuscles,apairof
pizzasliceshapedmusclesalittleforwardofyourhippocket.Othermusclesintheregionareusuallyinvolvedaswell,suchasthegluteusmaximus,piriformis,andthelumbarparaspinalmuscles.
However,thegluteusmediusandminimusareabitspecial:theircontributiontopaininthisareaisparticularlysignicant,andyetpeoplewhohavebuttockandlegpainrarelysuspectthatmuch
ofitiscomingfrommuscleknotssohighandfaroutonthesideofthehip.(Click/tapheadingtoreadmore.)
forpain:inthelowback,hip,buttocks(especiallyimmediatelyunderthebuttocks),sideofthe
thigh,hamstrings

relatedto:sciatica,trochantericbursitis,lowbackpain

muscle(s):gluteusmediusandminimus

PerfectSpotNo.7MassageTherapyforBruxism,JawClenching,andTMJSyndrome

Yourmassetermuscleisyourprimarychewingmusclenottheonlyone,butthemainoneanditcoversthesidesofthejawjustbehindthecheeks.Itsalsothemainmusclethatclenchesyour
jawandgrindsyourteeth,unfortunately,anditsoneofthemostcommonlocationsfortriggerpointsinthehumanbody.Itisprobablyanaccompliceinmostcasesofbruxism(thatsLatinfor
grindingyourteeth)andtemporomandibularjointsyndrome(jawjointpain),plusotherunexplainedpainfulproblemsinthearea.(Click/tapheadingtoreadmore.)
forpain:inthesideoftheface,jaw,teeth(rarely)

relatedto:bruxism,headache,jawclenching,TMJsyndrome,
toothache,tinnitus

muscle(s):masseter

PerfectSpotNo.8MassageTherapyforYourQuads

Alotofquadricepsaching,stinessandfatigueemanatesfromanepicentreofknottedmuscleinthelowerthirdofthethigh,inthevastuslateralis,ahugemuscleoneofyourbiggestthat
dominatesthelateralpartoftheleg.Stretchingitiseectivelyimpossible,butmassageisanoption:althoughoftenshockinglysensitive,PerfectSpotNo.8canalsobequitesatisfying.Italsooften
complicatesorcontributestootherproblemsinthearea,especiallyrunnersknee(iliotibialbandsyndrome).(Click/tapheadingtoreadmore.)
forpain:inthelowerhalfofthethigh,knee

https://www.painscience.com/articles/spot11erectorspinaeupper.php

relatedto:iliotibialbandsyndrome,patellofemoralpainsyndrome

muscle(s):quadriceps(vastuslateralis,vastusintermedius,vastus
medialis,rectusfemoris)

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PerfectSpotNo.9MassageTherapyforYourPectorals

Thepecsarepopular:of700+muscles,thepectoralismajorisoneofjustadozenorsothatmostpeoplecannameandpointto.Italsoharboursoneofthemostcommonlyencounteredand
signicanttriggerpointsinthehumanbody,andcanproducepainmuchlikeaheartattackinbothqualityandintensity.(Click/tapheadingtoreadmore.)
forpain:anywhereinthechest,upperarm

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relatedto:heartattack,respiratorydysfunction

muscle(s):pectoralismajor

PerfectSpotNo.10MassageTherapyforTiredFeet(andPlantarFasciitis!)

ThetenthofthePerfectSpotsisoneofthemostpopularofthelot,andrightunderyourfeetliterally.Itliesinthecenterofthearchmusclesofthefoot.ThisisoneofthePerfectSpotsthat
everyoneknowsabout.Nomassageiscompletewithoutafootmassage!(Click/tapheadingtoreadmore.)
forpain:inthebottomofthefoot

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relatedto:plantarfasciitis

muscle(s):archmuscles

PerfectSpotNo.11MassageTherapyforUpperBackPain

Thisspotistoolargetoreallybecalledaspotitsmoreofanarea.Thethickcolumnsofmusclebesidethespineareoftenlitteredwithmuscleknotsfromtoptobottom.Nevertheless,there
isonesectionofthegroupwheremassageisparticularlyappreciated:fromthethickmuscleatthebaseoftheneck,downthroughtheregionbetweentheshoulderblades,taperingoaround
theirlowertips.Thereisnodoubtthatthispartofabackmassagefeelsevenbetterthantheresteventhelowback,despiteitsownquiteperfectspots,cannotcompete.(Click/tapheadingto
readmore.)
forpain:anywhereintheupperback,mainlybetweentheshoulderblades

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relatedto:scoliosis

muscle(s):erectorspinaemusclegroup

PerfectSpotNo.12MassageTherapyforLowBackPain(SoLowThatItsNotIntheBack)

AtthetopofthebuttocksliesaPerfectSpotformassage:asneakybuttroublemakingbruteofatriggerpointthatcommonlyformsintherootsofthegluteusmaximusmuscle.Itsbelowthe
lowestpartofthelowback,butitoftenfeelslikelowbackpain.ThisisthekindofspotthatthePerfectSpotsseriesisallabout:notonlydoesittendtoproduceaprofound,sweetachewhen
massaged,buttheextentofthepainthatspreadsoutarounditisalmostalwaysasurprise.Itfeelslikeakeytomuchmorethanexpected.(Click/tapheadingtoreadmore.)
https://www.painscience.com/articles/spot11erectorspinaeupper.php

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