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Upper back pain


Your health expert: Jasmine Ward, Musculoskeletal Therapist at Bupa
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, November 2023
Next review due November 2026

Upper back pain (thoracic back pain) is pain anywhere between your neck and your waist, including between your shoulder blades. This can be due to poor posture, injuries and strains, or because of other health conditions, such as arthritis. Although less is known about upper back pain compared with lower back pain, it’s still common.

About your back

Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons, and your spine supports your back. Your spine is made up of separate bones called vertebrae that are stacked on top of one another. Below these are the bones of your sacrum and coccyx, which are at the bottom of your spine. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend.

Your spinal cord passes through the vertebrae. It carries nerve signals between your brain and the rest of your body. The spinal cord ends in your lower back as a bundle of nerves called the cauda equina.

It’s possible to get upper back pain or middle back pain, as well as pain in your lower back.

An image showing the different parts of the spine

Causes of upper back pain

There are lots of potential causes of upper back pain but sometimes you can’t find a cause. The muscles and soft tissues in your back are irritated for some reason.

Upper back pain is often caused by having poor posture for a long time. Good posture means being able to maintain, but not increase, the natural curves of your spine. Keep your head level – try not to tilt it. Your ears, shoulders, hips and ankles should all be in line.

Other causes of upper back pain include:

  • an accident or sudden injury, such as whiplash or a sports injury
  • straining a muscle or ligament in your back
  • weak muscles in your back, from not doing much exercise, for example 
  • sitting at a computer for long periods of time
  • carrying a back pack
  • repetitive movements causing overuse injury

Upper back pain can also be caused by some health conditions, such as: 

  • osteoporosis
  • osteoarthritis
  • spinal stenosis – the tunnel-like passage that carries your spinal cord through your vertebrae (the spinal canal) narrows and presses on the nerve
  • ankylosing spondylitis
  • disc herniation – one of the shock-absorbing discs between the bones in your spine (vertebrae) can bulge to one side (although this rarely causes upper back symptoms and is often found naturally in people)
  • psychological stress – this can affect how much pain you feel

Symptoms of upper back pain

Symptoms of upper back pain can vary 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.

If your back pain significantly affects your daily activities or stops you from getting a good night’s sleep, see a physiotherapist or GP.

Upper back pain doesn’t necessarily mean you have an injury or damage to your body as pain can be influenced by many things. Although pain can be useful to warn us there’s something wrong, it can also be a sign that you're overdoing it and need to take care of yourself.

Diagnosis of upper back pain

Your physio or GP will ask about your symptoms and examine you. They may 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 upper back pain red flags and they include if you:

  • have had a recent injury to your back, such as a car accident or a fall
  • have cancer, or a weakened immune system
  • have symptoms of an infection, such as a fever, unexplained weight loss and chills
  • are younger than 20, or older than 50
  • have diabetes

Your physio or GP 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:

  • your 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’re very stiff in the morning
  • you have pain all the time and it’s getting worse

Your physio or GP may ask if you’ve had any weakness in your legs, or any bladder and bowel problems, such as incontinence. This may mean there’s 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 that affects your lungs, oesophagus (food pipe), stomach, pancreas, liver or gall bladder, you might have referred pain. This is when a problem elsewhere causes pain in your upper back.

Depending on your symptoms, examination and medical history, your GP or physio may refer you for further tests. These might include blood tests, X-rays and an MRI scan. You might also have a bone density scan (DEXA scan) which measures how strong your bones are.

Self-help for upper back pain

You can try some self-care measures to get upper back pain relief, for example, you can:

Treatment of upper back pain

If you have upper back pain, it’s likely to get better by itself without treatment. If it’s not caused by anything serious, it may get better within a few weeks.

If the pain is caused by a particular condition, your treatment will vary depending on the underlying problem that’s causing the pain.

Treatments may include:

  • medicines
  • physiotherapy
  • injections
  • manual therapies, such as physiotherapy, osteopathy and chiropractic
  • surgery

Prevention of upper back pain

The following tips may help to prevent you from developing upper back pain.

  • Properly support your back when you’re sitting.
  • If you work at a desk, arrange an assessment of your set up to make sure your equipment is set up correctly.
  • If you wake up with back pain, a more supportive mattress that adjusts to your back and supports it properly may help.
  • Take regular breaks from sitting for long periods of time and from doing repetitive tasks.
  • Have good posture and when you lift objects, do this safely and correctly.
  • Exercise regularly.
  • Stop doing any activity that you know causes your back pain.
  • Stop smoking – it can damage the discs between your vertebrae that act as shock absorbers.
  • If you’re overweight, losing weight may help to reduce the risk of back pain.
  • Change activities that cause you pain so you can still enjoy them – slow down, do less, get help, for example.

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Lots of things can cause upper back pain. Often it’s because of poor posture or upper back pain may be caused by an injury or straining a muscle or ligament. Some conditions can cause upper back pain, such as osteoporosis, osteoarthritis and spinal stenosis.

See our causes of upper back pain section for more information.

There are some things you can try to relieve upper back pain. For example, you can take over-the-counter painkillers  and keep moving within your limits. You can try to improve your posture too, and do some stretches. If the pain is caused by a health condition, it’s important to treat this with anything that helps, such as medicines or physiotherapy, for example.

See our self-help for upper back pain and treatment of upper back pain sections for more information.

Upper back pain is likely to get better by itself without treatment but sometimes there may be signs that you need to see a health professional. For example, if you have problems with your balance or walking, or difficulty with bladder or bowel control, seek urgent medical attention. Also, do this if you have pins-and-needles tingling, weakness, and/or numbness anywhere in your upper or lower back and down your legs. If you have difficulty breathing, have a fever or chills, or a severe headache, contact your GP.

See our diagnosis of upper back pain section for more information.

Yes, upper back pain can be a sign of something else. If you have another condition that affects your lungs, oesophagus (food pipe), stomach, pancreas, liver or gall bladder, you might have referred pain. This is when a problem elsewhere causes pain in your upper back. See your GP to check what the cause might be.

See our diagnosis of upper back pain section for more information.

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