How physiotherapy can treat upper back pain

Studies have shown that about 1 in 10 men and 1 in 5 women will suffer from upper back pain at some point in their lives.[1] Thoracic spine and upper back pain is a complex issue with many biological, muscular, joint and lifestyle factors contributing to the overall problem.

In between the neck and lower back lies the thoracic spine region, containing 12 vertebral segments and 12 pairs of ribs that attach to the spine at the back and front, forming the rib cage that protects your heart and lungs and provides the mechanics that are essential for breathing.

So you could say it’s a pretty important area.

What causes upper back pain?

Unfortunately for our thoracic spine, our modern lifestyles include long periods of time sitting, slouching, and looking at our mobile phones and computers. This leads to stiffness and reduced movement, increasing the natural kyphosis (rounding curve) of your thoracic spine which can lead to injury and long term pain.

Pain in the thoracic spine is the ugly cousin of lower back pain. Upper back pain can range from a dull ache to borderline debilitating pain that can spread to the shoulders, neck and down to the lower back.[2]

The root cause of your upper back pain may be quite complicated, it is essential that a thorough body assessment is undertaken by your physiotherapist to ensure any underlying issues are identified.

The most common causes of upper back pain include:

  • Poor posture while using technology for long periods of time[3]
  • Myofascial pain
  • Osteoarthritis
  • Injury or overuse of muscles and ligaments
  • A herniated disc (rare) or degenerative joint disease (DJD)
  • Repetitive strain injury (RSI)

How can I prevent upper back pain?

Preventing every single cause of upper back pain may not be possible, but there are some basic steps you can take that may avoid some of the more common causes.

These include:

  • Spending less time on your mobile phone looking down
  • Taking regular breaks from sitting
  • Stretching any stiff or sore areas
  • Warming up the body before any strenuous activities or sports
  • Avoiding excessive unaccustomed twisting or lifting with your back
  • Have regular massage or physio to help work out the tension and reduce spasms
  • Work with a musculoskeletal physio to strengthen weak muscles
  • Being conscious of your posture at all times including walking upright and sitting correctly

By undertaking an in depth physical assessment, utilising techniques such as mobilisation, deep tissue massage, dry needling and patient education we aim to restore normal function and improve your quality of life and mobility.

At Fixio, we are experts in assessing all vertebral movements and analysing postural conditions. Your physio will undertake an assessment that will involve thoracic spine movements such as extensions, rotations, side bending and rib expansion.

Other areas of assessment may include shoulder movements such as serving for volleyballers and stroke analysis for swimmers, neck movements and lumbar spine movements as well. Sitting and standing posture will also be assessed by your musculoskeletal physio to watch for kyphosis.

Always remember prevention is much better than a cure.

If you live on the Northern Beaches and would like to know more about our Personal Training or Thoracic Mobility programs



[1] N. Fouquet, J. Bodin, A. Descatha, A. Petit, A. Ramond, C. Ha, Y. Roquelaure, Prevalence of thoracic spine pain in a surveillance network, Occupational Medicine, Volume 65, Issue 2, March 2015, Pages 122–125,

[2] Theisen, Christina & Wagensveld, Ad & Timmesfeld, Nina & Efe, Turgay & J Heyse, Thomas & fuchs-winkelmann, Susanne & D Schofer, Markus. (2010). Co-occurence of outlet impimgement syndrome of the shoulder and restricted range of motion in the thoracic spine – a prospective study with ultrasound-based motion analysis. BMC musculoskeletal disorders. 11. 135. 10.1186/1471-2474-11-135.

[3] Heneghan NR, Baker G, Thomas K, et al What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting BMJ Open 2018;8:e019371. doi: 10.1136/bmjopen-2017-019371


Is running on the beach good for me?

One of the best things about living at Dee Why is being spoilt for choice when it comes to which Northern Beaches paradise to enjoy on a beautiful summer’s day. Whether you’re catching waves at Curl Curl or hitting the Manly Lagoon Reserve outdoor gym, the Northern Beaches offers up plenty of outdoor activities that also have great physiotherapy benefits.

One of my favourite activities is feeling the soft sand between my toes during a steady jog. Don’t get me wrong, I hit the pavements regularly on my morning jogs, but a soft surface like sand can be a great way to add diversity to your regular training routine.

Running exclusively on hard surfaces, especially without proper technique and supportive shoes can increase your risk of impact-associated injuries like stress fractures.

Is running on the beach good for joints?

Studies have shown that mixing up your running routine and adding in some sand runs can help to put less stress on weight-bearing joints such as your hips, knees, and ankles. A 2017 study in the European Journal of Sport Science compared women who ran on soft sand and those who ran on grass and found that the sand runners experienced less muscle damage and inflammation than those who ran on grass.[1]

Running on the beach isn’t easy

The softer sand also causes many of your ankle, hip and knee stabilisers to work harder than they would on a surface like concrete or bitumen. The Journal of Experimental Biology found that running in sand actually causes 1.6 times the energy expenditure of running on firmer surfaces.[2]

This can make beach runs the perfect antidote for when you need a lower-impact session on the body but still want to have a workout that’s going to make you sweat.

