Upper Back Pain While Running: Causes, Prevention, and Relief Strategies

Why does my upper back hurt while running?

Upper back pain during running often stems from a combination of suboptimal posture, muscular imbalances, and inefficient movement mechanics that place excessive strain on the thoracic spine and surrounding musculature, compounded by factors like breathing patterns or equipment.

Introduction

Running, while a fundamental human movement, is a complex interplay of biomechanics, muscular control, and cardiovascular endurance. When pain arises, particularly in the upper back or thoracic spine region, it signals an imbalance or inefficiency within this system. For many runners, this discomfort can be perplexing, as the legs and lower body typically bear the brunt of the work. However, the upper back plays a critical role in maintaining an upright posture, stabilizing the trunk, and facilitating efficient arm swing and breathing – all crucial components of a smooth, pain-free stride. Understanding the anatomical and biomechanical factors at play is the first step toward effective resolution.

Anatomy of the Upper Back

The upper back primarily refers to the thoracic spine, which comprises 12 vertebrae (T1-T12) and forms the central section of your spine. Unlike the more mobile cervical (neck) and lumbar (lower back) regions, the thoracic spine is designed for stability, largely due to its articulation with the rib cage, which protects vital organs.

Key structures involved in upper back function and pain include:

• Vertebrae and Intervertebral Discs: Provide structural support and shock absorption.
• Rib Cage: Attaches to the thoracic vertebrae, influencing mobility and breathing mechanics.
• Muscles: A complex network including:
  • Erector Spinae: Deep muscles running along the spine, responsible for extension and posture.
  • Rhomboids (Major and Minor): Retract (pull back) and stabilize the scapulae (shoulder blades).
  • Trapezius (Upper, Middle, Lower): Elevates, retracts, depresses, and rotates the scapulae.
  • Latissimus Dorsi: Extends, adducts, and internally rotates the arm, also influences trunk stability.
  • Pectoralis Muscles: Located on the chest, often tight in runners with rounded shoulders.
  • Levator Scapulae: Elevates and rotates the scapula, often tight with neck and shoulder tension.
  • Intercostal Muscles: Between the ribs, crucial for breathing.

Common Biomechanical and Postural Culprits

The root causes of upper back pain in runners are frequently tied to how the body moves and holds itself during the activity.

• Poor Running Form and Posture:

  • Forward Head Posture: The head juts forward, placing excessive strain on the cervical and upper thoracic musculature as it works harder to support the head's weight.
  • Rounded Shoulders (Thoracic Kyphosis): A common postural deviation where the upper back is excessively rounded. This position shortens the chest muscles (pectorals) and lengthens/weakens the upper back extensors and scapular retractors (rhomboids, middle/lower traps), making them prone to fatigue and pain.
  • Excessive Forward Lean from the Waist: Instead of leaning slightly from the ankles, some runners hinge from the waist, forcing the upper back muscles to work harder to maintain an upright torso against gravity.
  • Lack of Trunk Rigidity: A weak core (abdominal and lower back muscles) can lead to compensatory movements in the upper body to maintain stability, overworking the upper back.

• Inadequate Thoracic Mobility:

  • The thoracic spine, while designed for stability, still requires a degree of mobility for optimal arm swing and breathing. Stiffness in this region limits the ability to extend and rotate, forcing compensatory movement elsewhere (e.g., lower back, neck) or leading to localized strain.

• Muscle Imbalances:

  • Weakness: Often seen in the deep neck flexors, rhomboids, and lower trapezius muscles, which are crucial for scapular stability and maintaining an upright posture.
  • Tightness/Overactivity: Common in the upper trapezius, levator scapulae, sternocleidomastoid (SCM), and pectoralis muscles due to sustained tension or poor posture, pulling the shoulders forward and upward.

• Inefficient Arm Swing Mechanics:

  • High Arm Carriage: Holding the arms too high or too close to the chest can elevate the shoulders, engaging the upper traps and levator scapulae excessively.
  • Overly Aggressive or Wide Arm Swing: Wastes energy and can introduce rotational forces that strain the thoracic spine and associated musculature.
  • Carrying Tension: Many runners unconsciously clench their fists or hold tension in their shoulders and neck, leading to muscle fatigue and pain.

Non-Biomechanical Factors

Beyond mechanics, other elements can contribute to upper back discomfort during running.

