Detailed guides to painful problems, treatments & more

Massage Therapy for Upper Back Pain

Perfect Area No. 11, the erector spinae muscle group of the upper back

PAGE INFO updated  by Paul Ingraham
Word count: 1,400
Reading time: 6 minutes
Published: 2005
Trigger points (TrPs), or muscle “knots,” are a common cause of stubborn & strange aches & pains, and yet they are under-diagnosed. The 14 Perfect Spots (jump to list below) are trigger points that are common & yet fairly easy to self-treat with massage — the most satisfying & useful places to apply pressure to muscle. For tough cases, see the advanced trigger point therapy guide.

This “spot” is too large to really be called a “spot” — it’s more of an area. The thick columns of muscle beside the spine are often littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest — even the low back, despite its own quite perfect spots, cannot compete. Area No. 11 belongs in this series even though it is not, strictly speaking, a single spot.

Why is Area no. 11 perfect?

Many people suffer from what I call “brick back” — that is, their upper back feels like a brick, specifically between the shoulder blades. It is dense, rigid, and sometimes seemingly impervious to pressure, as though the spine is held so tightly by the muscles that it has been fused.

This state is mostly the work of the erector spinae muscle group. The erector spinae are the thick columns of muscle on either side of your spine. They often feel ropy and hard, and are a natural target for massage. Trigger points in the erector spinae are often numerous, like a string full of knots. Unlike many of the other Perfect Spots, which are unfamiliar, most people are well aware that they have knots in the upper back: their only question is, “How do I get rid of them?” Even people who do not have obvious trigger points in this area will usually find that massage here feels especially good.

There is no good explanation for why these muscles accumulate so many trigger points. Along with the shoulders, lower back, and hips, it’s another common spot for stress and anxiety to express itself.

It may be related to the sheer amount of muscle that attaches to the upper thoracic vertebrae, like rigging on a sailing ship converging on the masts. The area is a stable foundation to support neck and shoulder action. For instance, the neck is highly mobile but can still be stabilized strongly because it has the solid mass of the upper back to cling to. This region of unusually thick muscle may get more trigger points simply because it has more muscle.

And, of course, stress and evolution aside, the upper back and shoulders both often suffer from the postural stress of computer work. Although poor posture and lots of sitting are generally over-rated as a cause of pain, they probably are associated with some discomfort here.

How do you find Area No. 11?

Finding this area is easy, because it’s big and the landmarks are obvious. Start by finding the spine. Now move just to one side of the spine. There is a groove here between the spine and the bulky column of the erector spinae.

You will find sensitive knots at the bottom of the groove, on the inner edges of the erector spinae, and on top of them. This is true for the entire back, but the most useful area ranges from the base of the neck to about two thirds of the way down between the shoulder blades.

Like any of the other Perfect Spots, you can find a knot and press on it until the tension eases. However, because there are so many knots in these muscles, a couple of other approaches produce even more satisfying results.

The first is called “stripping,” in which you lubricate the skin and slide slowly and strongly along the length of the groove, using a thumb, fingertips, the heel of your hand, knuckles, or even an elbow. The amount of pressure you use depends completely on the person you are massaging. Keep it manageable! This technique will treat many trigger points instead of just one: more bang for your buck.

Another way of treating several trigger points at once is called “strumming” or “frictions.” (Not the same idea as friction massage, but the same movement.) The erector spinae are often quite ropy, and sometimes feel surprisingly like guitar strings. Especially when this is the case, you can create a delicious sensation of release by rubbing back and forth (side to side) across the fibres with your fingertips. This does not require lubrication, as the skin moves with the fingers.

For the best results from strumming, carefully feel around in the groove between the spine and the bulkiest column of the erector spinae for a single clearly identifiable “string” of muscle. You may need to press quite firmly to do so. You can use the same technique quite broadly and lightly across the entire group, but it doesn’t feel nearly as dramatic as deep strumming of individual strands.

How does Area no. 11 feel?

Heavenly! In my experience, strumming in the very uppermost part of the back is one of the most vivid sensations in all of massage. However, this combines both a location and a specific technique — which doesn’t affect everyone the same way. At its best, though, the sensation is deeply penetrating and people often speak of feeling it “in my chest.”

Nowhere is the idea of “good pain” or a “sweet ache” more obvious than it is here. While many trigger point releases have a satisfying quality, these muscles produce the gold standard of good pain by which all other good pains are judged. Only excessive pressure on the most unhappy backs will feel sharp or burning. Most people will experience a deep, spreading, warming ache.

These muscles also often produce vivid and diverse referred sensations. Most commonly, feelings of (good) pain or pressure will spread down and outwards. The shoulders often respond, as do the chest and throat. With several trigger points being released at once, some people report a widespread feeling of being pleasantly paralyzed throughout the entire torso! The sensation may be “breathtaking,” which can be alarming if it’s too strong, or wonderful if the pressure is tolerable.

Although the arch of the foot (Spot No. 10) may be the nicest single spot for massage in the body, it is just a mere spot, and far from the core. By contrast, the summed effect of all the trigger points in this area is so potent and useful that I always request treatment for it every time I see a massage therapist myself.

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.

What’s new in this article?

2016 — Miscellaneous editing, and in particular replaced paragraph about the evolutionary perspective on back pain with some more relevant explanation of the anatomy of this area. New image showing the location of Spot 11.

2005 — Publication.

Appendix A: Is trigger point therapy too good to be true?

Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.

But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. Their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle tissue may well be wrong. What we do know is that people hurt, and it can often be helped.

The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it

Picture of the cover of my ebook, Save Yourself from Trigger Points and Myofascial Pain Syndrome.

Not too good to be true.

Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little & many will experience significant relief from stubborn aches & pains. The first few sections are free.

Appendix B: All the perfect spots

There’s also a more detailed index of the spots and other trigger point resources.

  1. Massage Therapy for Tension Headaches — Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.
  2. Massage Therapy for Low Back Pain — Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner
  3. Massage Therapy for Shin Splints — Perfect Spot No. 3, in the tibialis anterior muscle of the shin
  4. Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain — Perfect Spot No. 4, an area of common trigger points in the odd scalene muscle group in the neck
  5. Massage Therapy for Tennis Elbow and Wrist Pain — Perfect Spot No. 5, in the common extensor tendon of the forearm
  6. Massage Therapy for Back Pain, Hip Pain, and Sciatica — Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip
  7. Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome — Perfect Spot No. 7, the masseter muscle of the jaw
  8. Massage Therapy for Your Quads — Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group
  9. Massage Therapy for Your Pectorals — Perfect Spot No. 9, in the pectoralis major muscle of the chest
  10. Massage Therapy for Tired Feet (and Plantar Fasciitis!) — Perfect Spot No. 10, in the arch muscles of the foot
  11. Spot No. 11 is this page.
  12. Massage Therapy for Low Back Pain (So Low That It’s Not In the Back) — Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle
  13. Massage Therapy for Low Back Pain (Again) — Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point
  14. Massage Therapy for Shoulder Pain — Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain