What Could Be the Cause of Upper Back Pain?

By Chris Bodle, MD
Medically reviewed checkmarkMedically reviewed
April 23, 2020

Not all back pain is created equal, so it’s important to understand and identify the exact problem area in order to begin working towards relief. The upper back comprises the area of the spine beginning at the base of the neck, extending to the bottom of the ribcage.

Compared to other areas of the back (such as the neck or lower back), the upper back is less prone to injury. And while you’re less likely to injure or feel irritation in your upper back, getting familiar with potential causes and treatments for this area of the back can help in the long run.

Understanding You Back

If you’re experiencing back pain, it may seem to radiate into different areas. There are five different sections of the spine:

  • Cervical spine: The skull is supported by seven cervical vertebrae (C1-C7).
  • Thoracic spine: Structured to support the rib cage and shield the heart and lungs, 12 vertebrae make up the thoracic spine (T1-T-12).
  • Lumbar spine: The five lumbar vertebrae are also the largest, used to support the other areas of the spine and carry most of the weight (L1-L5).
  • Sacrum: This triangle-shaped bone consists of five vertebrae that are fused together (S1-S5).
  • Coccyx: The four fused coccyx vertebrae attach the muscles and ligaments of the pelvic floor.

If you’ve narrowed it down to upper back pain (which would be the thoracic spine), you’re on your way to better understanding how to treat your pain. It is important to focus on the exact location of discomfort. In doing so, you’ll be more likely to understand the area and cause—making it easier to seek treatment.

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Common Causes of Upper Back Pain

Studies show nearly one in 10 men and one in five women experience upper back pain. While it’s impossible to defend against every type of upper back stressor, learning about the most common triggers can help you protect your back. Pain in the upper back can be related to lifestyle or caused by injuries, and causes may include:

  • Posture: Poor posture is a common cause of upper back pain. This includes standing with your pelvis tucked under, your pelvis sticking out, or always leaning on one leg. The way you stand can cause extra stress on your back.
  • Muscular weakness: Do you sit often or work at a desk? Many individuals work at least 40 hours per week, likely sitting, without access to ergonomic office equipment. Hunching your shoulders can deteriorate your muscles and ultimately aggravate the upper back over time.
  • Muscular overuse or repetitive strain: Overuse is a common cause of upper back pain. Repeating the same movement can leave upper back muscles feeling tight or uncomfortable. If your everyday tasks, work or otherwise, include repetitive motion, you may be at risk for upper back pain. For example, lifting boxes overhead, using one specific arm to lift or toss objects, etc. can all cause upper back muscle pain.
  • Injury: An acute trauma or accident can lead to pain in the upper back. Always consult a medical professional when feeling pain after an accident to provide a plan to recover without long-term disability or pain, as well as provide continuing care through any specialists. Injuries resulting in upper back issues include car accidents, falling, overly-strenuous workouts, or direct trauma to the area.
  • Disc complications: Some upper back pain could result from disc or nerve damage. Discs provide cushion between vertebrae. When a disc slips out of place (herniation), this can cause painful pressure. If a disc is displaced far enough, it can compress nerves, resulting in weakness, numbness or pain in the back, arms and/or legs.

Can stress cause upper back pain?

In short, yes—emotional stress can cause upper back pain. In times of stress, the body responds with ‘fight or flight’ behavior; the nervous system kicks into overdrive in order to protect vital organs. Feeling stress in the body can result in reduced blood flow to soft tissues (like muscles, ligaments, and nerves in the back), meaning less oxygen can pass through the area. As a result, those under stress are likely to experience muscle spasms, tension and, pain in the back.

Why does my upper back hurt between my shoulder blades?

Pain between the shoulder blades or in the right shoulder could be a symptom of many other medical ailments including gallstones, lung disease, heart disease, or blood vessel disease. Chat with a doctor if the discomfort becomes severe.

Is upper back pain a sign of cancer?

On rare occasions, upper back pain could be a sign of cancer. That said, there are many causes of back discomfort that are not at all related to cancer. Speak to your health care professional if you’re experiencing severe symptoms or pain.

