Achieving Clinical Success With Upper Back Pain

By Justin Mandel - April 30, 2018
Achieving Clinical Success With Upper Back Pain

By Justin Mandel, DOM, AP, LAc

Chronic upper back pain affects millions of people across the United States every year. Upper back pain does not discriminate and affects people of all ages from highly diverse backgrounds and professions alike. Because upper back pain is so extremely prevalent, the chances are incredibly high that it will be commonly seen in a general practice, sports medicine practice, or orthopedic specialization.

A fascinating online social media poll of acupuncturists conducted in 2017 revealed the staggering number of upper back pain patients commonly seen by acupuncturists:

  • 37% of acupuncturists see upper back pain in 75% to 100% of their patients
  • 10% of acupuncturists see upper back pain in 50% to 75% of their patients
  • 42% of acupuncturists see upper back pain in 25% to 50% of their patients
  • Up to 11% saw upper back pain in 0% to 25% of their patients.

Typically, upper back pain is treated locally by acupuncturists with non-specific treatments like acupuncture and dry needling, which can be applied to any body part. But all too often for patients suffering in pain, these treatments only offer temporary relief. Worse yet, patients often get locked in a negative cycle of reoccurring pain with root causes that are rarely properly treated.

In such cases, Western medical doctors have resorted to prescribing dangerous opioids to help control the severe pain. This highly addictive prescription medication merely masks the pain and can ultimately destroy families. With this surging epidemic, we need natural solutions now more than ever that deliver real results.

Patients who suffer from upper back pain often have complicated, difficult-to-treat medical conditions such as musculoskeletal pain, bulging or herniated cervical spine discs, radiculopathy that causes numbness, tingling and weakness that radiates down the arms into the finger tips, or even limited range of motion from rotator cuff surgery. Multiple medical conditions such as these will often occur simultaneously, which unfortunately complicates treatment.


When we look at the causes of upper back pain we find that, most of the time, the nagging constant chronic pain that’s so difficult to get rid of is due to fibrous bundles of muscles (F-BOMs) that have accumulated in the upper trapezius muscle. This twisting of one’s once-healthy individual muscle fibers often proves frustrating to treat permanently. The endless cycle of temporary relief following treatment followed by terrible, frequently debilitating pain, needs to be broken once and for all.

These incredibly painful F-BOMs can occur due to a variety of reasons such as a lifetime of poor posture, accidents like trips and falls, poor ergonomics at work, repetitive stress injury from performing the same actions repeatedly, and from craning one’s neck for long periods of time while using a smartphone.

Without treatment, upper back pain can get worse over time and become more difficult to treat. Heading off upper back pain at the pass is important because it can quickly go from tolerable to debilitating. As it progressively gets worse, treatment times can increase and conventional treatment effectiveness rates can decrease, which is another reason why upper back pain needs to be treated after it sets in.


Achieving clinical success for upper back pain starts with a proper physical examination. The 4 general parameters of the upper trapezius muscles that need to be thoroughly assessed are:

  1. Superior/Inferior
  2. Medial/Lateral
  3. Anterior/Posterior
  4. Spasm/Flaccidity

Without first properly assessing the degree of our patient’s upper back pain, we will fail as practitioners to properly communicate its impact on our patients. Without properly communicating its impact, the likelihood that we will convert our prospective patients into paying patients will deteriorate. Over time, a low prospective patient to paying patient conversion rate will sink our practice into the financial doldrums.

Worse yet, without proper examination we’ll ultimately fail to properly treat it. Without properly treating it, we will lose out on short-term and long-term patient referrals along with honest testimonials, which can aid practice success. This vicious cycle that will negatively impact both practitioners and patients alike can be stopped dead in its tracks by simply understanding how to do a thorough upper back pain examination.

Beyond that, we can buoy our success by offering our patients an upper back pain “report of findings” and “care plan” that details exactly what their issue is. This highly professional touch will put you in the league of truly successful doctors who deliver to their patients all of the reasons why they are the right practitioner to treat a particular condition.

The added benefit of a care plan will place your patients on an easily understood plan for the future–how many treatments they will need and what the exact course of action will be to remedy their upper back pain. Providing this road map will put your patients at ease, since they will know exactly what they to do. Without such a care plan, a seed of doubt can grow in prospective patients’ minds, especially if their treating practitioner is not specific about what their plan of attack needs to be.

All three together–report of findings, care plan, and upper back pain examination–will leave them with the feeling that they are in the best, most capable hands possible.


Without directly acting upon these renegade F-BOMs that have formed over time, pain will eventually return with a vengeance even after the very best acupuncture treatments possible from needling GB21, SJ15, SI13, etc. The problem with using a 38-gauge acupuncture needle, for example, is that even if we needle directly into small diameter F-BOMs, the needle is way too small to break up and separate the gangly individual muscle fibers into healthy sections of muscle.

With the right examination, our patients will finally feel like they are in competent hands since we can accurately zero in on the precise areas of their upper back pain. Once we identify the locations of F-BOMs along with their size, including length and thickness, we can go about systematically breaking them up over time in a highly organized fashion. Then, treatment by treatment, we can objectively observe our results and see how closely they match up with our patient’s subjective reports of their progress. It’s extremely common for the objective and subjective results to sync up perfectly, thus making one’s professional assessment of what’s happening with their patient’s case highly accurate.


In 2018, busy acupuncture professionals are saddled with complicated existences. In addition to needing to be highly proactive in publicizing and marketing one’s services, practitioners need to provide excellent care and deliver results that’ll make patients keep on returning. This makes running a successful practice very tricky, but without the right systems in place practitioners won’t be able to consistently deliver easily repeatable results and generate the necessary level of success.

A successful system to treat upper back pain will ease a practitioner’s burden by streamlining the entire process from start to finish. This means: (1) helping practitioners find the local upper back pain patients who need their help, (2) providing the most comprehensive upper back examination possible, (3) supplying prospective patients with a report of findings and care plan that will position the practitioner as the perceived expert on upper back pain, (4) furnishing readable, direct response-based marketing materials for prospective patients following their examination, and finally (5) offering a proven 4-step formula for resolving upper back pain by systematically diminishing and/or eliminating the F-BOMs that cause the debilitating upper back pain in the first place.

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Justin Mandel

Dr. Justin Mandel, DOM, AP, LAc, started his first acupuncture internship in 1997 with Dr. Jun Tu, OMD in his college hometown of Oneonta, NY. He’s the visionary and developer behind the patent-pending TrapEAZE Technique™. The TrapEAZE Technique™ has been positioned to be the “gold standard” for how post graduate courses will be offered in 2018 and beyond thanks in part to it’s proprietary done-for-you online and offline marketing system that makes it much easier to get hyper targeted upper back pain patients into ones practice.

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