The upper back, or thoracic spine, is the longest section of the spine running from the base of the neck down to the abdomen. It is the only section of the spine that is attached to the rib cage.
The upper back is remarkably resistant to injury and pain. Because it is anchored to the rib cage, the upper back bears less body weight and has a more limited range of motion than the neck (cervical spine) and lower back (lumbar spine). When upper back pain occurs, however, it is typically due to long-term poor posture or an injury that overpowers the thoracic spine’s sturdiness.
Back pain can range from a mild, dull, annoying ache, to persistent, severe, disabling pain. Pain in your back can restrict mobility and interfere with normal function and quality of life. You should always consult your health care provider if you have persistent pain.
The upper back is the area of the spine located between the base of the neck and the bottom of the ribcage. There are 12 bones that make up the upper back (thoracic spine). The first bone of the upper back begins at the base of the neck, and the 12th bone ends just below the ribcage. Because this area of the spine is located between the neck (cervical spine) and lower back (lumbar spine), it is often referred to as either the “upper back” or “middle (or mid) back.”
Unlike the cervical spine (neck) and lumbar spine (lower back), the thoracic spine is relatively immobile. The rigidity is because each of the thoracic spine’s vertebrae are connected to a pair of ribs which, along with the sternum at the front of the chest, and the spine, form the body’s rib cage.
What Causes Upper Back Pain?
Upper back pain can appear suddenly anywhere between bones of the thoracic spine. The pain can be the result of poor posture, muscle overuse (also infrequent use), or the result of an injury. There may also be no apparent reason for the pain or a serious underlying cause. In rare cases, the pain may be the result of a progressing infection or illness, or from spinal instability that has started to affect a nerve root or even the spinal cord.
When the upper back becomes painful, it is most likely due to an injury resulting in muscular irritation or joint dysfunction. Some of the more common causes of upper back pain are:
Accident or collision. Trauma from a vehicular accident, a fall, or sports injury can damage spinal bones, discs, muscles, ligaments, nerves, or other soft tissues.
Degeneration of vertebrae. The stresses on the muscles and ligaments that support the spine, or the effects of aging, can cause the vertebrae to deteriorate.
Herniated disc. When the area around the disc is damaged, the cushioning material can push out between the vertebrae and press on spinal nerves. Though this is more common in the lower back, it can also happen in the upper back.
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 center, can leave the shoulder and upper back susceptible to injury.
Muscle deconditioning. Just as one can exercise to condition and strengthen their muscles, one can also decondition their muscles over time by not using them correctly. Over time, the weakening of muscles can lead to pain.
Muscle overuse. Typically, repeating the same motions over time can cause muscle strain and irritation. A classic example is a baseball pitcher who repeats similar movements with every pitch, resulting in shoulder pain. Strenuous activity causes muscle strains, ligament sprains, and inflammation in the upper back.
Myofascial pain syndrome. This ongoing (or “chronic”) pain disorder is often triggered after a muscle has contracted over and over. The pain may stem from connective tissue problems in the back. It can be job-related or the result of any activity that requires repetitive motion.
Obesity. Excess weight places increased stress on the spine as well as pressure on the discs.
Osteoarthritis. The source of back pain is sometimes not the muscles, but a problem in the bones and joints. The cartilage that protects the bones can wear down (osteoarthritis), leading to pain.
Pinched nerve. A herniated disc can slip and compress a nearby nerve which can cause numbness and pain in the arms, legs, or even a loss of control in the legs.
Poor posture. Living a sedentary lifestyle or routinely sitting for long periods with poor posture can cause structural changes in the back and neck. As the muscles become deconditioned and weak, they no longer continue to hold the spine in proper alignment.
Some of the less common causes of upper back pain include:
Abdominal problems, such as an aortic aneurysm.
Abnormal growth, such as a tumor or bone spur or a congenital (present at birth) abnormality of the vertebrae and bones.
Arthritis. Various types of arthritis from normal wear and tear (osteoarthritis) or an autoimmune disease (rheumatoid arthritis).
Compression fractures. Most commonly caused by osteoporosis in older adults, a vertebral bone can weaken and not be able to fully support the weight upon it. Small fractures develop at the front of the vertebra as it becomes compressed. If the vertebra loses enough height, it can cause changes in posture resulting in pain.
Fibromyalgia. A condition causing widespread pain and fatigue throughout the body. The upper back is commonly affected.
Gallbladder issues. Gallstones can cause pain between the shoulder blades or around the right shoulder.
Lung cancer. In very rare cases, complications can cause the cancer to spread to the bones in about 30 to 40 percent of people with non-small cell lung cancer.
