What's Missing in Your Upper Back Pain Treatment?

Upper back pain typically stems from an imbalance between spinal mobility (how freely your vertebrae move) and stability (how well your supporting muscles hold everything in place), with most patients falling into one of two categories: overly mobile but weak, or overly stiff but lacking movement.

I'm Dr. Rob Letizia, PT, DPT, owner of Spectrum Therapeutics in Wayne, NJ. "Why does my upper back hurt so much when I've been stretching constantly?" This question comes up regularly at my clinic.

And often the answer surprises patients: stretching might actually be making things worse if mobility isn't your problem.

Your thoracic spine is designed to do two things well. It needs to move freely so you can bend, twist, and reach. But it also needs stability so movement doesn't cause injury.

When these two qualities get out of balance, pain follows.

At Spectrum Therapeutics of NJ, we determine which side of the spectrum you're on before prescribing exercises. This prevents the common mistake of doing the wrong thing for your specific issue.

Can You Really Fix Upper Back Pain by Doing the Right Exercises?

A patient named Rachel from Montville came to see me last fall completely confused. She'd been doing yoga three times a week for months. Stretching constantly. But her upper back pain kept getting worse.

"I thought flexibility was supposed to help," she told me. "Why am I hurting more than before I started?"

Her evaluation revealed the problem immediately. Rachel was already extremely mobile. Her thoracic spine moved beautifully. What she lacked was stability.

The muscles that should support her spine were weak. All that stretching was making her even more unstable.

"You're on the wrong end of the continuum," I explained. "You don't need more mobility. You need strength."

We shifted her entirely to stability exercises: rows, wall angels, prone W's. I asked her to back off the stretching temporarily.

Week three, she told me: "This is the first time in six months my back hasn't hurt after sitting at my desk all day."

By week six, Rachel had built enough muscular support that her spine could handle her yoga practice without pain. Now she does both. Mobility work in yoga and stability work at home. Her back feels better than it has in years.

"I was doing exactly the wrong thing," she said at her last visit. "I needed someone to tell me to stop stretching and start strengthening."

That's why assessment matters. The right exercises depend entirely on which end of the spectrum you're on.

Let me explain how this works and what you can do about it.

What Is the Mobility-Stability Continuum?

Your spine exists on a continuum between mobility and stability. Both are necessary for healthy function. But too much of either creates problems.

Mobility refers to how freely your vertebrae move. Each individual segment contributes a small amount of motion. When combined across your entire spine, this allows for complex movements like bending forward, twisting to look behind you, and reaching overhead.

Stability refers to your spine's resistance to injury. Primarily provided by muscular strength. The stronger your supporting muscles, the more stable your spinal column becomes.

Problems arise when you drift too far in either direction.

Too mobile, not strong enough: Your spine moves freely. But without adequate muscular support, it becomes vulnerable to strain and pain. These patients often feel like their back is "loose" or "unstable."

Too stable, not mobile enough: Your spine is stiff and restricted. The joints don't move well. This lack of motion itself causes significant pain. These patients feel "stuck" or "frozen" in their upper back.

At Spectrum Therapeutics of NJ, we assess where you fall on this spectrum during your evaluation. This determines whether we prioritize mobility work, strengthening, or a combination of both.

How Do You Know If You Need More Mobility?

Stiffness is the first line of concern when it comes to thoracic spine pain. If your vertebral joints are stuck or frozen, that restriction itself causes significant discomfort.

You likely need more mobility if your upper back feels stiff (especially in the morning), turning to look behind you feels restricted, reaching overhead is difficult or uncomfortable, you spend long hours sitting at a desk or driving, or your posture has become increasingly rounded.

Winter makes this worse. Cold temperatures cause muscles to tighten. Reduced activity lets joints stiffen further.

Hunching against the cold creates postural patterns that restrict thoracic movement.

The good news is that mobility responds well to targeted exercises. Getting those vertebral bodies moving again often produces rapid relief for patients whose primary issue is stiffness.

What Are the Best Mobility Exercises for Thoracic Spine Pain?

These exercises serve as the first line of defense when stiffness is contributing to your pain. The goal is to mobilize the vertebral joints and restore normal movement.

Thoracic Rotation Stretch

Lie on your side with knees bent up high. This position locks out your lower back so the rotation happens in your thoracic spine.

Use your bottom hand to hold your top knee down. With your top hand, grab your ribs and rotate your upper body. Bring your top shoulder toward the floor.

For a more intense stretch, extend the top arm back. Let its weight help facilitate deeper rotation.

Parameters: 3 repetitions per side, holding each for 15-20 seconds.

Thoracic Extensions Over a Chair

Use a sturdy chair that doesn't swivel. Sit with your hands behind your head and extend backward over the chair's back. The edge of the chair creates a pivot point for the extension.

Here's the key: by sliding your buttocks forward or backward in the chair, you change which vertebral level gets mobilized. This allows you to target different areas of stiffness throughout your mid-back.

Parameters: 3-5 second holds at each level, mobilizing 3-4 different segments.

Thoracic Mobilizations with Foam Roller

Lie with a foam roller perpendicular to your spine. Support your head with your hands.

This is important: do not brace your abs or neck. Relax your back completely and allow it to extend over the roller.

Roll slowly up and down your thoracic spine. Spend extra time on areas that feel particularly stiff.

Parameters: 10-15 rolls, approximately 60 seconds total.

How Do You Know If You Need More Stability?

Some patients have plenty of mobility but lack the muscular strength to support their spine. This creates a different type of problem. One that requires a different solution.

