Upper Back Pain

Pain in the upper back, index finger and thumb

Table of Contents

How People Describe This Pain Pattern

People complain about pain just inside of the shoulder blade, and in the thumb, and index finger. It doesn’t always create pain in the hand; sometimes it is tingling like it is “falling asleep” or “going numb.” Sometimes, they have pain or tingling when reaching out with the hands near shoulder level, like when you’re driving or cutting hair.

The pattern almost never occurs completely, as illustrated. But this pain along the shoulder blade and in the hand are most common. As the illustration indicates, the pain, tingling and “numbing” is most likely to occur in the areas of darkest red. When there are stiff, swollen hands, the sensations around the index finger and thumb are a greater focus, although the tension behind the shoulder is often there. If I press into this muscle at the base of the neck, the client almost always describes the sensation between the shoulder blades and down the arm.

How You Activate and Intensify This Pain Pattern

The most common cases that I see for this involve people that sit with their shoulders forward so that it is difficult to breathe with their diaphragm. The scalenes go from being assistive breathing muscles to being the primary respiratory muscles as they lift the upper ribs and collarbone to inhale. They get overworked, displace the upper ribs, and create chronic trigger point activity.

When they identify an activity, it usually involves an activity where they are seated with the hands up in front of them. This might be when they are driving with the arms at 10 & 2, or working while slumped forward, or rowing, or activity that created heavy breathing.

Another common report is that their arms go to sleep when they sleep on their back. Tight scalene muscles choke the neurovascular bundle that runs to your arms.

These muscles also get involved in assisting with heavy breathing as when sprinting or climbing stairs. People with this problem complain of tingling in their hands while huffing and puffing. This can also be a sign of thoracic outlet syndrome.

The Musculoskeletal Anatomy Behind Your Pain

This pain pattern comes from the scalene muscles which assist in stabilizing the neck, moving the head side to side and breathing. you can read more about the anatomy in this post.

This is usually a part of Thoracic Outlet Syndrome. There is a better explaination of the related structures and a short video in this post.


Getting Relief on Your Own

Clinically Proven
Self-Care Strategies

This post has strategies for getting relief on your own. Explore how to change your activities, stretch, and other strategies that relieve the pain associated with this trigger point.

Therapy Notes for Massage and Bodywork

Better Bodywork
Through Shared Expertise

This post has techniques, tips, treatment routines, and anatomy illustrations to improve the bodyworker’s approach.


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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written materials and instructed classes since the mid-90s. This includes anatomy, trigger points, cranial, and neuromuscular.

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*This site is undergoing significant changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and include more patterns with better self-care. Meanwhile, there may be formatting, content presentation, and readability inconsistencies. Until we get older posts updated, please excuse our mess.

Tony Preston

Tony Preston, LMT has been treating adults and children since the early 90s. He has authored a number of texts on neuromuscular and craniosacral techniques. He has taught Neuromuscular Therapy for ASHA School of Massage and craniosacral the National Institute of Craniosacral Studies. He currently teaches seminars in Integrative Craniosacral techniques at The Body Guild.

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