Severe spinal deformity. If a spinal deformity progresses enough, it can cause painful muscle spasms and even stress discs and joints. Some examples include Scheuermann’s kyphosis and scoliosis.
Spinal infection. Although rare, an infection (spinal epidural abscess) can result in the accumulation of pus in the epidural space that mechanically compresses the spinal cord.
What are the Symptoms of Upper Back Pain?
Upper back pain symptoms can vary greatly depending on the underlying cause. Most people describe upper back pain as a burning or pulling sensation in one place, which may be at the location of an injury or strain. For some, the pain might be mild and go away within a couple of days; but for others, the pain can worsen and interfere with daily tasks.
Common upper back pain symptoms can include one or more of these:
Aching. A consistent pain in the middle part of the back, especially after standing or sitting for an extended period.
Dull, burning, or sharp. The pain may be confined to a single spot or covering a large area.
General discomfort. An achy or throbbing pain may be felt in part of the upper back, and it could potentially spread into a nearby area, such as the neck, shoulder, or lower in the back.
Radiating pain. This pain can travel along a nerve from the thoracic spine and potentially go into the arm, chest, stomach, or further down the body. Radiating pain can range from dull to sharp or electric shock-like, and it may come and go or be continuous. It is usually only felt on one side of the body, such as going into the chest on one side. The pain may radiate into the buttocks, down the back of the thigh, and into the calf and toes.
Tingling, numbness, or weakness. Just like radiating pain, these symptoms can radiate along a nerve into the arm, chest, stomach, or lower in the body. Pins-and-needles tingling or numbness radiating from the thoracic spine can feel like a band running along one of the ribs.
Stiffness. If either sharp pain or general soreness becomes bad enough, it can contribute to reduced mobility of the upper back’s muscles, ligaments, and joints. While reduced mobility in the upper back is typically not significant, certain arm movements, such as rotation or lifting, can be more difficult, even impossible.
If upper back pain becomes intense enough, it can affect normal activities. The pain can interfere with the ability to lift moderately heavy objects, throw a ball, sit comfortably, or even rest.
If any of the following accompanies upper back pain, the patient should see a doctor immediately:
Problems with balance or walking.
Difficulty with bladder or bowel control.
Pins-and-needles tingling, weakness, or numbness anywhere in the upper back or below, such as in the chest, stomach, buttock, or down the legs.
Fever or chills.
Any upper back pain that follows a high-impact event, such as an auto accident or a fall from a ladder, should be evaluated by a doctor.
How is Upper Back Pain Diagnosed?
Compared to other regions of the spine, diagnosing upper back pain can be especially complex because there are more potential sources of pain. The pain can originate from any of the ribs, internal organs, or muscles in the area. Although it may sometimes be impossible to find the exact cause of a person’s upper back pain, the diagnostic process generally follows three steps to narrow down a likely cause.
The process begins with a thorough medical history of the patient. The doctor will want to know when the symptoms started and what symptoms the patient is experiencing. In addition, the doctor will want to know if there was a recent accident or injury. It is also essential to know the patient’s lifestyle and regular habits. Patient history is likely to provide the most reliable clues as to the underlying cause of upper back pain.
After the patient’s medical history is collected, a physical examination can help narrow down the cause of the pain. This process can include tests to see if specific movements exacerbate the pain.
Based on the information collected from the patient’s history and physical exam, the doctor may want to conduct diagnostic testing. Typical tests include:
X-ray. An X-ray (radiograph) uses electromagnetic radiation to create an image of the bones. The imaging may show spinal degeneration, fractures, or possibly tumors.
MRI. Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create cross-sectional images of soft tissues and bones. In particular, an MRI can be helpful detecting compression of spinal nerves or the spinal cord, infections, tumors, or damage to ligaments, muscles, or other soft tissues.
Medial branch nerve block. Using X-ray guidance (fluoroscopy), an anesthetic is injected near the medial nerves that exit a facet joint. If numbing the nerves of that joint causes the pain to go away, the source of the pain has been found and can guide future treatments.
Bone mineral density exam. This test uses X-rays to measure bone density (based on how much of the X-rays are absorbed into the bones). It is commonly performed to check for osteoporosis, which can occur in the thoracic spine and cause upper back pain.
Several other diagnostic tests may also be used, including:
Electrodiagnostic (EDX) testing. A common technique to check nerve and muscle function. (The test may also be called an “EMG” for electromyography.)