You likely need more stability if your upper back feels "loose" or "unstable," pain worsens with prolonged positions rather than movement, you have naturally flexible joints throughout your body, your posture collapses when you're tired, or stretching provides only temporary relief that doesn't last.

Rachel from Montville was doing yoga three times a week but getting worse. She had plenty of mobility. What she lacked was stability.

For these patients, doing more mobility work can actually make things worse. What they need is strengthening to build the muscular support their spine lacks.

At Spectrum Therapeutics of NJ, we identify this pattern during evaluation. We shift the treatment focus toward stability exercises rather than more stretching.

What Are the Best Stability Exercises for Thoracic Spine Support?

These exercises strengthen the muscles that support your thoracic spine. Particularly the scapular muscles and core stabilizers.

These are the exercises that transformed Rachel's back pain after months of ineffective stretching.

Rows (Band or Cable)

Brace your core and pull back. Focus on initiating the movement from your back muscles rather than just your arms. Squeeze your shoulder blades together at the peak of each contraction.

A variation involves single-arm rows with rotation: as you pull, open your chest and rotate slightly. This engages your thoracic rotators and core stabilizers in addition to your back muscles.

Parameters: 3 sets of 10 repetitions for bilateral rows. 3 sets of 10 repetitions per side for unilateral variations.

Wall Angels

Stand with your buttocks, shoulder blades, and the back of your head all touching a wall. Position your feet about 8-10 inches away from the wall.

Place your knuckles against the wall in a "goalpost" position with elbows bent.

Slide your hands up and overhead while maintaining all points of contact with the wall. This is harder than it sounds, especially for people with rounded posture.

The exercise activates your scapular retraction muscles. It challenges thoracic extension.

Parameters: Perform for a 1-2 minute timer, moving slowly and maintaining wall contact throughout.

Prone W Exercise

Lie face down on the floor. Lift your chest slightly off the floor (thoracic extension). Simultaneously pull your elbows down toward your back pockets. This creates a "W" shape with your arms.

The primary focus is squeezing your shoulder blades together. Hold briefly at the top of each repetition before lowering.

Parameters: 2-3 sets of 10 repetitions with a 2-3 second hold at the top.

How Do You Find Your Balance Point?

The goal isn't to become extremely mobile or extremely stable. It's to find the balance point where you have enough motion combined with enough strength for pain-free function.

Most patients need some combination of both approaches. Even if stiffness is your primary issue, you'll eventually need to strengthen the muscles that support your newly mobile spine.

And even if weakness is the main problem, some mobility work usually helps.

Rachel now does both mobility work in yoga and stability exercises at home. The combination keeps her pain-free.

At Spectrum Therapeutics of NJ, we reassess as you progress. We adjust the ratio of mobility to stability work based on how your body responds.

What you need in week one often differs from what you need in week six.

When Should You Seek Professional Help?

Basic mobility and stability exercises help many people with thoracic spine pain. But certain situations warrant professional evaluation.

Pain that doesn't respond to consistent exercise over two to three weeks. Pain that radiates around your ribs or into your chest. Numbness or tingling in your arms or hands.

Pain following a fall or injury. Difficulty breathing associated with back pain.

Even without these warning signs, getting evaluated ensures you're doing the right exercises for your specific issue. Doing mobility work when you need stability (or vice versa) can slow your progress. Or make things worse.

Your Upper Back Pain Questions Answered

How do I know if I need mobility or stability exercises?

The simplest indicator is how your back feels. If you feel stiff and restricted, you likely need mobility work. If you feel loose or unstable, you likely need strengthening. Rachel from Montville felt like she needed more stretching, but her evaluation revealed she was already too mobile. She needed stability work instead. At Spectrum Therapeutics of NJ, we perform specific tests during evaluation to determine which approach will help you most. Many patients need both, but the ratio varies significantly between individuals.

How long does it take for thoracic spine exercises to help?

Most patients notice some improvement within one to two weeks of consistent exercise. Rachel from Montville noticed significant relief by week three once we shifted her from mobility work to stability exercises. However, lasting change typically takes four to eight weeks of regular work. Mobility gains often come faster than strength gains, but both require consistency. Doing exercises occasionally won't produce the results you want.

Can poor posture cause thoracic spine pain?

Yes. Prolonged rounded posture contributes to both stiffness and weakness in the thoracic region. The joints adapt to the position you spend most time in, and muscles that aren't used regularly weaken. However, the solution isn't constant rigid posture correction. It's building enough mobility and strength that your spine can handle various positions without pain.

Should I use heat or ice for upper back pain?

Heat generally works better for thoracic spine pain because it helps relax tight muscles and improve blood flow to stiff joints. Apply heat for 15-20 minutes before doing mobility exercises. Ice may be appropriate if there's acute inflammation following an injury, but most chronic thoracic pain responds better to warmth.

Can stretching actually make upper back pain worse?

Yes, if mobility isn't your problem. At Spectrum Therapeutics of NJ, we assess which end of the mobility-stability continuum you're on before prescribing exercises. Doing the wrong thing for your specific issue can slow progress or make things worse.

Ready to Find Your Balance Point?

Upper back pain doesn't have to control your life. With the right assessment and targeted approach addressing your specific imbalance, most patients see significant improvement.

Schedule an evaluation at Spectrum Therapeutics of NJ, 601 Hamburg Turnpike, Suite 103, Wayne NJ. Call (973) 689-7123 or book online. We'll figure out whether you need more mobility, more stability, or a combination of both, and build a plan to get you pain-free.

See you in the clinic, 

Dr. Rob Letizia