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Upper Back

Upper back pain can occur because of trauma and sudden injury, or through strain or poor posture developed over time. In many cases, the latter has  become a familiar complaint from people who work at computers most of the day, with many suggesting that we are sitting for more than 1680 a year! Often, upper back pain occurs along with neck pain and/or shoulder pain.

Signs and symptoms

Pain in different regions may present different signs and symptoms. However, many overlap and include the following:

  • Burning pain in the muscle
  • You feel the need to click or crack your back by twisting your shoulder or neck
  • You feel like there is a muscle knot on the underside of your scapula (shoulder blade)
  • It feels like you need to apply pressure on your upper back to some sort for relief
  • It can be sore to reach your chest with your chin
  • Stretching your trapezius muscles could cause discomfort and pain.

Risk Factors 

There are a number of risk factors for upper back (thoracic) pain including:

  • Age
  • Genetics
  • Occupational hazards
  • Sedentary lifestyle
  • Excess weight/high BMI
  • Poor posture
  • Pregnancy
  • Smoking
  • Trauma/fracture
  • Stress
  • Osteoporosis
  • Arthritis

The most common causes of upper back pain are due to one (or both) of the following causes:

Muscular irritation (myofascial pain)

Often, muscular irritation and upper back pain is due to either de-conditioning (lack of strength) or overuse injuries (such as repetitive motions). Muscle strains, sports injuries, RTCs, or other injuries can all result in pain from muscular irritation.


  • Exercise prescription
  • Active and passive physical therapy
  • Spinal manipulation/mobilisations
  • Massage therapy
  • Acupuncture
  • Pain medications/NSAIDs

Because the upper back pain is related to large muscles in the shoulder area, most rehabilitation programs will include a great deal of stretching and strengthening exercises.

Joint dysfunction

The ribs connect with the vertebrae in the thoracic spine by two joints that connect with each side of the spine. Dysfunction in these joints can result in upper back pain.


  • Spinal/joint manipulation/mobilisations
  • Massage therapy
  • Acupuncture
  • Pain medications/NSAIDs

Home exercise program for stretching the spine and shoulders that include strengthening and stretching exercises

Aerobic conditioning is also very important to maintain sustained upper back pain relief.


Problematic kyphosis:

When looked at from the side, your spine is supposed to curve outwards in your upper back (thoracic spine) region; that curve is called kyphosis or a kyphotic curve. However, it can start to curve outward too much, and that’s problematic kyphosis.

Various conditions, such as osteoporosis, can cause problematic kyphosis in the thoracic spine, leading to upper back pain.


Scoliosis causes an unusual curvature of the spine. It can make your spine look like an “S”or “C” shaped spine when viewed from the back. If your spine is curving to the left or to the right in the upper back (thoracic spine), you may have pain because of how the curve affects spinal nerves, muscles, and other soft tissue structures.


  • Postural correction
  • Back bracing
  • Exercise prescription
  • Manual treatments
  • Corrective surgical interventions
  • Pain medications/NSAIDs

Spinal Compression Fracture

Vertebral compression fractures can be caused by osteoporosis, trauma, and diseases affecting bone (pathologic fracture). Osteoporosis is a disease of bone in which bone density is reduced, which may increase the chance that a person could sustain a vertebral compression fracture with little or no trauma. If you suspect a compression fracture in the spine, please seek urgent medical attention.