CT scan with myelography. A CT Scan is a type of X-ray that takes cross-sectional images of the body. The myelogram consists of injecting a radiographically opaque dye (that is picked up by X-rays) to better view the nerve roots. This test is typically conducted on patients who cannot have an MRI.
Blood tests. In some cases, blood tests can help identify an infection or inflammatory arthritis that might be causing the pain.
Most diagnostic tests for upper back pain are performed to confirm a suspected cause, rather than make a diagnosis. An official diagnosis of upper back pain must consider the patient’s reported symptoms.
How is Upper Back Pain Treated?
The treatment of upper back pain depends on the underlying cause of the condition. Even in cases where the cause may seem obvious, such as a fall injury, the specific source of pain within the body can sometimes remain elusive.
The treatment goal is to help the patient manage the pain, improve mobility, and improve the overall quality of life.
If upper back pain develops without any signs of an emergency, most patients can safely try to alleviate the pain with their own self-care. Options for self-care treatments include rest, adjusting posture, or applying heat or ice. If the pain persists, other treatments may be needed, such as medication, physical therapy, or manual manipulation. In some cases, a combination of one or more treatments works best to help reduce the pain.
Some early treatment options to try when upper back pain develops include:
Over-the-counter (OTC) medications. Various pain medications are available without a doctor’s prescription. Most of these OTC medications work by reducing inflammation in the body or preventing pain signals from reaching the brain. Even though OTC medications do not require a prescription, it is important to read and follow the label directions to avoid serious side effects.
Cold or heat therapy. Ice may be applied to reduce swelling within the first couple days after the pain begins. Heat is typically recommended after the first 48 hours. However, the patient should choose the one which provides the best relief. Regardless of which temperature is preferred, it is essential to limit applications to 20 minutes at a time and check the skin regularly to avoid tissue damage.
Massage. Many people find that a massage can provide relief from back pain. Even if the effects are temporary, a good massage can help loosen tight muscles and get more blood flowing to the painful area.
Rest and activity modification. If the pain gets worse with certain movements or activities, a rest period for a day or two may help. After an initial period of rest, try to become active again. Resting for too long can cause muscles in the back to become weaker, which can lead to more pain.
When upper back pain has lingered or not responded to rest and other self-care methods, a medical professional may be needed to develop a treatment plan to reduce the pain.
Some of the more common medical treatments for upper back pain include:
Aerobic exercise. If permitted by the doctor, exercises such as stretching and flexing can help relieve pain and help with overall fitness and strength.
Biofeedback. A process that makes one more aware of normally involuntary processes in the body (such as muscle tension) to help the patient gain some conscious control of these processes. The awareness can help with relaxation and help relieve pain.
Braces or corsets. To help stabilize spinal curvature of scoliosis, kyphosis, and other spine curvatures, a brace or corset can help alleviate the pain and muscle tension caused by the curvature.
Physical therapy. A doctor or other medical professional can design a physical therapy program to meet a patient’s specific needs. Most physical therapy programs for upper back pain focus on strengthening and stretching the upper back’s muscles.
Prescription pain medications. For debilitating pain or severe flare-ups, short-term use of prescription medications may be advised. Common pain medications work by preventing pain signals from reaching the brain; and muscle relaxants, which typically work as a sedative for the neuromuscular system.
Injections. Several spinal injection options are available to block spinal pain. For example, an epidural steroid injection typically delivers a steroid medication in or near the pain source to reduce pain. Medial branch blocks and facet injections can help temporarily relieve pain by injecting medication into the joints of the spine to block pain signals to the brain. Injections tend to provide varying amounts of short-term relief and are not considered a good long-term solution.
Infusion therapy. The administration of pain medication through a needle or catheter into the treatment area. A special infusion pump delivers the medication at a slower rate than an injection for pain management.
Nerve block. The deliberate interruption of pain signals traveling along a nerve by an injection of a medicine that blocks signals from a specific nerve.
Peripheral nerve blocks and ablation. Nerves leading away from the spinal cord (peripheral nerves) are often the source of pain. Using a local anesthetic, the nerves can be blocked and then destroyed (ablation).
Cognitive-behavioral therapy (CBT). A type of psychotherapeutic treatment that helps patients understand the thoughts and feelings to help treat pain. A therapist can teach ways to focus on positive thoughts instead of pain.
Electrotherapy. Various electrotherapy treatments can help alleviate pain by sending small electrical pulses to the painful area. The most common type of electrotherapy is a transcutaneous electrical nerve stimulator (TENS). The unit typically uses small adhesive pads to place electrodes on the skin. The TENS unit sends a small electrical current to the electrodes causing a soothing, tingling sensation and a reduction in the perception of pain.
