back pain



Upper and middle back pain may be caused by:

  • Overuse of, or injury to, the muscles, ligaments and discs that make up the thoracic spine.
  • Poor posture. Slumping or slouching when you sit or stand, especially when using a computer for a long time.
  • Pressure on the spinal nerves from problems such as a herniated disc.
  • Osteoarthritis from the breakdown of the protective cartilage that cushions your facet joints in the spine.
  • A fracture of one of the vertebrae.


(1) Exercises and stretches
Stretching and an active lifestyle help reduce back pain and speed the recovery process following an injury.

As upper back pain is related to large muscles in the shoulder area, exercise to stretch and strengthen the muscles of your back, shoulders, and stomach are largely recommended. These muscles help support your spine. Exercise will also strengthen the muscle groups that support your mid-back to help relieve back muscle pain. Both specific exercises and stretches for this region together with general exercise, such as swimming, walking, cycling, are recommended.

Regular yoga or Pilates sessions can also help relieve back muscle pain as they incorporate a number of positions and moves that use the upper and middle back muscles.

(2) Manual therapy and physical therapy
Manual therapy includes massage or spinal manipulation. It helps reduce muscle tension and pain in the back and improve blood flow.

(3) Practice good posture

Poor posture puts stress on your back and can cause upper and middle back pain. Try to stand or sit tall, keeping your back as straight as possible and balance your weight evenly on both feet. Don’t slump or slouch. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when using computers and driving. If you spend a lot of time at a computer, at home and work, make sure the screen is at eye level, never below and not too far away so that you have to reach to it. If you spend a long time in the car raise the steering wheel and sit closer to it.

back pain


Pain affecting the back often restrict movement. The pain usually lasts for only a week or so but can recur in some people.

Back pain is usually caused by minor damage to the ligaments and muscles in the back because muscles and ligaments supports most of the body’s weight from movements such as bending, twisting and stretching. Less commonly, lower back pain may result from an underlying disorder such as prolapsed intervertebral disc in the spine.

Investigations for back pain, such as x-rays, CT scan or MRI sometimes reveal abnormalities such as disc prolapse that may require surgical treatment.

In most cases, back pain can be treated with over-the-counter painkillers, nonsteroidal anti-inflammatory drugs or muscle-relaxant drugs. Other treatments include acupuncture, spinal injection, exercise or spinal manipulation.

neck pain


(A) Flexion Stretch

  • keeping the shoulder back, bring the chin toward the chest by bending the head straight forward. A slight stretch will be felt in the back of the neck.
  • Hold for 15 to 30 seconds.

(B) Lateral Flexion Stretch

  • Start in an upright, standing position.
  • Keeping the shoulders even, bring one ear toward the shoulder by bending the head to one side. A slight stretch will be felt in the side of the neck.
  • Hold for 15 to 30 seconds then repeat on the other side. 

(C) Levator Scapula Stretch

  • Stand straight, raise the right hand and elbow, and place it on a nearby wall or door.
  • While keeping everything else still, rotate the head to the left about 45 degrees which is about halfway toward the shoulder.
  • Tilt the chin down to the left collarbone until a good stretch is felt on the back right side of the neck.
  • Hold for 30 to 60 seconds or as tolerated, repeat on the other side.

(D) Corner Stretch

  • Face the corner of a room or a doorway.
  • Position both feet together, about 2 feet away from the corner.
  • Place a forearm on each wall with the elbows slightly below shoulder height.
  • Lean forward until a good stretch is felt across the chest and shoulders. If any pain is felt, the stretch can be reduced or stopped altogether.
  • Hold the stretch 30 to 60 seconds and repeat 3 to 5 minutes.
back pain


Below are some of the positions that help ease back pain:

  • Lie on your back with a pillow or two under your knees.
  • Lie flat on your front. If this position is too painful, try again with one or two pillows under your hips. As your pain eases, remove the pillows so that you are completely flat.
  • Lie on your side with a pillow between your knees. Sometimes a rolled-up towel around your waist also helps.
  • Sitting is often very uncomfortable so it is best to only sit for short periods. If you have to sit it may help to sit on an upright chair with a small rolled towel placed between your lower back and the chair.
Restless leg syndrome


During an episode of restless legs syndrome, the following measures may help relieve your symptoms:



Before you start any exercise routine, check with your doctor or physical therapist. They can tell you what’s safe for your stage of osteoporosis, your fitness level and your weight. Your doctor also will consider any other health problems that have a bearing on your ability to exercise, such as high blood pressure and heart disease.

There is no single exercise programme that’s best for everyone with osteoporosis. The exercise programme you choose should be unique to you and based on your:

  • Muscle strength
  • Level of physical activity
  • Fracture risk
  • Range of motion
  • Balance
  • Gait
  • Fitness


These are exercises you do on your feet so that your bones and muscles have to work against gravity to keep you upright. There are two types of weight-bearing exercise: high-impact and low-impact. High-impact includes workouts like:

  • Jumping rope
  • Jogging
  • Step Aerobics
  • Tennis or other racquet sports

Low-impact exercises include:

  • Walking (either outside or on a treadmill machine)
  • Low-impact aerobics
  • Stair-step machines


These workouts can include basic moves such as standing and rising on your toes, lifting your body weight with exercises like push-ups or squats and using equipment such as:

  • Free weights
  • Weight machines
  • Elastic exercise bands


These moves improve your coordination and flexibility. That will lower the chance that you’ll fall and break a bone.

Balance exercises such as Tai Chi can strengthen your leg muscles and help you stay steadier on your feet.

Routines such as yoga and Pilates can improve strength, balance, and flexibility in people with osteoporosis.

back pain

Treatments for back pain from a specialist

Extra treatment from the specialist may be recommended if self-help measures alone do not improve the back pain.

These extra treatments include:

  • group exercise classes where you’re taught exercises to strengthen your muscles and improve your posture,
  • manual therapy treatments, such as manipulating the spine and massage, which are usually done by a physiotherapist, chiropractor, osteopathy,
  • psychological support, such as cognitive behavioural therapy (CBT) if you are struggling to cope with pain.

Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.

back pain


In general, most back muscle spasms occur because of the following reasons:

(1) The muscles are trying to protect themselves from muscle strain

A back spasm can occur after any type of strain or injury to the soft tissues (muscles, tendons or ligaments) in the spine. This type of soft tissue injury typically heals enough within a week or two for the muscle spasms to stop.

(2) The muscles can spasm in response to an underlying anatomical problem

If your back spasm does not get better in 1 to 2 weeks, or it comes and goes overtime in the same area of your back, you may have an underlying anatomical problem in your spine. Some examples of underlying issues that could cause your back to spasm include:

  • Facet joint osteoarthritis
  • Spinal stenosis
  • Degenerative disc disease
  • Herniated disc

When these or other underlying anatomical problems are present in the spine, muscle spasms are likely to keep recurring due to ongoing inflammation or instability. It is important to seek medical attention to treat the underlying cause of your symptoms, rather than just treating the symptoms.