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published 3/20/05, updated 5/02/06

Massage Therapy for Upper Back Pain

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

by Paul Ingraham, Vancouver, Canada MORE

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


Trigger points (muscle knots) are the world’s most common cause of aches and pains. The Perfect Spots series of articles teaches you how to self massage the most satisfying and therapeutically significant places on the human body to apply pressure. Each Perfect Spot article focuses on a specific location. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!

This “spot” is too large to really be called a “spot.” Although nearly any location in the erector spinae muscle group is a satisfying place for massage, there is one section of the group that particularly appreciates treatment: the upper back, right between the shoulder blades. As a massage therapist, I work there every day, while other parts of the back remain relatively untouched. There is no doubt that this part of a back massage feels even better than the rest, and 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 condition is 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 numerous, like a string full of knots, and they can be loud complainers. Unlike many of the other Perfect Spots, which are unfamiliar, people are often 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 obviously painful trigger points in this area will usually find that massage here feels especially good.

There is no definite, satisfying explanation for why these muscles accumulate so many nasty active and latent trigger points. Along with the shoulders, lower back, and hips, they just seem to be a favourite spot for stress and anxiety to express itself.

Evolution doesn’t care if we’re comfortable, as long as we survive.

The cause may also be structural. Most people think that the spine is a marvel of biological engineering, and so it is — but it is engineered by natural selection for quadrupeds, not bipeds. We have the same basic spinal anatomy as every other vertebrate on Earth, but we are the only ones using it in an upright position on a daily basis. Bipedality has advantages that are so valuable that we’ve evolved that way even though it may be painful. Evolution doesn’t care if we’re comfortable, as long as we survive.

And, of course, stress and evolution aside, the upper back and shoulders both often suffer from common activities such as sitting, slouching and computer work!

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.

The erector spinae are often quite ropy, and sometimes feel surprisingly like guitar strings.

Another way of treating several trigger points at once is called “strumming” or “frictions.” 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.

While many trigger point releases have a satisfying quality, these muscles are the gold standard by which all others are judged.

These muscles also often produce extravagant referred sensations. A wide variety are possible. 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 sometimes 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 best 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.


Further Reading

All The Perfect Spots for Trigger Point Massage

Choose your
perfect spot!

Or, for general information and advanced tips about trigger point therapy, see Save Yourself from Trigger Points!

and …


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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 relieve some pain cheaply and safely in many cases. The existence of trigger points is not controversial. You can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well.

The Perfect Spots are based on a decade of my own clinical experience, and on the research and writing of Drs. Janet Travell and David Simons, pioneers of myofascial pain syndrome research. They produced “the Big Red Books” (a massive pair of texts).

Trigger points are clinically significant, but unfortunately obscure. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.”