Typically, more than one treatment is needed to help manage upper back pain. For example, medications might be required when the pain first starts, but over time the medications might be phased out in favor of physical therapy or other treatments to manage ongoing chronic pain.
Minimally Invasive Treatments
Minimally invasive procedures to relieve upper back pain are less severe than open surgery, while being very effective to relive severe pain. In contrast to surgery, minimally invasive procedures typically limit the size of the incision resulting in less pain and a shorter recovery period. Some of the treatments include:
Radiofrequency Ablation (Disc Denervation). This procedure disrupts pain originating from a damaged vertebral disc from reaching the brain. The process works by destroying abnormal tissue through applying extreme levels of heat via electrical stimulation.
Spinal cord stimulation (SCS). An implanted electrical device decreases the perception of pain by confusing the spinal cord and brain processing centers with mild electrical signals.
Kyphoplasty and Vertebroplasty. Kyphoplasty is the injection of an inflatable balloon to elevate a fractured vertebra and to return it to a more normal position. Vertebroplasty is similar, but a bonding material is injected into a fractured vertebra which hardens, stabilizing and strengthening compressed vertebrae.
Alternative treatments, commonly referred to as complementary and alternative medicine, can help relieve pain in some cases. Many pain patients report experiencing at least some pain relief from treatments such as:
Manual manipulation. A chiropractor, physiatrist, or other qualified medical professional makes spinal adjustments by using hand thrusts and other maneuvers. Manual manipulation (also known as chiropractic manipulation) helps loosen stiff or misaligned joints and may reduce pain.
Acupuncture. Depending on the specific pain symptoms, an acupuncturist places thin needles in strategic locations of the body that is believed to alter energy flows and reduce pain.
Mindful meditation. An approach that involves learning meditation and breathing techniques, as well as practicing yoga. One study found mindful meditation to be as effective as cognitive behavioral therapy for improving a patient’s ability to deal with chronic back pain.
It is rare for upper back pain to be treated with surgery. Operating on the thoracic spine is difficult as it requires working around the rib cage and the close proximity of several vital organs. However, surgery may be indicated if one or more of the following conditions are met:
The health of the spinal cord or nerve roots are at risk.
Severe spinal deformity has developed or is likely to develop.
Debilitating pain cannot be managed with nonsurgical methods.
Is It Possible to Prevent Upper Back Pain?
It may not be possible to prevent all causes of upper back pain, but there are some easy steps you can take that may avoid some of the more common causes. These include:
Take regular breaks from sitting or lying down to stretch and move different muscle groups, so the muscles stay loose and strong.
Take a few minutes to stretch the muscles or warm up the body before any activities.
People who lift heavy objects should avoid twisting or lifting with their back.
Have regular massages to help work out the tension of the muscles.
Work with a physical therapist to strengthen weak muscles and keep pressure off the joints.
Avoid wearing heavy backpacks or purses.
Be conscious of posture at all times; walk upright, sit correctly, and use back supports if necessary.
Lifestyle Changes to Reduce Upper Back Pain
Some risk factors from daily routines are known to increase the risk of back pain. Making one or more of the following lifestyle changes could help reduce the risk of developing upper back pain:
Exercise and stay active. Go for regular walks or hikes, participate in noncontact sports, strength training, and stretching to help keep the upper back in good condition. Do exercises that improve balance.
Practice better posture. When standing, keep the head in a neutral position with the ears directly over the shoulders which tends to put the least amount of stress on the neck and back. Using good posture throughout the day can reduce the risk of developing pain.
Practice correct lifting techniques. Avoid heavy lifting. When you do lift something, bend your legs, keep your back straight, and then slowly lift with your legs.
Quit smoking. Multiple studies have shown that people who smoke are more likely to have chronic back pain and accelerated degeneration of spinal discs. One of the suspected reasons is that nicotine restricts blood flow, which can reduce the flow of nutrients to the discs.
Maintain a healthy weight. Excess weight places increased stress on the spine and pressure on the discs.
Reduce stress. Cortisol, the ‘stress hormone,’ is released by the body in response to stress. When cortisol levels are elevated for extended periods, negative effects can result, including diminished bone density.
Eat healthy. Make sure you have enough Vitamin D and calcium in your diet. Vitamin D is necessary for strong bones and muscles. Without Vitamin D, our bodies cannot effectively absorb calcium, which is essential to good bone health.
Get enough sleep. Proper rest helps manage stress and can help reduce the risk for developing back pain. Lack of sleep also affects bone marrow development, leading to diminished bone flexibility.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating upper back pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.