However, because different muscles are working harder in the sand, beach running can potentially increase overuse injuries of the of the foot, knee and ankle if you do too much too soon, don’t have the correct foot support or have inefficiencies in your running technique.


Should I see a physio about my running technique?

In-depth biomechanical assessments and running technique analysis aren’t just for the professionals.

Research indicates that biomechanical running assessments can not only help runners improve their times and run more efficiently but it can also help prevent common running injuries such as[3]:

  • Runners knee
  • Iliotibial band friction syndrome
  • Plantar fasciitis
  • Patellofemoral pain syndromes
  • Shin pain
  • Low back pain

If you have had a previous injury such as plantar fasciitis, Achilles tendinopathy, ankle sprains, or recent calf strains, these injuries may flare up if you start training on a beach surface. Lower back niggles might also flare up if you may have an underlying back complaint combined with weak core muscles

Beach and sand running also puts varying levels of stress on different parts of the body and can exacerbate other existing conditions or lead to overuse injuries if your biomechanics are sub-optimal.

At Fixio, our musculoskeletal physiotherapists are experts in working with novice and experienced runners who want to improve their technique, biomechanics, performance, efficiency and ultimately prevent running injuries before they occur.

If you need help with a running injury, or would like some more information on biomechanical assessments we’d love to help you. Call us on 8964 4086 or email to

[1] Brown, H., Dawson, B., Binnie, M. J., Pinnington, H., Sim, M., Clemons, T. D., & Peeling, P. (2017). Sand training: Exercise-induced muscle damage and inflammatory responses to matched-intensity exercise. European Journal of Sport Science17(6), 741-747.

[2] Mechanics and energetics of human locomotion on sand. T M Lejeune, P A Willems, N C Heglund Journal of Experimental Biology 1998 201: 2071-2080;

[3] Chan, Zoe & Zhang, Janet & Au, Ivan & An, Winko & Shum, Gary & Ng, Gabriel & Cheung, Roy. (2017). Gait Retraining for the Reduction of Injury Occurrence in Novice Distance Runners: 1-Year Follow-up of a Randomized Controlled Trial. The American Journal of Sports Medicine. 46. 036354651773627. 10.1177/0363546517736277.


Diagnosing and treating Quadriceps strains and injuries

If I had a dollar for every time I saw a new patient who had been self treating a “quad strain” for months when the pain is actually from something completely different, I could be retired right now.

Your thigh and quadriceps might seem like a straightforward area to self diagnose when you’re feeling pain, but it’s actually a rather complicated musculoskeletal zone.

Without treatment from a sports physio or musculoskeletal specialist, thigh pain can linger and deteriorate into a more serious ailment. Thankfully, with the right diagnosis and treatment, your thigh pain is unlikely to become chronic.

Are my thighs and quadriceps the same thing?

No. Your thigh includes the quadriceps femoris, but the quads alone are not the entire thigh. Your thigh is actually a region made up of 3 main groups of muscles:

  • The quadriceps (located at the front of your leg)
  • The adductors (on the inside area of your leg)
  • The hamstrings (at the rear of your leg towards your glutes)

The quadriceps is comprised of four muscles that connect just above your knee:

  • The Vastus Lateralis (located to the outside of your thigh)
  • The Vastus Intermedius (located in the centre of your thigh)
  • The Rectus Femoris (smaller and located at the front of the thigh covering the Vastus Intermedius)
  • The Vastus Medialis (to the inside of your thigh)

What are the signs of a quadriceps strain and how is it treated?

As with most muscular and tendon tears, thigh strains are divided into three grades:

  • Grade one – the symptoms of a grade 1 tear may not be present until after the activity is over. It can commonly feel like a thigh cramp with associated tightness and mild pain when the muscles are stretched or contracted.
  • Grade two – you will feel immediate pain during stretch and muscle contraction worse than a grade 1 injury and is usually sore to touch.
  • Grade three – is a serious injury where the muscle is completely torn. You will feel an immediate burning or stabbing pain in your thigh that will stop you being able to walk without pain and there may even be a large lump of muscle tissue above a depression accompanied by bruising.

Your thigh is a prime area for referred pain

What is referred pain? Pain is a continually evolving science that we don’t know everything about yet. Referred pain is any pain felt at a location in your body that is not the direct source of the pain.

Have you ever visited a physio for a sore shoulder and the first place they started looking at was your neck? That’s referred pain.

Due to your thigh’s proximity to the groin, pelvis and role in ITB function, it is a prime candidate to feel referred pain from any number of local regions.

