Right Upper Back Pain During Pressing Movements - Rehabilitation

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Understanding right upper back pain, especially during pressing movements, can be quite complex and multifactorial. Based on your description, it seems that you are experiencing pain localized between your spine and scapula (shoulder blade) on the right side, particularly when you perform pressing movements or reach backward. This type of pain can often be attributed to several potential causes, including muscle strain, joint dysfunction, or nerve irritation.


Possible Causes of Your Pain
1. Muscle Strain: The muscles in the upper back, including the rhomboids and trapezius, can become strained due to overuse, poor posture, or sudden movements. If you have been engaging in activities that require repetitive overhead or pressing motions, this could lead to muscle fatigue and subsequent pain.

2. Joint Dysfunction: The thoracic spine (the upper back) consists of vertebrae that can become misaligned or restricted in movement. This can occur due to poor posture, especially if you spend long hours sitting or working at a desk. Joint dysfunction can lead to pain during specific movements, such as pressing backward.

3. Nerve Irritation: If there is any compression or irritation of the nerves that exit the spinal column in the thoracic region, it can lead to pain that may radiate or be felt in specific areas of the back. This is often accompanied by sensations such as tingling or numbness.

4. Scapular Dyskinesis: This refers to abnormal movement of the shoulder blade, which can occur due to muscle imbalances or weakness. If the muscles that stabilize the scapula are not functioning properly, it can lead to pain during movements that involve the shoulder and upper back.


Why Physical Therapy May Not Have Improved Your Condition
While physical therapy is often beneficial for musculoskeletal pain, there are several reasons why you may not have seen improvement after three sessions:
1. Inadequate Assessment: If the underlying cause of your pain was not accurately identified, the treatment may not have targeted the right issue. A thorough assessment by a physical therapist is crucial to develop an effective treatment plan.

2. Insufficient Treatment Duration: Sometimes, it takes more than a few sessions to see significant improvement, especially if the condition is chronic or has been present for an extended period.

3. Home Exercise Compliance: Physical therapy often includes a home exercise program. If these exercises are not performed consistently, it may hinder recovery.

4. Underlying Conditions: If there are underlying conditions such as herniated discs, arthritis, or other structural issues, these may require more specialized treatment beyond standard physical therapy.


Recommendations for Management
1. Re-evaluate with a Specialist: Consider returning to your healthcare provider or a specialist, such as an orthopedic doctor or a physical therapist, for a comprehensive evaluation. They may recommend imaging studies, such as X-rays or MRIs, to rule out any serious underlying conditions.

2. Focus on Posture: Pay attention to your posture, especially during activities that involve pressing or reaching. Ergonomic adjustments to your workspace can also help reduce strain on your upper back.

3. Strengthening and Stretching Exercises: Engage in exercises that strengthen the upper back and shoulder stabilizers, as well as stretching to improve flexibility. A physical therapist can provide a tailored program for your needs.

4. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may help alleviate pain and inflammation. However, consult with your healthcare provider before starting any medication.

5. Alternative Therapies: Consider complementary therapies such as acupuncture, massage therapy, or chiropractic care, which may provide relief for some individuals.

In conclusion, understanding the cause of your right upper back pain during pressing movements is essential for effective treatment. A thorough evaluation and a targeted approach to rehabilitation can significantly improve your symptoms and overall function. If your pain persists, do not hesitate to seek further medical advice.