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Causes of pain most commonly are the result of injuries in the intervertebral discs, zygapophyseal joint and rib articulations. These may have a gradual or sudden onset. Hands on treatment and graded exercise prescription may be required to restore normal function. However, severe strain or injury may occur with overload especially with high energy sports and can result in disabling pain in the region. 

If you experience pain with deep inspiration or with specific active movements, it could be a result of rib articulation dysfunction caused by inflammation, degenerative changes or mechanical sprain.  Treatment could include mobilization of this joint in order to decrease your pain and restore function. 

Scheuermann’s disease is developmental disorder of unknown cause but may be a cause of habitual flexion during training. It is a condition affecting the adolescent population and a common cause of pain in and around the middle back as a result of abnormal growth of the vertebrae in the thoracic region. The pain is usually worse with sports that require flexion, extension and twisting of the back.  The physiotherapist will use a variety of different modalities to reduce pain. Restoring full function will be under physiotherapy guidance in regaining extension of the spine, improving muscular control and strength and making necessary adaptations to training postures in order to return to sport. 

Intervertebral Joint injuries

These are the most commonly causes upper back injury and involve the discs, rib articulations and zygapophyseal joints. These may be result in decrease in the mobility or be present with muscle guarding in the area as well as localised tenderness.
These disorders are not normally disabling and normal pain free movement can be restored with passive techniques and specific exercises. 

Muscle strain

Muscle strains in the upper back can be a result of acute sudden pain with activity. A strain can be caused by overstretch, overuse or improper use of a muscle.
Treatment includes soft tissue techniques and exercise in order to restore function and reduce pain. 

Rib articulation disorders

These conditions can be a cause of discomfort in the upper back and may be a result of inflammatory conditions, degenerative changes or joint sprains.
Discomfort is evident during active movements especially in rotations, deep inspiration and localised pain on pressure.
Treatment may include a combination of physiotherapeutic modalities such us joint mobilizations, soft tissue techniques and daily adaptations. 

Postural imbalance of neck and shoulder and upper thoracic spine 

Postural imbalance is one of the most common cause of upper back and shoulder pain in the general population due to the increase of sedentary lifestyle. Changes in the muscle length and structure are gradually developing due to prolonged sustained positions. These changes may give initial discomfort but can also progress into disabling pain for some individuals.
An experienced physiotherapist can identify the cause of pain and rule out any other pathologies. Treatment can include soft tissue techniques in combination with specific exercise programs as well as daily adaptations.  

T4 syndrome 

It is a condition that can cause localised pain or stiffness in the mid-upper back. It can also result in sensory disturbances such as pins and needles or numbness in the arms and headaches.
The treatment of this condition involves postural changes, soft tissue techniques, joint mobilization and specific exercises.