Thigh pain can also be the manifestation of:

  • Sciatica type symptoms – your femoral nerve can refer pain to the front of your thigh
  • Hip joint conditions such as arthritis
  • Meralgia Paresthetica – when the lateral femoral cutaneous nerve becomes impinged
  • Lower back pain
  • Vascular problems such as a deep venous thrombosis
  • And rarely; a fracture to the femur bone

As a musculoskeletal physio we have years of clinical experience diagnosing and treating thigh injuries of all kinds along with diagnosing causes of referred pain to the thigh. After a detailed clinical assessment of your injury, biomechanics, sporting technique and muscle coordination, we will devise a rehabilitation program tailored to your needs.

Give us a call on (02) 8964 4086 or book an appointment and


Throwing biomechanics and common throwing injuries

Summer is nearly here and that means Northern Beaches cricketers will be dusting off the whites and getting ready for a spit free Summer of cricket. It also means your local Dee Why physio is getting prepared for the annual increase in throwing injuries and other shoulder, elbow and wrist injuries.

While throwing injuries usually occur in throwing sports such as cricket, softball, javelin and water polo, they can also pop up in sports that simply use a lot of overhead rotation and movement like serving in volleyball and tennis.

The biomechanics of throwing

Throwing is the co-ordinated effort of a number of muscle groups and is one of the fastest actions human beings can perform. Major league pitchers’ maximum humeral internal rotation velocity has been measured at over 7500°/second.[1]

An overhead throw has 6 phases:

  • wind up,
  • stride,
  • cocking,
  • acceleration,
  • deceleration and
  • follow through


Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports[2]

Throwing injuries tend to occur due to overuse, poor throwing technique and can come on gradually, sneaking up on you before you realise you’ve done yourself a painful injury.

Throwing injuries most commonly occur in the shoulder of the throwing arm, but can also appear as elbow and wrist complaints too.

Shoulder injuries

The shoulder is the most common location for injuries from throwing and overhead movements and different phases of throwing gives us the possibility of all kinds of different injuries.[3]

  • Windup – No injuries are common
  • Cocking – Anterior subluxation, internal impingement, glenoid labrum lesions, subacromial impingement.
  • Acceleration – Shoulder instability, labral tears, overuse tendinitis, tendon ruptures.
  • Deceleration – Labral tears at the attachment of long head of biceps, subluxation of long head of biceps by tearing of transverse ligament, lesions of rotator cuff
  • Follow Through – Tear of superior aspect of glenoid labrum at the origin of biceps tendon, subacromial impingement.

Elbow injuries

During the throwing motion, your arm is acting like a whip just before it cracks. This leaves your elbow under a lot of stress and at risk of injury as well.

That repetitive sideways force to the elbow combined with a poor throwing technique is the recipe for a Medial Collateral Ligament Sprain and swelling and pain.

How do physiotherapists treat throwing injuries?

A number of factors contribute to the development of throwing injuries and your physio will do an in-depth biomechanical and injury assessment before getting stuck into your new program.

A bespoke program designed by a musculoskeletal physio will aim to:

  • Improve shoulder flexion, abduction, external and internal rotation
  • Utilise manual and massage therapy techniques on muscle tightness in your latissimus dorsi, pectorals, rotator cuff, abdominals & hip flexors
  • Improve thoracic spine flexibility when performing extension and rotation of throwing

Help prevent throwing injuries with help from your physio

Whether you’re a weekend warrior or an elite athlete, a musculoskeletal physio is a goldmine for injury prevention techniques to ensure you can maintain optimal performance while taking care of your body.

A visit to a physio can help decrease your chances of injury in the future.

  • Help to correct your throwing technique

Ensure your throwing technique is safe and efficient, minimising the risk of injury to the shoulder and elbow. Make sure you use the whole body, including the legs and hips rather than confining the throwing motion to the upper body.

  • Improving flexibility

Upper back flexibility is extremely important for athletes that throw or use overhead motions regularly. Not only does upper back flexibility help with injury prevention to the shoulder, but it also acts as a performance enhancer. Having adequate flexibility in your upper and lower body is important to improving your throwing technique, reducing the risk of injury and performing to your full potential Key joints which require adequate range of motion for throwing include:

  • Shoulder
  • Elbow
  • Upper Back
  • Lower Back
  • Hips
  • Core

For more information on throwing injuries, injury prevention techniques and managing sports injuries, give us a call on (02) 8964 4086 and send an email to

[1] Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health. 2010 Mar;2(2):135-46. doi: 10.1177/1941738110362656. PMID: 23015931; PMCID: PMC3445080.

[2] Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med. 2009;39(7):569-90. doi: 10.2165/00007256-200939070-00004. PMID: 19530752.

[3] Houglum PA, Bertoti DB. Brunnstrom’s clinical kinesiology. FA Davis; 2012

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