It’s possible to get upper back pain or middle back pain, as well as in your lower back. This is called thoracic back pain. It’s rarer than lower back pain, but still very common. You may have pain between your shoulder blades or anywhere between your neck and your waist.
Are you experiencing upper back pain? While upper back pain is less common than neck and lower back pain, it’s still an uncomfortable and stressful experience. Back pain, regardless of the location, can be debilitating. In fact, back pain is one of the leading reasons of missing work and is the second most common reason for visiting the doctor. Let our trusted Las Vegas pain doctors explain to you the different types of upper back pain, its causes, and various treatment options.
The thoracic spine—also referred to as the upper back or middle back—is designed for stability to anchor the rib cage and protect vital internal organs within the chest.
Compared to the neck (cervical spine) and lower back (lumbar spine), the upper back is remarkably resistant to injury and pain. When upper back pain does occur, it is typically due to long-term poor posture or an injury that overpowers the thoracic spine’s sturdiness.
The upper back is the area between the base of the neck and the bottom of the ribcage. There are 12 bones that make up the upper back, which doctors call the thoracic spine.
Lower back pain is a common problem among people suffering from chronic pain, and while upper back pain is not a very common spinal disorder, it can cause significant discomfort and pain when it does occur. The most common causes of upper back pain are muscular irritation (myofascial pain) and joint dysfunction.
While there can sometimes be an injury to a disc in the upper back (such as a thoracic herniated disc or degenerated disc) that causes severe upper back pain, such injuries are usually very rare.
The first bone of the upper back begins at the base of the neck, and the 12th bone ends just below the ribcage. Upper back pain can appear anywhere between these bones.
Most people describe upper back pain as a burning or pulling sensation in one place, which may be the location of injury or strain.
What Is Upper Back Pain?
Upper back pain is any type of pain or discomfort throughout the area of the thoracic spine. The thoracic spine and upper back run from the cervical spine in the neck to the lumbar spine in the lower back. The upper back area includes the shoulder blades and back of the rib cage.
Most people will experience back pain at some point in their lives. However, pain in the upper back is not as common as lower back pain because the thoracic spine does not move as much as the spine in the lower back and neck.
Upper back pain may either be acute, lasting briefly, or it may be chronic, lasting longer than three months. Your pain may be dull and throbbing or sharp and stabbing. You may be in constant pain, or the pain may occur only during a particular activity, such as lifting grocery bags or after working at your desk for a prolonged period of time.
In addition to the thoracic spine and shoulder blades, there are numerous nerves, muscles, tendons, and ligaments in the upper back. Any of these structures can become irritated or inflamed in response to a variety of different factors and conditions. This includes poor posture, overuse, trauma, arthritis and, rarely, bone cancer. However, most upper back pain causes involve muscle irritation or joint problems and are usually not a cause for concern.
Upper back pain occurring with other symptoms, such as chest pain or difficulty breathing, may be a sign of a heart attack and should be immediately evaluated in an emergency setting. In addition, if your pain is extreme, persistent, or causes you concern, contact your doctor.
Symptoms Of Upper Back Pain
Symptoms can vary from person to person and depend on what’s causing the pain. The pain can be mild or more severe. You might have sharp pain in one particular spot or a general achiness that comes and goes. Back pain that doesn’t have a clear or known cause is called non-specific back pain.
If your back pain is significantly affecting your daily activities or stopping you from getting a good night’s sleep, see your physiotherapist or GP.
Acute Back Pain Symptoms
The most common acute back pain symptoms are –
Sharp pain
Discomfort in back
Stiff back
Radiating pain
Numbness or weakness or tingling
Chronic Back Pain Symptoms
Intense pain that affects the functional ability
Pain for a prolonged time
Numbness and tingling on back and legs
Fever, chest pain, weakness, sudden weight loss and problem to urinate
Most Common Causes of Upper Back Pain
The reason why upper back pain is so rare is because the thoracic spine (also called upper back, middle back, or mid-back) is very different in form and function than the cervical spine (neck) or the lumbar spine (lower back). The neck and lower back are designed to provide us with mobility, but the thoracic spine is designed to be very strong and stable to allow us to stand upright and to protect the vital internal organs in the chest.
Because this section of the spinal column has a great deal of stability and only limited movement, there is generally little risk of injury or degeneration over time in the upper back.
Because there is little motion and a great deal of stability throughout the upper back (thoracic spine), this section of the spine does not tend to develop common spinal disorders, such as a herniated disc, spinal stenosis, degenerative disc disease, or spinal instability. These conditions can cause upper back pain but are exceedingly rare in the upper back.
Because of this stability and lack of motion, in most cases, anatomic causes of upper back pain cannot be found, and an MRI scan or CT scan will rarely image an anatomic problem that is amenable to any sort of surgical solution for the upper back pain.
Upper back pain can occur as a result of trauma or sudden injury, or it can occur through strain or poor posture over time. As an example of the latter cause, in recent years, upper back pain has become a familiar complaint from people who work at computers most of the day. Often, upper back pain occurs along with neck pain and/or shoulder pain.
