Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
Upper back pain is an extremely common complaint in the general population; studies show that roughly one in five people experiences back pain at some point in their lives. Although it most often stems from simple causes such as poor posture or muscle fatigue, upper back pain can sometimes also be a herald of a more serious health problem. In this article, we explain in plain language why you feel pain in your upper back, which situations are simple and which require attention, and what helps relieve the pain.
What Is Upper Back Pain?
In medical terms, the part of the spine that lies between the neck and the lower back is called the “upper/mid back” (the thoracic region). This region contains 12 vertebrae stacked one on top of another, along with the surrounding muscles, ligaments, and other soft tissues; nerve roots also emerge from between the vertebrae toward the trunk.
Because the thoracic vertebrae are attached to the rib cage, this part of the spine is more stable and less mobile than the neck and lower back regions. For this reason, upper back pain is somewhat less common compared with lower back and neck pain. A problem arising in any of these structures in the upper back region can manifest as upper back pain.
What Causes Upper Back Pain?
Upper back pain has many causes. These causes can generally be mechanical (musculoskeletal), postural (related to posture), neurological (nerve-related), or related to the internal organs.
Poor Posture and a Sedentary Lifestyle
The most frequently encountered cause is poor posture habits and a sedentary lifestyle. Sitting in the same position for long periods, especially at a computer, weakens the back muscles, increases the load on the spine, and leads to muscle tension, fatigue, and pain. The fact that regular exercise is not part of one’s life is the underlying factor in the vast majority of cases of upper back pain.
Muscle Strain, Spasm, and Trigger Points
Sudden movements, heavy lifting, or improper positions can cause strain and spasm in the back muscles. In muscles that remain tense for a long time, trigger points (sensitive knots), known colloquially as “knots,” can develop over time. Such muscle-related pain is notable for being triggered when pressure is applied to the back muscles.
Stress and Muscle Tension
Stress and anxiety are an important source of upper back pain that most people do not notice. A person under stress unknowingly tightens the muscles of the spine; this prolonged tension can cause upper back pain and, over time, a hunched posture. Hunching, in turn, increases the load on the spine even further and intensifies the pain.
Spine-Related Causes
Sometimes a problem directly related to the spine underlies upper back pain: calcification of the vertebrae, spinal curvatures (scoliosis, kyphosis), vertebral compression fractures due to bone loss (osteoporosis), and the rarely seen thoracic disc herniation are among these. In addition, because a cervical (neck) herniation is anatomically close to the upper back, it can cause pain that radiates to the upper back; if this pain is accompanied by weakness or numbness in the arm, it may be a herald of a cervical herniation.
Pain Referred from the Internal Organs
A very important point is this: upper back pain does not always originate from the musculoskeletal system; problems in internal organs such as the heart, lungs, stomach, gallbladder, or kidneys can also cause pain that radiates to the upper back. For this reason, the nature of the pain and the accompanying symptoms are particularly important (see the warning section below).
Fibromyalgia and Rheumatic Causes
Fibromyalgia, a type of soft-tissue rheumatism, frequently manifests as upper back pain, together with sensitive points in various parts of the body. It is more common in women in particular and may run a course alongside symptoms such as fatigue, sleep problems, stress, and low mood.
The Symptoms and Types of Upper Back Pain
Upper back pain presents in different forms depending on the underlying cause. Muscle-related pain is generally a dull pain that gives a sense of tension and changes with movement or certain positions. Nerve-related pain, on the other hand, can be sharper and may occur together with numbness, tingling, or loss of strength. Whether the pain is constant or arises with movement, whether it increases at night, and whether it goes away with rest provide decisive clues that help the doctor reach the correct diagnosis.
In Which Symptoms Should You Definitely See a Doctor?
The vast majority of upper back pain is due to simple causes and is temporary. However, some symptoms may be a sign of a serious condition and should be evaluated without delay. See a doctor in the following situations:
- Upper back pain accompanied by chest pain, shortness of breath, and cold sweating, or pain radiating to the arm, jaw, or shoulder blade. This picture may be a sign of a heart attack and is an emergency; you should go to the nearest emergency department without delay.
- Upper back pain that does not go away with rest and increases at night, accompanied by fever, weight loss, and fatigue (which may be a sign of an infection or rarer serious diseases).
- Pain that begins after a fall, accident, or blow (the possibility of a fracture in the spine).
- Progressive loss of strength or numbness in the legs or arms, or a change in bladder/bowel control.
- Sudden and severe pain on the sides of the back (which may be an internal organ–related problem such as a kidney stone).
