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Upper Back Pain (10 player)
Defeat Icehowl while at least 2 Snobolds remain alive in 10-player mode.
Upper Back Pain (10 player) requires you to defeat Icehowl in the Trial of the Crusader with at least 2 Snobolds still alive, which means keeping the Snobolds that Gormok throws at players during the first phase alive through the entire encounter.
Enter Trial of the Crusader
Enter the Trial of the Crusader raid on 10-player mode and begin the encounter. Gormok, Acidmaw and Dreadscale (the two jormungar), and Icehowl all count as the same boss fight, so you cannot skip any phase.
Wait for Snobolds from Gormok
During the Gormok phase, wait for him to throw at least 2 Snobolds onto players before killing him. Gormok is the only source of Snobolds — Icehowl does not summon them. You can delay killing Gormok until the desired number of Snobolds have been tossed.
Avoid AoE Through All Phases
Use only single-target attacks through the Gormok, jormungar, and Icehowl phases. AoE damage will kill the Snobolds and fail the achievement. When fighting Acidmaw, be aware that the poison debuff can be difficult to manage while a Snobold is slowing you.
Kill Icehowl with 2 Snobolds Alive
Continue single-targeting through the jormungar phase and into the Icehowl phase, then kill Icehowl while at least 2 Snobolds remain alive to complete the achievement.
Tips
This encounter is soloable at max level — avoid any AoE abilities entirely and use only single-target damage throughout all three phases.