The vast majority of cases of upper back pain are due to one (or both) of the following: muscular irritation (myofascial pain) and joint dysfunction.
Poor Posture
Living a sedentary lifestyle or routinely sitting for long periods with poor posture can cause structural changes in the back and neck. The muscles can become deconditioned and weak, and thus not hold the spine in neutral alignment as easily as before. As the head and shoulders hunch forward, more pressure is placed on the spine’s bones, discs, muscles, ligaments, and other soft tissues. If a person leans to one side more often, such as while driving or working at a computer, that could also cause an imbalance in the upper back that leads to pain.
Slouching in a chair over a desk may cause a loss of strength in the muscles. Over time, the weakening of muscles may lead to pain in the area as they experience strains or irritation.
When a person slouches, pressure from gravity and the body itself pushes on the spine, neck, discs, and ligaments. Over time, this pressure can lead to pain and other complications.
It is possible to condition the muscles to be stronger and more durable in most cases. This process starts with correcting the posture while sitting, and taking regular breaks from the desk to move around and stretch.
Exercises may also improve strength in the back, and using a standing desk can help, too.
Conditioning the muscle requires patience, however, and anyone with chronic upper back pain from weak muscles might benefit from seeing a physical therapist to find an exercise routine for their specific needs.
Muscle Overuse
Overusing back muscles is another common cause of upper back pain. This typically occurs due to repeating the same motions over time. This can be a cause of:
- muscle strain
- tightness
- irritation
The classic example of how this occurs is a pitcher in baseball, who does a similar motion every time they pitch, which can often take a toll on their shoulder.
Other repetitive activities may cause similar pain. Someone who has to make the same motion all day, or lifts things above their head throughout the day, for example, may start to experience muscle irritation, tightness, or strain. This could turn into chronic pain if they ignore these signs.
Treatment for muscle overuse typically begins with resting the area, as well as using heat or ice packs to promote blood circulation to the muscle tissues. It may help to find ways to avoid the repeated motion where possible or to take breaks between activities.
A physical therapist may recommend exercises to promote flexibility and strength in the area.
Muscular Irritation
There are many large muscles at work in your upper back, and they are prone to strain and irritation. Muscular irritation usually occurs from poor posture, improper lifting, overuse, or muscle deconditioning.
Joint Dysfunction
The joints in your upper back can become painful and not function properly if you sustain an injury. Joint dysfunction may also occur from aging and degeneration.
Repetitive Stress Injury
The causes of long-term, or chronic, upper back pain due to overuse are more subtle and sometimes difficult to pinpoint. Chronic upper back pain often results from repeating an action many times throughout the day or week, every week. Repetitive stress injury is another way to term these causes.
Motions carried out with minimal strain can still cause irritation, inflammation, and pain when repeated hundreds of times. Pain may start at a mild level and build over time, or it may become severe without warning.
Rest and using hot or cold compresses are the first steps in treating a repetitive stress injury, but you need to find alternative ways to complete the task. If this is not possible, frequent breaks combined with stretches and exercises can alleviate pain and prevent further injury.
If the pain persists, physical therapy may help you find relief, regain flexibility, and build strength.
Injury
Did your upper back pain develop suddenly after an accident or lifting heavy objects? If so, an injury may be causing your back pain.
While the back may seem simple compared to some of the body’s other complex systems, it has dozens of muscles, bones, discs, and nerves that work together. Trauma to any of them can cause localized or radiating pain.
Don’t discount the possibility of injury if the pain did not start until hours or even a day later. Adrenaline, shock, and other factors can cause a delayed pain response. Spine and back injuries require treatment to heal well, so make sure you seek medical attention for any suspected injury.
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.
Improper Lifting Technique.
Lifting a heavy object without keeping the spine aligned can put undue stress on the upper back. In particular, lifting or holding a heavy object above the head, especially more toward the left or right as opposed to centered, can leave the shoulder and upper back susceptible to injury. Lifting an object that is too heavy can also cause upper back pain.
Pinched Nerve
A herniated disc can slip far enough out that it compresses the nearby nerve. A pinched nerve in the middle back may cause:
numbness and pain in the arms or legs
problems with controlling urination
weakness or loss of control in the legs
When a pinched nerve comes from a herniated disc, the treatment is similar to treating the herniated disc. A pinched nerve does not usually need surgery, though doctors may recommend spinal steroid injections in some cases.
Osteoarthritis
The source of back pain is sometimes not the muscles, but a problem in the bones and joints.
The cartilage that cushions and protects the bones may wear down as a person ages. The term for this is osteoarthritis. It is the most common form of arthritis among older adults, according to the United States National Institute on Aging.
Osteoarthritis may eventually lead to cartilage between the bones completely wearing away, causing the bones to rub together. This can also put pressure on the nerves in the spine, causing numbness or tingling in the arms and legs.
Anyone who suspects they have osteoarthritis should see a doctor for a diagnosis and treatment plan. Treatment typically focuses on managing pain and keeping the joints functioning.