• Breathing Mechanics:

  • Shallow, Apical Breathing: Relying primarily on the upper chest and accessory breathing muscles (like the upper traps and SCM) instead of the diaphragm. This can lead to chronic overuse of these muscles and contribute to upper back and neck tension. Efficient diaphragmatic breathing is crucial for core stability and reducing strain on the upper body.

• Equipment:

  • Hydration Packs or Backpacks: Ill-fitting or heavily loaded packs can pull on the shoulders and upper back, altering posture and causing discomfort.
  • Restrictive Clothing: Tight sports bras or tops that restrict movement can contribute to localized pressure or alter natural biomechanics.

• Stress and Tension:

  • Psychological stress often manifests as physical tension, particularly in the shoulders, neck, and upper back. This pre-existing tension can be exacerbated by the repetitive impact and demands of running.

• Pre-existing Conditions:

  • Less commonly, upper back pain during running could indicate underlying issues such as thoracic disc herniation, facet joint irritation, costo-vertebral joint dysfunction, or scoliosis. While running typically doesn't cause these, it can aggravate pre-existing conditions.

Strategies for Relief and Prevention

Addressing upper back pain requires a multi-faceted approach focusing on form correction, strengthening, mobility, and awareness.

• Form Analysis and Correction:

  • Video Analysis: Record yourself running from the side and back to identify postural issues like forward head, rounded shoulders, or excessive trunk lean.
  • Postural Cues: Focus on running "tall" with a slight lean from the ankles, keeping the chest open, and shoulders relaxed and down. Imagine a string pulling you upwards from the crown of your head.
  • Efficient Arm Swing: Keep elbows at roughly a 90-degree angle, swinging from the shoulders (not across the body), and keeping hands relaxed. Arms should move like pendulums, facilitating forward momentum.

• Strengthening Exercises:

  • Core Stability: Planks, bird-dog, dead bugs. A strong core provides a stable base for the upper body.
  • Posterior Chain: Rows (dumbbell, band, cable), face pulls, band pull-aparts to strengthen rhomboids, middle/lower traps, and posterior deltoids.
  • Scapular Stabilizers: Y, T, W raises to activate and strengthen the muscles that control shoulder blade movement.

• Mobility Work:

  • Thoracic Extension: Foam rolling the upper back (with arms crossed over chest), cat-cow stretches, seated thoracic rotations.
  • Shoulder Mobility: Arm circles, shoulder dislocations (with a stick or band), wall slides to improve range of motion and reduce stiffness.
  • Pectoral Stretches: Doorway stretches to lengthen tight chest muscles.

• Breathing Re-education:

  • Practice diaphragmatic breathing (belly breathing) daily. Lie on your back, place one hand on your chest and one on your stomach. Focus on making your stomach rise and fall with each breath, minimizing chest movement. This can improve oxygen delivery and reduce reliance on accessory breathing muscles.

• Ergonomics and Equipment Check:

  • Daily Posture: Be mindful of your posture at work, while driving, and using electronic devices. Avoid prolonged slouched positions.
  • Running Gear: Ensure hydration packs fit snugly and distribute weight evenly. Choose comfortable, supportive sports bras.

• Progressive Overload:

  • Avoid sudden increases in running volume or intensity. Gradually build mileage and speed to allow your body to adapt.

• Warm-up and Cool-down:

  • Incorporate dynamic stretches (arm circles, torso twists) before running and static stretches (pec stretch, thoracic extension stretches) after.

When to Seek Professional Help

While many cases of upper back pain can be managed with self-care and corrective exercises, it's important to know when to consult a healthcare professional. Seek advice if:

• Pain is severe, sharp, or doesn't improve with rest and self-care.
• Pain radiates into your arms, hands, or legs.
• You experience numbness, tingling, or weakness in your limbs.
• Pain is accompanied by fever, unexplained weight loss, or changes in bowel/bladder function.
• You suspect a pre-existing condition is being aggravated.
• You are a coach or trainer and are unable to resolve the issue with your client.

A physical therapist, chiropractor, or sports medicine physician can provide an accurate diagnosis, targeted treatment plan, and personalized exercise recommendations.

Conclusion

Upper back pain while running is a common but often resolvable issue. By understanding the intricate relationship between posture, muscle balance, and movement mechanics, runners can proactively identify and address the underlying causes. Implementing targeted strengthening and mobility exercises, refining running form, and being mindful of daily habits are key steps toward alleviating discomfort and fostering a more efficient, enjoyable, and pain-free running experience. Remember, consistency and patience are vital in correcting long-standing postural patterns and building resilience in the upper back.