Causes of Upper Back Pain

Upper back pain can occur as a result of trauma or sudden injury, or it can occur through strain or poor posture over time.

Upper back pain, along with neck and shoulder pain, is often caused by poor posture. 

Learn more: Thoracic Spine Anatomy and Upper Back Pain

As an example of the latter cause, in recent years, upper back pain has become a familiar complaint from people who work at computers most of the day. Often, upper back pain occurs along with neck pain and/or shoulder pain.

Read more about Chronic Neck Pain

The vast majority of cases of upper back pain are due to one (or both) of the following causes:

Muscular irritation (myofascial pain)

Joint dysfunction

Muscular Irritation Causing Upper Back Pain

The shoulder girdle attaches by large muscles to the scapula (the shoulder blade) and the back of the thoracic rib cage. These large upper back muscles are prone to developing irritation (myofascial pain) that can be painful and difficult to work out.

Watch a video about Myofascial Pain Syndrome

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, auto accidents, or other injuries can all result in pain from muscular irritation.

This type of upper back pain is most amenable to manual treatments, such as:

Exercise/Active and passive physical therapy

Chiropractic or osteopathic manipulation

Massage therapy

Acupuncture

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.

A conservative care (nonsurgical) specialist such as an osteopathic physician, a physiatrist/physical medicine and rehabilitation physician, or a chiropractor would be appropriate to see for treatment of upper back pain.

If there is a specific area that is very tender, the source of the upper back pain may be an active trigger point. Trigger points are usually located in a skeletal muscle and can be worked on by either one or a combination of the following treatments:

Massage therapy

Acupuncture

Trigger point injections with a local anesthetic (such as Lidocaine).

Pain medications can also be helpful. Muscular irritation usually includes some form of inflammation, so anti-inflammatory medications (such as ibuprofen or COX-2 inhibitors) can be helpful to reduce the inflammation.

Dysfunction in the joints where the ribs connect to the thoracic spine can cause upper back pain. It may be relieved by stretching. Learn more: Stretching for Back Pain Relief

Joint Dysfunction Causing Upper Back Pain

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.

See also: Thoracic Spine Anatomy and Upper Back Pain

Treatment for this type of injury usually includes manual manipulation (with an osteopathic physician, chiropractor or a physical therapist trained in manipulation) to help mobilize the joint and reduce the discomfort. Lasting relief usually also requires a home exercise program for stretching the spine and shoulders as well as strengthening. Aerobic conditioning is also very important to maintain sustained upper back pain relief.

Read more: Stretching To Relieve Back Pain

In addition to manual treatments, pain medications can help. Usually the most helpful medications are the anti-inflammatory medications (such as ibuprofen or COX-2 inhibitors), as the joint dysfunction can create inflammation.

Injections (e.g. epidural steroid injections) are usually not warranted for thoracic pain other than local trigger point injection.

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