Myofascial Pain
Pain may also stem from problems in the connective tissue in the back, which doctors call the fascia.
Myofascial pain may begin after an injury or overuse, but chronic myofascial pain may last long after the initial injury.
It is still uncertain why myofascial pain continues in some cases. Doctors may recommend physical therapy and myofascial release therapy to enable a person to work the fascia and relieve the pain.
Diagnosis Of Upper Back Pain
Your doctor will ask about your symptoms and examine you. They may then be able to diagnose and explain the cause of your back pain or they may need to refer you for some tests. Upper back pain is often caused by muscle strain, but sometimes there might be a more serious cause. There are particular symptoms your doctor will look for that may indicate this. They call these red flags and they include:
- a recent injury to your back such as a car accident or a fall
- back pain caused by a minor injury or lifting something heavy – particularly if you have osteoporosis
- if you’ve had cancer or you have a weakened immune system
- other symptoms such as a fever, unexplained weight loss and chills
- a recent bacterial infection
- if you’re younger than 20 or older than 50
Your doctor will also ask you about the pain to understand how severe it is and what could be causing it. It can also mean a red flag if:
- symptoms haven’t eased despite changing position or resting
- you’ve had pain for more than two weeks despite having treatment
- you have pain that you don’t think has been caused by a sprain or strain in your upper back
- you are very stiff in the morning
- you have pain all the time and it’s getting worse
Your doctor may ask if you’ve had any weakness in your legs, or any bladder and bowel problems such as incontinence. This may point towards pressure on the nerves in your spine or spinal cord, which could be caused by a slipped disc or injury.
If you have another condition affecting your lungs, oesophagus, stomach, pancreas, liver or gall bladder, you might have referred pain. This is when a problem elsewhere is causing pain in your upper back.
Depending on your symptoms, examination and medical history, your doctor may refer you for further tests. These might include blood tests, X-rays and an MRI scan (a test that uses magnets and radio waves to produce images of the inside of your body). You might also have a DEXA scan, which measures how strong your bones are.
Treatment Of Upper Back Pain
The range of treatments for upper back pain – and neck and mid-back pain, too – suggest there is no best option. These are some examples of different approaches that may help you.
In most cases, upper back pain is not a cause for worry; however, it can be uncomfortable, painful, and inconvenient. Furthermore, if pain develops suddenly and is severe—such as from an injury (eg, fall)—and, certainly if pain and symptoms (eg, weakness) progressively worsen you should seek medical attention.
Simple home remedies. In general, the following home treatments may help relieve upper back pain. Ignore the hype about special products marketed on TV or social media. Stick with what science says works, at least for most people with minor musculoskeletal strain:
- Gentle stretches
- Over-the-counter medication such as ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol)
- Ice to reduce pain and swelling
- Heat to improve mobility and ease stiffness
Posture exercises. If your posture is good, your spinal structures should be correctly aligned, which reduces back strain. Start with these strategies to improve the way you stand or sit.
- Imagery. Imagine there’s a cord passing through your body from ceiling to floor. Now imagine someone pulling that cord upward, slightly lifting your chest and ribcage.
- Chin tuck. Sit in a chair with your feet flat on the floor. Your shoulders should be relaxed and down. Now pull your chin in toward your neck. Count to five, then relax. Repeat 10 times.
- Shoulder blade squeeze. Put your hands on your thighs and keep your shoulders down, roughly at chin level. Slowly squeeze your shoulder blades together. Count to five, then relax. Repeat three or four times.
- Upper back stretch. Raise your right arm to shoulder level, directly in front of you. Bend your arm at the elbow and grasp that elbow with your left hand. Now gently pull it across your chest and hold for 20 seconds. Repeat three times on each side.
Prescription drugs. In many cases, a prescription anti-inflammatory or muscle relaxant will do the trick to ease your upper and mid back pain. If your doctor suspects depression plays a role in your pain, you may be given an anti-depressant to take longer-term (months, not weeks). Opioid pain relievers may be prescribed for severe pain that isn’t helped by other painkillers, but they’re not recommended for long periods (7 to 10 days(. Finally, you may benefit from an anticonvulsant medicine; it works best for pain caused by nerve damage.
Injections. A trigger point injection is a direct shot of powerful pain medicine. It may solve your problem, or it may just buy you enough pain-free time to pursue other interventions (e.g. exercise and stretching; see the hands-on hearling bullet below) to get your upper back pain in check.
Hands-on healing. Physical therapy, acupuncture, and chiropractic care may each provide relief of your upper back pain. Ask your doctor if it’s safe for you to do more than one of these interventions during a given time frame.
Most cases of upper back pain resolve in 1 to 2 weeks without further treatment. Resume your normal activities gradually, when you can perform them without pain. Don’t rush things, though: you could interfere with your recovery and risk re-injury.
Surgery. The idea of spine surgery can be scary, but sometimes it’s the most reliable way to get relief. Surgery is rarely indicated for isolated upper back pain. This is almost always due to an issue with spine itself, such as a herniated disc, vertebral fracture, or deformity.
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.