Associated Symptoms

When feeling upper back pain, other correlated indications can include:

  • Neck pain
  • Tightness in the chest
  • Stiffness across the back
  • Upper back pain when breathing deeply
  • Indigestion
  • Aching, burning, or sharp sensation between shoulder blades

Those who experience upper back pain may be diagnosed with:

  • Herniated disc: A herniated disc occurs when the outer portion of the vertebral disc is damaged, allowing the inner portion to poke through, often causing radiating pain in the back, arms or legs.
  • Spinal degeneration or fracture: A damage or break to a vertebrae in the spinal column.
  • Osteoporosis: A condition that causes bones to deteriorate, becoming weak and brittle.
  • Muscle or ligament strain: An injury to the muscle or tendon.
  • Fibromyalgia: A disorder causing musculoskeletal pain, often seen with fatigue, sleep, memory, and mood issues.
  • Gallstones: An accumulation of hardened deposits of digestive fluid which have formed in your gallbladder—sometimes presents as pain between the shoulder blades.

Upper Back Pain Treatment

There are many ways to alleviate upper back discomfort yourself.

  • Activity moderation: If you’ve noticed upper back pain gets worse with certain activities or movements, take a break from those movements. Resting or inactivity for too long can cause muscles to weaken over time, so monitor pain and resume your normal and necessary activities when possible.
  • Apply heat or ice: Using heat or ice packs can provide relief from upper back pain. Explore the warm or cool temperature works for your body and ensure each application lasts no more than 20 minutes before taking a break.
  • Stretching: Gentle movement and making space in the body can ease muscular strain and tension. Upper back pain could be caused by issues in the chest or shoulders as well, so opening up these areas can offer upper back pain relief. Stretches for upper back pain include simple backbends, cat-cow pose, and a corner stretch to soften tight chest muscles.
  • Massage: Massage therapy is a non-invasive and gentle way to encourage healing of upper back discomfort. Massaging the upper back increases circulation, aiding in the recovery of damaged tissue.
  • Medication: Over-the-counter (OTC) medication can also be used to treat upper back pain. Certain medications can ease inflammation in sore areas or intercept pain signals before they reach the brain. While an OTC medication does not require a doctor’s prescription, always read the instructions and contraindications thoroughly. Some medication for upper back pain does require a prescription and should only be taken under the supervision of a doctor, such as some anti-inflammatories, narcotics, and antidepressants.
  • Injections: For radiating or severe upper back pain, a doctor may suggest a cortisone injection—where a numbing or anti-inflammatory medication is injected into the space around the spinal cord.
  • Surgery: For most upper back pain, surgery is not recommended. However, if the pain is radiating, worsening or weakening muscles due to nerve compression, a doctor may explore this option.

Preventing Upper Back Pain

Lifestyle changes are the quickest way to address and prevent upper back pain. Consider adding more activity and exercise into your routine. Individuals with a sedentary day-to-day routine generally see more instances of upper back pain. Strength training and conditioning help solidify core muscles, essential for good posture. Activities such as yoga can be helpful for upper back pain.

Be mindful of your posture—ensure your working and home conditions are optimal. Small changes like wearing a backpack instead of carrying a purse on one shoulder, or lifting objects with the strength of the lower body, can make all the difference when it comes to prevention.

If you’re a smoker and experiencing upper back pain, now is the time to stop—smoking is shown to deteriorate disc health.

When to See a Doctor for Upper Back Pain

While most upper back pain goes away within a few weeks, with or without at-home treatment, this type of pain could require medical attention. So when should you worry about upper back pain, and how do you know if upper back pain is serious? Some serious symptoms, as outlined below, warrant a visit to the doctor.

Contact your doctor for an appointment if discomfort still persists after a week of at-home treatment or if:

  • Discomfort has become severe, especially when lying down
  • You notice weakness or numbness in one (or both) arms or legs
  • Pain radiates down one (or both) legs
  • You experience unintended weight loss
  • Your upper back is swollen, discolored, or red
  • You have shortness of breath

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How K Health Can Help

There are steps you can take to prevent and treat upper back pain.

Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a clinician in minutes. K Health’s AI-powered app is based on 20 years of clinical data.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chris Bodle, MD

Dr. Bodle is a board certified emergency medicine physician. He received his medical degree from Indiana University School of Medicine, and completed his residency in emergency medicine at Emory University. In addition to K Health, he currently works as an Emergency Medicine physician in an Urban, Level 1 Trauma Center in the south east.

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