Massage Therapy for Upper Back Pain
Perfect Area No. 11, the erector spinae muscle group of the upper back
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, a big one, like a cinder block 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 intense sensation of stiffness is mostly the handiwork of the erector spinae muscle group. The erector spinae are the thick columns of muscle on either side of your spine. They often feel ropey 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 just one of the common spots for stress and anxiety to express itself.
It might 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 spine has more than it’s fair share of the body's 700 or so skeletal muscles. 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.
“As a 1990 massage grad, and still practicing after all these years, I still say to clients ‘let’s see what happens’ … and some places just feel good to have applied pressure.”
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
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., or subscribe:
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 …
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, and many will experience significant relief from stubborn aches and pains. The first few sections are free.
Appendix B: Quick Reference Guide to the Perfect Spots
This index is also available on its own page.
1For headache, neck pain
Under the back of the skull must be the single most pleasing and popular target for massage in the human body. No other patch of muscle gets such rave reviews. It has everything: deeply relaxing and satisfying sensations, and a dramatic therapeutic relevance to one of the most common of all human pains, the common tension headache. And no wonder: without these muscles, your head would fall off. They feel just as important as they are. (Click/tap heading to read more.)
| for pain: almost anywhere in the head, face and neck, but especially the side of the head, behind the ear, the temples and forehead | muscle(s): suboccipital muscles (recti capitis posteriores major and minor, obliqui inferior and superior) |
2For low back pain
This Perfect Spot lives in the “thoracolumbar corner,” a nook between your lowest rib and your spine — right where the stability of the rib cage and thoracic vertebrae gives way to the relative instability of the lumbar spine. It consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine, the erector spinae. (Click/tap heading to read more.)
| for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip | muscle(s): quadratus lumborum, erector spinae |
3For shin splints
Perfect Spot No. 3 is in your shins — seemingly an unlikely place for muscle knots! But there is meat there, and if you’ve ever had shin splints then you know just how vulnerable that meat can be. Even if you’ve never suffered so painfully, your shins probably still suffer in silence — latent trigger points in the upper third of the shin that don’t cause symptoms, but are plenty sensitive if you press on them. (Click/tap heading to read more.)
| for pain: in the shin, top of the foot, and the big toe | muscle(s): tibialis anterior |
4For thoracic outlet syndrome, throat pain and tightness, chest pain
Deep within the Anatomical Bermuda Triangle, a triangular region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again. The region and its muscles are complex and peculiar, and many lesser-trained massage therapists have low confidence working with them. (Click/tap heading to read more.)
| for pain: in the upper back (especially inner edge of the shoulder blade), neck, side of the face, upper chest, shoulder, arm, hand | muscle(s): scalenes (anterior, middle, posterior) |
5For carpal tunnel syndrome, tennis elbow
Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the more inevitable trigger points in the body: Perfect Spot No. 5. It is constantly provoked both by computer usage today, and more often by the use of a pen in simpler times — and by the occasional tennis match, then and now, or maybe crocheting. (Click/tap heading to read more.)
| for pain: in the elbow, arm, wrist, and hand | muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris |
6For gluteal and hip pain, sciatica, bursitis, low back pain
When you have back pain, buttock pain, hip pain, or leg pain, much or even all of your trouble may well be caused by trigger points in the obscure gluteus medius and minimus muscles, a pair of pizza-slice shaped muscles a little forward of your hip pocket. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is particularly significant, and yet people who have buttock and leg pain rarely suspect that much of it is coming from muscle knots so high and far out on the side of the hip. (Click/tap heading to read more.)
| for pain: in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings | muscle(s): gluteus medius and minimus |
7For jaw pain, bruxism, headache
Your masseter muscle is your primary chewing muscle — not the only one, but the main one — and it covers the sides of the jaw just behind the cheeks. It’s also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and it’s one of the most common locations for trigger points in the human body. It is probably an accomplice in most cases of bruxism (that’s Latin for “grinding your teeth”) and temporomandibular joint syndrome (jaw joint pain), plus other unexplained painful problems in the area. (Click/tap heading to read more.)
| for pain: in the side of the face, jaw, teeth (rarely) | muscle(s): masseter |
8For runner’s knee
A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of “knotted” muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle — one of your biggest — that dominates the lateral part of the leg. Stretching it is effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. It also often complicates or contributes to other problems in the area, especially runner’s knee (iliotibial band syndrome). (Click/tap heading to read more.)
| for pain: in the lower half of the thigh, knee | muscle(s): quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris) |
9For chest pain & tightness
The “pecs” are popular: of 700+ muscles, the pectoralis major is one of just a dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. (Click/tap heading to read more.)
| for pain: anywhere in the chest, upper arm | muscle(s): pectoralis major |
10For plantar fasciitis
The tenth of the Perfect Spots is one of the most popular of the lot, and right under your feet — literally. It lies in the center of the arch muscles of the foot. This is one of the Perfect Spots that everyone knows about. No massage is complete without a foot massage! (Click/tap heading to read more.)
| for pain: in the bottom of the foot | muscle(s): arch muscles |
11For upper back pain
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. (Click/tap heading to read more.)
| for pain: anywhere in the upper back, mainly between the shoulder blades | muscle(s): erector spinae muscle group |
12For low back and gluteal pain, sciatica
At the top of the buttocks lies a Perfect Spot for massage: a sneaky but trouble-making brute of a trigger point that commonly forms in the roots of the gluteus maximus muscle. It’s below the lowest part of the low back, but it often feels like low back pain. This is the kind of spot that the Perfect Spots series is all about: not only does it tend to produce a profound, sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. It feels like a key to much more than expected. (Click/tap heading to read more.)
| for pain: in the lower back, buttocks, hip, hamstrings | muscle(s): gluteus maximus |
13For low back pain, sciatica
Some of the Perfect Spots are perfect because they are “surprising” — it’s delightful to find a place to massage that feels highly relevant your pain in an unexpected location. Others are perfect because they are exactly where you expect them to be — and what a relief it is to be able to treat them. Perfect Spot No. 13 is perhaps the ultimate, the quintessential example of a trigger point that is usually “right where I thought the problem was”: in the “pit” of the low back, at the bottom of the thick columns of back muscle beside the spine. (Click/tap heading to read more.)
| for pain: in the low back, buttocks, hamstrings | muscle(s): erector spinae muscle group at L5 |
14For shoulder pain
I avoided adding Spot 14 to this series for many years, because it’s a bit tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere under the ridge of bone on the shoulder blade is worthwhile, and often a surprising key to pain and stiffness everywhere else in the shoulder, especially all the way around on the other side, facing forward. (Click/tap heading to read more.)
| for pain: any part of the shoulder, and upper arm | muscle(s): infraspinatus, teres minor |