Upper back pain: causes, warning signs and treatment

What is upper back pain?

Your upper and middle back is called the thoracic spine: the 12 vertebrae between your neck and lower back, which connect to your ribs. Upper back pain is common, but it has received far less research attention than neck and lower back pain.

Common causes

• Muscle strain or tension, including tight, tender spots (trigger points) in the muscles between and around the shoulder blades
• Stiff joints where the ribs meet the spine
• Long hours in one position, such as at a desk, on a phone or riding
• Neck problems that refer pain into the upper back (neck pain)
• Age-related changes in the thoracic spine
• Injury, such as a fall or road accident

Symptoms

• aching, burning or sharp pain between or around the shoulder blades
• stiffness when twisting, or taking a deep breath
• tight, tender spots in the muscles
• pain that's worse after long periods sitting or looking down

When upper back pain needs urgent help

How it's diagnosed

At your Maana Spine assessment, your physiotherapist asks about your symptoms, work and daily routine, screens carefully for warning signs, checks how your upper back, neck, ribs and shoulders move, and reviews any MRI, X-ray or lab reports you bring. Scan changes in the upper back aren't necessarily linked to pain, so how you move and feel matters most.

You'll get a physiotherapy diagnosis and a personalised plan. You don't need a scan to book; if one would help, your physiotherapist will recommend an MRI or X-ray.

→ What happens at your spine assessment

What the research says

Upper back pain has had much less research than neck or lower back pain, so there's little evidence specific to it. Two findings are useful:

• Shockwave therapy (ESWT) for trigger points. Reviews show shockwave therapy (ESWT) reduces pain from neck and upper-back (trapezius) trigger points more than sham treatment. Evidence that it beats other active treatments, such as dry needling, is weaker.
• Exercise and hands-on care. The 2017 neck pain guideline from the American Physical Therapy Association recommends exercise and hands-on therapy, including treatment to the upper back, for many types of neck pain, which often overlaps with upper back pain.

Practical tips

• Move often. Change position and roll your shoulders regularly, especially at a desk or on your phone.
• Breathe and twist gently. Easy rotation and deep-breathing movements can ease stiffness.
• Set up your screen so you're not looking down for long periods.
• Stay active. Regular exercise helps your upper back cope with long days.

These are general tips, not a substitute for an assessment.

When to book a spine assessment

Book an assessment if upper back pain has lasted more than a couple of weeks, keeps coming back, or affects your work or sleep, and you don't have any of the warning signs above. Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.

Book a Spine Assessment · or call or WhatsApp +91 99950 09403