What To Know and Do About Upper Back Pain

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Medically reviewed by Soma Mandal, MD

Upper back pain—or, discomfort that can occur anywhere from the base of your neck to the bottom of your rib cage—can disrupt everything from your ability to perform daily activities to getting a good night’s sleep.

Your upper back (thoracic spine) contains 12 vertebrae (spinal bones) and intervertebral discs that separate and cushion the vertebrae, nerves, and connective tissues like ligaments and tendons. As an attachment point for many muscles, your upper back supports your body’s mobility and flexibility and protects the spinal cord and internal organs like your heart and lungs.

Injuries from accidents, repetitive motions, and poor posture can damage structures in your upper back and lead to pain. But sometimes, upper back pain is a sign of an underlying condition. Understanding and treating the cause of upper back pain is the best way to maintain mobility, prevent complications, and get pain relief to improve your quality of life.

Symptoms of Upper Back Pain

Upper back pain can affect your body anywhere between your shoulders, from the base of your neck to the bottom of your rib cage. It can be acute (short-term), lasting for days or weeks, or chronic (long-term), persisting for three months or longer.

You may have mild pain that comes and goes or persistent and debilitating pain that interferes with your ability to work, sleep, and engage in the activities you enjoy. Upper back pain can feel different for everyone depending on what’s causing the pain and what structures in your body are affected. Upper back pain may cause:

• Dull, aching pain 
• Tightness 
• Stiffness
• Soreness 
• Sharp or stabbing pain 
• Radiating pain that travels to the arms
• Numbness, tingling, or weakness 

Upper back pain can limit your range of motion, making it difficult to reach above or behind you, comfortably turn your head, or perform everyday tasks. Some people also have difficulty taking deep breaths with upper back pain because the thoracic spine is an attachment point for muscles connecting the ribs.

Potential Causes of Upper Back Pain

There are many causes of upper back pain, including traumatic injuries, overuse injuries, structural or mechanical problems, and underlying inflammatory conditions.

Back Sprain or Strain

Back sprains and strains are among the most common causes of upper back pain. The pain of a sprain or strain may feel like achiness, soreness, or tenderness and may often worsen with movement.

Repetitive motions, lifting objects incorrectly, and sudden awkward movements like twisting or pulling a muscle or tendon in the upper back can strain these tissues. A strain can develop suddenly or over time and cause pain, swelling, muscle spasms, and difficulty moving the muscles in the affected area.

A strain also affects ligaments, which are strong bands of connective tissue that connect bones at a joint. Twisting, falling, or using improper lifting techniques can tear or damage a ligament in the upper back, leading to symptoms like pain, swelling, bruising, and inflammation. However, strains are less common in the upper back than in other areas of the back and body.

Poor Posture

Posture is how you hold your body when in motion, sitting, and standing. Good posture—with your head above your shoulders and the tops of your shoulders over your hips—keeps your spine properly aligned, preventing muscle strain and overuse injuries.

But over time, poor posture from hunching over your computer or phone, slouching on the couch, or carrying a heavy bag on one shoulder can lead to postural imbalances and wear away at your spine and intervertebral discs. This can lead to tight, stiff, aching muscles in your upper back and neck, increasing your risk of injury.

Intervertebral Disc Problems 

The intervertebral discs act as cushions between the vertebrae (bones) in the spine. Problems with these discs can lead to upper back pain. Common problems include:

• Herniated disc: Sitting or standing in the same position for an extended period or improper lifting techniques can cause an intervertebral disc to entirely or partially slip out of place. If the disc puts pressure on the spinal cord or a nearby nerve, this can lead to sharp, shooting pain when moving your neck, deep pain near or around your shoulder blade, and numbness and tingling that radiates to your arm and hands. 
• Degenerative disc disease: An age-related condition that causes intervertebral discs to break down and wear away over time. Without cushioning, spinal bones rub together, leading to pain and stiffness that may worsen after specific movements like bending, twisting, or sitting.

Compression Fractures

A compression fracture occurs when a vertebra in the spine weakens and collapses. Compression fractures are common in people with osteoporosis (a condition that causes weak bones) and can lead to sudden, severe upper back pain that worsens when standing or walking. The condition usually improves when lying on your back.

People with a compression fracture may have limited mobility and eventually lose height or develop spinal deformities, such as a “hunchback” posture.

Spinal Osteoarthritis (Spondylosis)

Osteoarthritis is an age-related form of arthritis that develops when the cartilage that acts as a shock absorber or cushion at the ends of bones wears down. Spinal osteoarthritis (spondylosis) affects the facet joints —the small joints behind and between vertebrae.

When osteoarthritis affects the upper back, you may develop a deep, aching pain that radiates into your shoulder and down your arms. Many people experience pain and stiffness in the morning that improves with movement but worsens throughout the day with activity.

Over time, the lack of cartilage can cause the bones to rub together, leading to bony growths (spurs) in the facet joints. These bone spurs can press on nerves or the spinal cord, causing more intense pain or numbness in the shoulders and arms.

Spinal Deformities

Spinal deformities are abnormal curvatures of the spine that can cause upper back pain. Two common types that affect the upper back include:

• Kyphosis: This abnormal curving of the upper spine causes excessive rounding of the upper back, giving a hunched or “hunchback” appearance. People with kyphosis may experience upper back achiness, tenderness, stiffness, and fatigue quickly during physical activity.
• Scoliosis: This abnormal C or S-shaped curving of the thoracic spine can cause upper back pain, shoulder pain, or pain that radiates down to the legs.

