Pain between the shoulder blades or across the upper back is one of the most common musculoskeletal complaints, yet it often receives less attention than lower back pain. Understanding the causes of upper back pain is essential for finding relief and preventing the problem from becoming chronic.
The causes of upper back pain range from simple muscle strain to more complex spinal conditions. The upper back, known medically as the thoracic spine, consists of 12 vertebrae (T1 through T12) that connect to the rib cage. This region is inherently more stable than the cervical or lumbar spine because the ribs provide additional structural support, which is why upper back pain is less common than neck or lower back pain. However, when it does occur, it can be just as debilitating and disruptive to daily life.
Poor Posture and Muscle Strain
The most common cause of upper back pain in the modern world is poor posture, particularly the forward head position and rounded shoulders associated with prolonged sitting and device use. According to the Cleveland Clinic, for every inch your head moves forward from its neutral position, the effective weight on your cervical and upper thoracic spine increases by approximately 10 pounds. Since the average adult head weighs about 11 pounds, a forward head posture of just two inches effectively doubles the load on your upper back muscles.
This sustained postural stress leads to a condition sometimes called “upper crossed syndrome,” characterized by tightness in the chest and upper trapezius muscles combined with weakness in the deep neck flexors and lower trapezius muscles. Over time, this imbalance can cause chronic muscular pain, headaches, and restricted range of motion.
Muscle strain from overuse, sudden movements, or sleeping in an awkward position is another frequent cause. The rhomboids, trapezius, and levator scapulae muscles are particularly vulnerable to strain in the upper back. These injuries typically produce localized pain that worsens with specific movements and improves with rest. Most muscle strains resolve within a few days to weeks with appropriate self-care.
Thoracic Disc Problems
Although less common than cervical or lumbar disc herniations, thoracic disc problems can cause significant upper back pain. The intervertebral discs in the thoracic spine can degenerate, bulge, or herniate, potentially compressing nearby nerves or the spinal cord.
According to research published in PubMed, thoracic disc herniations account for less than one percent of all disc herniations but can be particularly challenging to diagnose because their symptoms often mimic other conditions. Pain may radiate around the rib cage following the path of the affected nerve, a pattern called radiculopathy. In severe cases, a thoracic disc herniation can compress the spinal cord, causing weakness, numbness, or bowel and bladder problems, which constitutes a medical emergency.
Degenerative disc disease in the thoracic spine becomes more common with age as the discs lose water content and height. This natural wear-and-tear process can cause chronic, dull upper back pain that worsens with prolonged sitting or certain movements.
Spinal Conditions
Several structural conditions of the spine can cause upper back pain:
Osteoarthritis. Degeneration of the facet joints in the thoracic spine can cause stiffness and pain, particularly in people over 50. The NIH reports that spinal osteoarthritis is one of the most common causes of chronic back pain in older adults. Symptoms tend to be worse in the morning and after periods of inactivity.
Kyphosis. Excessive forward curvature of the upper back, whether from Scheuermann’s disease in adolescents or osteoporotic compression fractures in older adults, can cause pain and functional limitation. Mild kyphosis may be asymptomatic, but more severe cases can cause persistent pain and difficulty standing upright.
Scoliosis. Abnormal lateral curvature of the spine can affect the thoracic region, causing uneven muscle loading and chronic pain. According to the American Association of Neurological Surgeons, scoliosis affects approximately two to three percent of the population, and the thoracic spine is the most commonly affected region.
Compression fractures. Osteoporosis can weaken the thoracic vertebrae to the point where they fracture under normal loads. The Mayo Clinic reports that approximately 700,000 vertebral compression fractures occur in the United States each year. These fractures can cause sudden, severe upper back pain and are most common in postmenopausal women.
Myofascial Pain and Trigger Points
Myofascial pain syndrome involves the development of tender, tight knots within the muscle fibers called trigger points. These points are exquisitely sensitive to pressure and can refer pain to distant areas. Trigger points in the upper back muscles, particularly the rhomboids, trapezius, infraspinatus, and levator scapulae, are extremely common and can cause widespread pain patterns that may mimic other conditions.
Research from the NIH suggests that myofascial trigger points develop in response to muscle overload, trauma, repetitive stress, or prolonged poor posture. They are particularly common in people who perform repetitive upper body movements or maintain static postures for extended periods, such as office workers, musicians, and dentists.
Treatment for myofascial pain includes trigger point release through manual therapy, dry needling or trigger point injections, stretching programs, and addressing the underlying postural or biomechanical factors that contribute to trigger point development.
Internal Organ Causes of Upper Back Pain
Not all upper back pain originates in the musculoskeletal system. Several internal organs can refer pain to the upper back, making accurate diagnosis important:
- Heart conditions. Heart attack, angina, and aortic dissection can all cause upper back pain, particularly between the shoulder blades. This is more common in women, who are more likely to experience atypical heart attack symptoms according to the American Heart Association.
- Gallbladder disease. Gallstones and cholecystitis often cause pain that radiates to the right upper back and shoulder blade area.