How Is Upper Back Pain Diagnosed?
Diagnosis begins with a detailed history and a physical examination. The doctor evaluates the location, nature, and duration of the pain and the accompanying symptoms. When necessary, imaging methods such as X-ray or MRI are used to clarify the diagnosis. In situations where the pain is thought to possibly originate from the internal organs, additional tests may be requested. What matters is identifying the correct cause by evaluating not the pain alone but the entire picture together.
What Helps Upper Back Pain? Treatment Methods
Most mild, muscle-related upper back pain can be brought under control with simple methods that can be applied at home. Treatment is always directed at the cause of the pain:
- Exercise and physical therapy: This is the primary treatment for pain due to muscle spasm, trigger points, and weakness. Programs that strengthen the back muscles and increase flexibility are applied.
- Posture and ergonomic adjustments: Making the work environment ergonomic and adopting correct sitting habits are at the center of both treatment and prevention.
- Medication: Painkillers and muscle relaxants deemed appropriate by the doctor help relieve the pain.
- Heat application: In pain due to muscle tension, applying heat generally relaxes the muscles and provides relief.
- Treatment directed at the cause: If the pain stems from a vertebral fracture, treatment of the fracture; in spinal curvatures (scoliosis/kyphosis), bracing or surgical approaches depending on the stage, may come into play.
Only a small portion of upper back pain requires surgery; this is generally considered when nerve compression or a serious spinal problem is involved.
Recommendations to Prevent Upper Back Pain
The most effective way to protect the health of your upper back is an active lifestyle. Keeping the back muscles strong through regular exercise and stretching, avoiding sitting in the same position for long periods and taking frequent breaks (and getting up during the break), setting up an ergonomic work arrangement, adopting correct posture habits, maintaining a healthy weight, managing stress, and staying away from smoking are the main measures that can be taken.
Frequently Asked Questions
Below, we have gathered the most frequently asked questions about upper back pain along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by your doctor.
What causes upper back pain?
The most common cause is muscle tension related to poor posture and a sedentary lifestyle. In addition, muscle strain, stress, calcification of the spine, curvatures, fractures due to osteoporosis, fibromyalgia, and sometimes problems in internal organs such as the heart, lungs, stomach, or kidneys can cause upper back pain.
How does upper back pain go away, and what helps it?
In muscle-related pain, regular exercise, physical therapy, correct posture, heat application, and the painkillers/muscle relaxants recommended by the doctor are generally effective. Staying active and making the work environment ergonomic also support recovery. However, if the underlying cause is different, the treatment must be directed at that cause.
Is upper back pain dangerous?
Most upper back pain is simple and temporary. However, pain that occurs together with chest pain and shortness of breath, that increases at night and does not go away with rest, that is accompanied by fever or weight loss, that begins after trauma, or that runs a course with loss of strength should be taken seriously, and a doctor should be consulted.
Can upper back pain be related to the heart?
Yes, it can. In particular, upper back pain that radiates to the shoulder blade, arm, or jaw and is accompanied by chest pain, shortness of breath, and cold sweating may be a sign of a heart attack. This situation is an emergency, and you must go to the nearest emergency department immediately.
Which doctor should I see for upper back pain?
Depending on need, you can consult a family physician or specialists in physical therapy and rehabilitation, orthopedics, neurology, or pain management. If the pain stems from a serious problem related to the spine, an evaluation by brain and spine surgery may be necessary.
Is heat or cold better for upper back pain?
In upper back pain due to muscle tension, applying heat generally relaxes the muscles and provides relief. Since which application is more appropriate may vary according to the cause of the pain, if you are unsure, it is best to consult your doctor.
How long does upper back pain take to go away?
Simple muscle-related pain often subsides within a few days to a few weeks with rest and appropriate measures. In pain that does not go away with rest, lasts a long time, or gradually increases, it is necessary to see a doctor so that the underlying cause can be investigated.
Is there such a thing as a thoracic disc herniation?
Yes, but a disc herniation in the thoracic (upper back) region is seen quite rarely compared with lumbar and cervical herniations. In cases that do not respond to physical therapy or that run a course with progressive neurological findings, surgery may be necessary.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The cause of upper back pain and its appropriate treatment vary from person to person and can only be determined by a doctor who evaluates you. If you have a complaint or before making any decision regarding your health, always consult a specialist physician. In the case of symptoms such as chest pain, shortness of breath, or pain radiating to the arm/jaw, go to the nearest emergency department without delay.