Less Common Causes

Although less common, the following conditions can also cause upper back pain:

• Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum (breastbone) can cause sharp chest pain that sometimes radiates to the upper back.
• Spinal stenosis: A condition in which your spine narrows, which can put pressure on the spinal cord and nerves, leading to pain in the back and neck and numbness that extends to the arms and legs.
• Thoracic outlet syndrome: Compression of the nerves and/or blood vessels in the thoracic outlet (the space between the collarbone and first rib) can lead to aching pain in the neck or shoulder and numbness or tingling that extends to your arms and hands.
• Spinal tumor: A benign (noncancerous) or malignant (cancerous) tumor in the spine can cause upper back pain that often worsens during physical activity or when lying down.

When to Contact a Healthcare Provider

Upper back pain often resolves with rest and self-care measures like stretching and ice or heat therapy. However, t’s important to see a healthcare provider when the pain:

• Lasts two weeks or longer
• Is severe enough to interfere with your daily activities 
• Disrupts your sleep or worsens at night
• Develops after a fall, accident, or injury 

Upper back pain that occurs with the following symptoms also warrants quick medical attention:

• Numbness, tingling, or weakness in the arms, legs, hands, or feet 
• Trouble urinating
• Dizziness
• Difficulty breathing 
• Severe headaches
• Loss of bladder or bowel control 
• A fever of 100 degrees or higher
• Unintentional weight loss 

Diagnosis

Healthcare providers use a combination of a medical history review, physical examination, and diagnostic tests to determine the underlying cause of your upper back pain.

When you visit your healthcare provider, they will ask you to describe your pain, including when it started, what activities improve or worsen it, and whether you experienced any recent accidents or injuries. They will also assess your posture and spine to look for abnormalities. They may ask you to move your body in specific ways, such as bending or lifting your legs, to test your range of motion. They will also test your reflexes, muscle strength, and sensation in your back and limbs.

Depending on the findings from your physical examination, your healthcare provider may order additional diagnostic tests, such as:

• Blood tests: These check for markers of inflammatory conditions or medical disorders that can cause upper back pain.
• Imaging tests: X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans take photos of your spinal bones, muscles, discs, and nerves to help healthcare providers identify tumors, fractures, inflammation, or spurs.
• Electromyography (EMG): An EMG measures the electrical activity of muscles to check for problems with your nerves and muscles.
• Bone scan: This imaging test uses a small amount of radioactive material and a camera to scan your body to detect problems affecting the spine, such as infections, fractures, and bone tumors.

Treatment Options

There are many treatment options for upper back pain—but your exact treatment plan will depend on the underlying cause of your symptoms and the severity of your pain. In most cases, home remedies and medical treatment are enough. However, surgery may be required.

Home Remedies

In many cases, at-home treatments and self-care measures are enough to relieve upper back pain until it resolves. This may include:

• Get rest: Limit or avoid activities that aggravate your pain. Avoid complete bed rest, which can worsen your pain, and gradually increase your activity level as you heal. 
• Buy over-the-counter (OTC) pain relievers: Medications like Advil (ibuprofen) or Tylenol (acetaminophen) can help manage pain and inflammation. Applying topical pain relievers, such as Bengay (methyl salicylate) or Aspercreme Warming (capsaicin), to the skin over the affected area may provide short-term pain relief.
• Use ice and heat therapy: Applying ice packs to the affected area can help reduce inflammation. Heat therapy via a heating pad or hot pack increases blood flow and promotes healing in your back muscles and other soft tissues. Healthcare providers recommend alternating both treatments.
• Practice stretching and strengthening exercises: Gentle stretches and exercises for the upper back and shoulders can improve flexibility and strengthen the muscles in your upper back.
• Focus on posture: Maintain good posture while sitting, standing, lifting heavy objects, and sleeping. Use pillows to find a comfortable sleep position and ergonomic cushions for your chair and workstation if you work at a desk.

Medical Treatments

Severe or chronic upper back pain may require medical treatments to reduce pain and inflammation. Depending on the cause of your pain, your healthcare provider may recommend the following options:

• Take prescription medication: Prescription-strength pain relievers, muscle relaxants, anticonvulsants (which help relieve nerve-related back pain), and antidepressants (to change how your brain perceives pain) are common prescription medications for easing upper back pain.
• Consider spinal injections: Epidural spinal injections deliver a powerful anti-inflammatory medicine directly into the affected area of your back to provide pain relief. 
• See a physical therapist: A physical therapist (PT) can design a personalized exercise program to strengthen your back muscles and improve flexibility and range of motion. Physical therapy also involves learning proper posture and movement techniques to manage upper back pain and prevent injury.
• Do manual therapy: Therapeutic techniques such as massage therapy, articulatory spinal manual therapy, or articulatory costal manual therapy may improve flexibility and mobility and reduce pain.

Surgery

Surgery is usually a last resort for treating upper back pain when self-care measures and medical treatments are ineffective. If you require surgery, your procedure may help treat:

• Herniated or ruptured intervertebral discs 
• Spinal stenosis (narrowing of space in your spinal column)
• Vertebral fractures (broken bones) 
• Degenerative disc disease 

A Quick Review

Upper back pain has many possible causes, like muscle strains from acute or overuse injuries, poor posture, and underlying spinal conditions. While many cases of upper back pain resolve with self-care measures and at-home treatments, medical treatments like medications, physical therapy, and spinal injections can help treat more severe cases.

What’s most important is to get treatment right away, as this can help reduce the risk of complications like nerve damage and chronic pain.

Read the original article on Health.com.