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Massage treatment for the upper back

This is an excerpt from Anatomy and Physiology of Sports Massage, The by Portia B. Resnick.

There is some crossover in treating the upper back using treatments for the shoulder (chapter 6) and low back (chapter 8), because the muscles are continuous in these three areas. Because of the crossover between the upper back and the low back and shoulders, if you are not having success with what you are using from here, be sure to check one of the other chapters for additional ideas.

Warming of the upper back can be done with compressions and some fascial spreading (using the hands in opposite directions along the back to elicit a stretch). While facing into the table, place your hands on the client's back, using the heel of your hand or a loose fist to engage the tissue. For compressions, you can engage and twist your hand or fist. For fascial spreading, lay your entire hand on the client's back with each hand crossed, facing the opposite direction. As you engage in the tissue, create a pull in opposing directions with your hands as the fascia guides them apart (do not force this; let the fascia pull your hands). This general warm-up need not focus on any specific structure; rather, it provides an opportunity to increase blood flow to warm the tissues. The warm-up can be done to the entire back region before moving to specific treatments of the upper back musculature. The time spent warming and engaging the tissues can also be used for palpation purposes to note any areas of tension or restriction that may not have been obvious from the initial clinician intake and history.

Specific treatment for the upper back starts with the trapezius as the most superficial muscle. Glides along the trapezius are initiated in relation to the fiber direction of the muscle (figure 7.3). To release the upper trapezius, start with glides on the lower trapezius. Using a palm or loose fist, work between the medial border of the scapula and the spinous processes, starting at the level of the spine of the scapula down to the 12th vertebra and rib. Glides should have slow engagement into the fascia. For movement, add passive abduction of the humerus, lifting the arm up while gliding down the lower trapezius. This technique will make it easier to address the upper trapezius both at the superior aspect of the shoulder and the posterior aspect of the neck. For the upper portion of the trapezius along the top of the shoulder, the muscle curls around as it attaches between the spinous processes and the lateral third of the clavicle. If the muscle is warm enough, you can use one hand and work to unroll the trapezius by grasping the portion that curls over the top of the shoulder while engaging the lower portions of the muscle (figure 7.4). This technique works to relieve tension from holding the shoulders up (elevation of the scapula). Remembering to work the lower trapezius first will make it easier to engage the postural upper portion.

As a scapular retractor, the middle trapezius runs more linear from the spinous processes to the acromion process of the scapula. The fibers will likely be influenced by the manual therapy treatments for the upper and lower trapezius; however, it does not hurt to do a few glides in the area before working the deeper muscles. Once the trapezius has been treated, it becomes warm enough to allow work through the rhomboids, which angle from the spinous processes to the medial border of the scapula. Changing the approach to the glides from more linear to an angle will address the rhomboids instead of the middle trapezius. As mentioned previously, the rhomboids are phasic, meaning they are eccentrically lengthened and do not need to be stretched. However, by adding passive movement to the glides, the eccentrically contracted muscle fibers can be encouraged to release with the fascia. This release is achieved with passive shortening of the rhomboids by lifting the arm into horizontal abduction, thereby retracting the scapula, then gliding from the medial border of the scapula toward the spinous processes on an angle distally to proximally while slowly bringing the arm down (figure 7.5). As the rhomboids attach to the medial border of the scapula, work across the table to access the medial border and add some cross-fiber friction over the attachments. By working this area, it becomes easier to lift and mobilize the scapula.

Lifting and mobilizing the scapula can help to reach the next layer, the serratus posterior superior. Serratus posterior superior muscle fibers have the same fiber direction as the rhomboid major, just one layer deeper, and the muscle fibers run under the scapula. If the scapula can be mobilized enough to provide some glides underneath the medial border, through the rhomboid and the trapezius muscles , then some additional work to the serratus posterior superior can be provided. This treatment may not be warranted for all patients, however; for patients experiencing any of the stressors listed earlier for the serratus posterior superior, this treatment is a great way to relieve discomfort.

Not listed here are treatments for the erector spinae group in the thoracic region, which are outlined in chapter 8 as part of the start of the back treatment. Addressing these muscles may be important for treating the thoracic spine and for relieving the cervical spine if the issue is related to the erectors. Instead of repeating the information here, visit chapter 8 for more details on the treatment.

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