Upper Back Pain: Causes and Relief

Why the upper back hurts less often than the lower back

The thoracic spine is held stiff by the rib cage, so it moves less than the neck and lower back and is less prone to disc problems. Most upper back pain comes from the muscles and the small joints where the ribs attach to the spine. But because the heart, aorta, lungs, esophagus and gallbladder sit close by, pain here sometimes comes from inside the chest or abdomen.

Common causes of upper back pain

Muscle strain and posture

Hours of sitting at a computer, looking down at a phone, carrying a heavy bag on one shoulder or driving can overload the trapezius and rhomboid muscles. Pain is aching, tight and often between the shoulder blades, worse at the end of the day, and eased by stretching and movement. Sudden lifting, twisting or a hard cough can strain a muscle. See muscle strain.

Myofascial pain

Tight, tender knots (trigger points) in the muscles can cause a deep ache that spreads to the shoulder, neck or arm. See myofascial pain syndrome.

Joint dysfunction

The facet joints of the spine and the joints between the ribs and vertebrae can become irritated, causing sharp, localized pain that catches with twisting or deep breaths.

Referred neck pain

Problems in the lower neck, such as arthritis or a pinched nerve, often cause pain over the shoulder blade. See neck pain.

Less common spinal causes

• Compression fracture: sudden pain from a collapsed vertebra, often in older adults with osteoporosis after a minor fall, a cough or lifting. Height loss and a rounded back may follow.
• Thoracic disc herniation: rare; can cause band-like pain around the chest and, rarely, pressure on the spinal cord.
• Kyphosis and Scheuermann's disease: an exaggerated forward curve, often in teenagers, causing aching and stiffness.
• Scoliosis: a sideways curve that can cause muscle fatigue and aching.
• Ankylosing spondylitis: inflammatory stiffness that improves with exercise and is worse in the morning, usually starting before 45.
• Spinal infection or cancer: constant pain, night pain, fever or weight loss.

Organ-related causes of upper back pain

Upper back pain when breathing

Pain that sharpens with deep breaths usually comes from a strained muscle between the ribs, an irritated rib joint or a rib fracture. It can also come from pleurisy, pneumonia or a blood clot in the lung, especially if you are short of breath, coughing or have a fever. See pain when breathing.

How doctors find the cause

A doctor will ask how the pain started, what it feels like, whether it is affected by movement or breathing, and about red flags such as fever, weight loss, cancer history, osteoporosis or heart risk factors. They will examine your spine, posture, muscles and nerves and listen to your heart and lungs.

Most upper back pain needs no tests. When needed, these include an X-ray for fracture or deformity, MRI for nerve symptoms, infection or cancer concerns, an ECG for possible heart pain, a CT scan for aortic dissection, and blood tests for infection or inflammation.

Relief and treatment

At home

• Keep moving. Gentle activity speeds recovery more than bed rest.
• Heat for muscle tightness; cold packs for the first day or two after a strain.
• Pain relievers: ibuprofen or naproxen, or acetaminophen (paracetamol). Follow the label dose. Avoid NSAIDs with stomach ulcers, kidney disease or some heart conditions.
• Stretching: shoulder blade squeezes, chest-opening stretches in a doorway, and gentle thoracic rotations, several times a day.
• Change positions every 30 to 45 minutes when sitting.

Fix your setup

• Put your screen at eye level and keep elbows by your sides.
• Hold your phone up rather than looking down.
• Use a backpack with both straps rather than a shoulder bag.
• Choose a supportive pillow that keeps your neck in line with your spine.

Medical treatment

• Physical therapy: strengthening the upper back and shoulder blade muscles and improving posture.
• Manual therapy and massage for short-term relief.
• Trigger point injections for persistent myofascial pain.
• Treating the cause: osteoporosis treatment and bracing or vertebroplasty for painful fractures, antivirals for shingles, specific treatment for organ causes.

Frequently asked questions

What causes pain between the shoulder blades?

Most often it is muscle strain from posture, desk work, phone use or sleeping position. Neck problems can refer pain there too. Less commonly, the gallbladder, heart, aorta or lungs cause it, especially if pain comes with chest symptoms, breathlessness or digestive symptoms.

When should I worry about upper back pain?

Get emergency care for sudden severe tearing pain, pain with chest symptoms or breathlessness, leg weakness or numbness, or loss of bladder or bowel control. See a doctor soon for pain with fever, after a fall with osteoporosis, at night, or lasting more than 6 weeks.

Can upper back pain be a sign of a heart problem?

Yes, occasionally. Heart attacks can cause pain between the shoulder blades, particularly in women and people with diabetes, often with chest pressure, sweating, nausea or breathlessness. Call 911 or your local emergency number if back pain comes with these symptoms.

How long does upper back pain take to go away?

Most muscular upper back pain improves within a few days and settles within 2 to 6 weeks. Staying active, improving posture and doing gentle stretches help it resolve faster. Pain that persists longer than 6 weeks should be assessed.

What is the best sleeping position for upper back pain?

Sleeping on your back with a pillow that supports your neck, or on your side with a pillow between your knees and one hugged to your chest, keeps the spine aligned. Sleeping on your stomach twists the neck and upper back and often makes pain worse.