- Pancreatitis. Inflammation of the pancreas can cause pain that radiates from the upper abdomen to the back.
- Lung conditions. Pneumonia, pulmonary embolism, pleurisy, and lung cancer can all present with upper back pain, often accompanied by cough, shortness of breath, or other respiratory symptoms.
- Esophageal conditions. GERD and esophageal spasm can cause pain between the shoulder blades that may be mistaken for musculoskeletal pain.
Seek immediate medical attention if upper back pain is accompanied by chest pain, shortness of breath, jaw or arm pain, sudden severe headache, or signs of stroke. These combinations can indicate life-threatening conditions requiring emergency treatment.
Effective Treatments for Upper Back Pain
Treatment depends on the underlying cause, but several approaches are effective for the most common causes of upper back pain:
Posture correction. Ergonomic adjustments to your workspace, including proper monitor height, chair support, and keyboard position, can significantly reduce postural strain. The Occupational Safety and Health Administration (OSHA) recommends that computer monitors be at arm’s length and at or slightly below eye level.
Exercise and stretching. Strengthening the muscles that support good posture, particularly the lower trapezius, serratus anterior, and deep neck flexors, while stretching tight muscles such as the pectorals and upper trapezius, addresses the muscular imbalances that contribute to upper back pain. The American College of Sports Medicine recommends a combination of strengthening and flexibility exercises for back pain management.
Physical therapy. A physical therapist can design a personalized program addressing your specific impairments and goals. According to the NIH, physical therapy is recommended as a first-line treatment for most types of back pain.
Manual therapy. Massage, chiropractic manipulation, and osteopathic manipulation can provide relief for musculoskeletal upper back pain. Research in the Annals of Internal Medicine supports the use of spinal manipulation for acute back pain.
Medications. Over-the-counter options include acetaminophen, ibuprofen, and naproxen. Topical treatments such as menthol patches or capsaicin cream can also provide relief. Prescription muscle relaxants or anti-inflammatory medications may be appropriate for more severe cases.
Heat and cold therapy. Ice is generally recommended for acute injuries during the first 48 to 72 hours, while heat is more effective for chronic muscle tension and stiffness. Many people find alternating between the two provides the best relief.
For more information about related conditions, visit our medical conditions guide.
Prevention Strategies
Preventing upper back pain is often more effective than treating it. Key strategies include maintaining good posture throughout the day, taking regular breaks from sitting every 30 to 60 minutes, performing daily stretching exercises targeting the chest and upper back, strengthening the core and upper back muscles through regular exercise, using ergonomic furniture and equipment, maintaining a healthy weight, sleeping on a supportive mattress with appropriate pillow height, and managing stress, which can contribute to muscle tension.
The CDC recommends that adults get at least 150 minutes of moderate-intensity aerobic activity and two or more days of muscle-strengthening activities per week. Meeting these guidelines helps maintain the muscular strength and flexibility needed to support the upper back and prevent pain.
Frequently Asked Questions
Can upper back pain be a sign of cancer?
While upper back pain is rarely caused by cancer, it can occasionally be a symptom of lung cancer, spinal tumors, or metastatic disease that has spread to the thoracic spine. Cancer-related back pain tends to be persistent, worsens over time, does not improve with rest, and may be accompanied by unexplained weight loss, fatigue, or other systemic symptoms. If your upper back pain does not respond to conservative treatment after four to six weeks, or if it is accompanied by concerning symptoms, your doctor may order imaging studies to rule out serious causes.
Why does my upper back hurt when I breathe?
Pain that worsens with breathing can have several causes. Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, is a common benign cause. Intercostal muscle strain between the ribs can also produce breathing-related pain. More concerning causes include pleurisy, pneumonia, pulmonary embolism, and rib fractures. If breathing-related upper back pain is severe, sudden in onset, or accompanied by shortness of breath, fever, or cough, seek medical evaluation promptly.
How long does upper back pain typically last?
Most episodes of upper back pain caused by muscle strain or poor posture resolve within two to six weeks with appropriate self-care. Acute injuries may improve within a few days. Chronic upper back pain that persists beyond three months may require more comprehensive evaluation and treatment. Factors that influence recovery time include the underlying cause, the severity of the initial injury, adherence to treatment recommendations, and whether contributing factors such as poor posture have been addressed.
Should I see a doctor for upper back pain?
See a doctor if your upper back pain is severe, has lasted more than two weeks without improvement, occurred after a traumatic injury, is accompanied by numbness or weakness in your arms or legs, is associated with bowel or bladder changes, occurs with unexplained weight loss or fever, or worsens at night. These features may indicate conditions that require specific diagnosis and treatment beyond self-care measures.
The causes of upper back pain are varied, but the vast majority of cases respond well to conservative treatment including posture correction, exercise, and physical therapy. By understanding the potential causes and taking proactive steps to maintain upper back health, you can reduce your risk of developing chronic pain and maintain the mobility needed for daily activities.