Causes of Upper Back Pain: Common, Rarer and Urgent

The causes of upper back pain are most often ordinary ones: muscles and joints that have worked hard, or stayed in one position for a long time. That is the likely answer if your ache eases when you move or change what you are doing, and no warning sign comes with it. If the pain comes with chest pressure, breathlessness or a sudden tearing feeling, call emergency services before you read on. This page groups the causes you will probably recognise, then the less common ones, then the causes that are not in the back at all and need a clinician. If you are asking why the area feels tight rather than sore, our explainer on why your upper back feels so tight goes there.

Pain in this part of the spine is common. A review of 33 studies in children, teenagers and adults found that 3.5% to 34.8% of people reported it over one year, a wide range because the studies measured it in different ways (Briggs et al., 2009). If your upper back hurts, you have plenty of company.

The most common causes of upper back pain

The upper back, also called the thoracic spine, is the part of the spine that carries the ribs. Muscles run from the spine to the shoulder blades and ribs. They work all day, so they tire easily. These are the triggers many people recognise.

• Long sitting and screens. No position is faulty. The trouble is staying in any one of them for hours. The same muscles keep holding while the mid spine barely moves.
• Carrying and lifting. A heavy bag on one shoulder, a toddler on one hip, or a box lifted with a twist can leave one side sore the next day.
• Sudden strain. A quick reach, a hard sneeze or a new activity can overload a muscle or irritate a rib joint. The pain is often sharp at first, then dull.
• Sleep position. A night with the neck and shoulders held in one shape can leave the upper back aching in the morning. It often eases once you are up and moving.
• Stress and shallow breathing. Under pressure, many people lift the shoulders and breathe high in the chest. The upper back muscles then keep working even when you sit still.
• Stiffness in the ribs and middle spine. Most ribs meet the spine at two small joints. When this part moves less, those joints can feel achy or catch with a deep breath or a turn.

Notice the common thread. In each case the back was either used hard or barely used. That is why a change in activity often helps. For more on how long holding builds up, see the Feldypedia article on desk posture and chronic neck pain, and our guide to upper back pain from sitting at a desk.

Less common causes of upper back pain

A few causes are rarer, and they are worth knowing about.

• Disc problems. A disc is the soft cushion between two spine bones. Disc trouble is uncommon in the upper back, because the ribs steady this part of the spine. It is seen far more in the neck and lower back.
• Arthritis. Wear in the small joints of the spine or rib joints can cause a dull, stiff ache. It is often worse after rest and eases a little as you start to move.
• Bone fragility and compression fractures. A compression fracture is a small collapse of a spine bone. It can follow a fall, or happen with osteoporosis, a condition in which bones become thinner and weaker. It tends to cause sudden pain in the middle of the back that is worse on standing. This needs a medical check.

If you already know you have thinner bones, treat any sudden new back pain as worth a call to your doctor.

Causes of upper back pain that are not from the back

Sometimes the pain is referred. That means it starts in one place and is felt in another. These causes need a clinician, not a movement lesson.

• Heart. Pain or pressure in the chest that spreads to the back, jaw or arm, or comes with sweating, nausea or breathlessness.
• Lung. Sharp pain that changes with each breath, or comes with cough, fever or breathlessness. A blood clot in the lung can feel this way.
• Gallbladder. Pain under the right ribs that can travel to the back or near the right shoulder blade, sometimes after a heavy or fatty meal, sometimes with nausea or vomiting. If your pain sits on one side, you may want our pages on upper back pain on the left or pain in the upper right back.
• Shingles. A burning or tingling band of pain on one side of the torso, which can appear a few days before a blistering rash.

Signs that need urgent care

Call emergency services if the pain comes with:

• chest pain or pressure, or pain spreading to the arm, neck or jaw
• shortness of breath, sweating, nausea, or feeling faint
• a sudden, severe, tearing pain in the chest or back, including between the shoulder blades
• new weakness or numbness in the legs or elsewhere, trouble speaking or seeing, or loss of control of bladder or bowels
• severe pain in the upper belly, or pain under the right ribs with fever, vomiting, or yellow skin or eyes

See a doctor promptly if the pain follows a fall or a blow, comes with fever or a blistering rash, wakes you at night, or arrives with unexplained weight loss.

What to notice about the causes of upper back pain

You do not need to find the one cause. A more useful question is when it starts. Over the next few days, notice what you were doing in the hours before the pain tends to come on, and when it eases. Does it build after long sitting and ease when you walk? Does it follow a stressful stretch of the day? Pain that changes with position or activity often points to muscles and joints, though that is only a clue. Pain that ignores all of that, or comes with the signs above, is the kind to have checked.

In the Feldenkrais Method®, this kind of noticing is the starting point. You learn how you hold and use your back, and you give it small, easy movements it may be missing. Many people find the area softer when they move it in varied, comfortable ways. Feldy offers short guided lessons in this spirit. If your neck joins in, Feldenkrais for neck tension is a natural next step, and our guide to upper back strain covers the sudden kind in more depth.

If you keep one idea from this page, let it be this: watch when your pain comes on and what eases it, and if a warning sign joins it, get help first.

Common Questions about causes of upper back pain (FAQ)

What causes upper back pain most often?

Most often it is muscles and the small joints around the ribs and mid spine that have been loaded for long stretches or have not moved much. Long sitting, carrying, a sudden strain, and an awkward night's sleep are common triggers. Stress and shallow breathing can keep the same muscles working without rest.

Could my upper back pain be something serious?

Usually it is not, but a few causes are outside the back. Call emergency services for chest pain or pressure, breathlessness, pain spreading to the arm, neck or jaw, or a sudden tearing pain. Fever or a blistering rash on one side needs a prompt visit to a doctor.

Can a slipped disc cause upper back pain?

It is uncommon in this region. The ribs attach to the mid spine and make it steadier than the neck or lower back, so disc trouble is seen less often. If pain comes with numbness or weakness in the legs, or trouble controlling bladder or bowels, call emergency services.

How long does muscular upper back pain last?

It varies. A strained or overworked muscle can settle over days to a few weeks as daily loading changes. Pain that lasts longer, keeps returning, or grows stronger deserves a clinician's look, especially if it is worse at night or when resting.

How often should I move if my upper back hurts?

Short and frequent breaks suit this area well. Once an hour, try standing, turning gently and breathing into the back of your ribs for a minute or two. That is easier on the area than one long session. Keep it comfortable, and stop if the pain sharpens. If you have thinner bones or a recent fall, ask your doctor before you try this.

How is gentle movement different from physiotherapy for upper back pain?

Physiotherapy is clinical care, and it can assess what is causing your pain and treat it. Feldenkrais® style movement is a different thing: slow, curious movement that helps you notice how you hold and use your back. It sits alongside care and does not replace a check when you have warning signs.

When should I see a professional about upper back pain?

Book a prompt doctor's visit when pain starts after a fall, arrives with fever, a rash or weight loss you cannot explain, or wakes you from sleep. The same goes for pain that has lasted several weeks. For chest pain or pressure, breathlessness, sudden severe pain, or new numbness or weakness in the legs, call emergency services.