Upper back pain between shoulder blade and spine

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due December 2023

It’s possible to get upper back pain or middle back pain, as well as in your lower back. This is called thoracic back pain. It’s rarer than lower back pain, but still very common. You may have pain between your shoulder blades or anywhere between your neck and your waist.

About your back

It can help to know more about how your back is constructed.

Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons. Your spine supports your back. It’s made up of 24 separate bones called vertebrae that are stacked on top of one another. Below these are the bones of your sacrum and coccyx, which are at the bottom of your spine. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord passes through the vertebrae. It carries nerve signals between your brain and the rest of your body. The spinal cord ends in your lower back as a bundle of nerves. This is called the cauda equina (Latin for ‘horse’s tail’, which it was thought to resemble).

Causes of upper back pain

There are lots of potential causes of upper back pain. Sometimes you can get pain with no known cause. Back pain that doesn’t have a clear or known cause is called non-specific back pain. This is often due to irritation in the muscles and soft tissues in your back.

Upper back pain is often caused by having poor posture for a long time. Good posture means standing tall and straight with your shoulders back and down. Keep your head level – try not to tilt it. Your ears, shoulders, hips and ankles should all be in one line.

Other causes of upper back pain include:

• an accident or sudden injury such as whiplash or a sports injury
• straining a muscle or ligament your back
• lack of strength in the muscles of your back (for example, from not doing much exercise)
• sitting at a computer for long periods of time
• carrying a back pack
• repetitive movements causing overuse injury

Upper back pain can also be caused by some more serious conditions, such as:

• osteoporosis
• osteoarthritis
• spinal stenosis – the tunnel-like passage that carries your spinal cord through your vertebrae (the spinal canal) narrows and presses on the nerve
• slipped disc – one of the discs that are located between the bones in your spine (vertebrae) pushes out of position (although this rarely causes upper back symptoms) 
• ankylosing spondylitis

Symptoms of upper back pain

Symptoms can vary from person to person and depend on what’s causing the pain. The pain can be mild or more severe. You might have sharp pain in one particular spot or a general achiness that comes and goes. Back pain that doesn’t have a clear or known cause is called non-specific back pain.

If your back pain is significantly affecting your daily activities or stopping you from getting a good night’s sleep, see your physiotherapist or GP.

Diagnosis of upper back pain

Your doctor will ask about your symptoms and examine you. They may then be able to diagnose and explain the cause of your back pain or they may need to refer you for some tests. Upper back pain is often caused by muscle strain, but sometimes there might be a more serious cause. There are particular symptoms your doctor will look for that may indicate this. They call these red flags and they include:

• a recent injury to your back such as a car accident or a fall
• back pain caused by a minor injury or lifting something heavy – particularly if you have osteoporosis
• if you’ve had cancer or you have a weakened immune system
• other symptoms such as a fever, unexplained weight loss and chills
• a recent bacterial infection
• if you’re younger than 20 or older than 50

Your doctor will also ask you about the pain to understand how severe it is and what could be causing it. It can also mean a red flag if:

• symptoms haven’t eased despite changing position or resting
• you’ve had pain for more than two weeks despite having treatment
• you have pain that you don’t think has been caused by a sprain or strain in your upper back
• you are very stiff in the morning
• you have pain all the time and it’s getting worse

Your doctor may ask if you’ve had any weakness in your legs, or any bladder and bowel problems such as incontinence. This may point towards pressure on the nerves in your spine or spinal cord, which could be caused by a slipped disc or injury.

If you have another condition affecting your lungs, oesophagus, stomach, pancreas, liver or gall bladder, you might have referred pain. This is when a problem elsewhere is causing pain in your upper back.

Depending on your symptoms, examination and medical history, your doctor may refer you for further tests. These might include blood tests, X-rays and an MRI scan (a test that uses magnets and radio waves to produce images of the inside of your body). You might also have a DEXA scan, which measures how strong your bones are.

Treatment of upper back pain

If you have upper back pain, it’s likely to get better by itself without treatment. If it’s not caused by anything serious, it will probably get better within a few weeks.

You can try some self-care measures such as improving your posture or putting an ice pack or heat pack on the area that hurts. Make sure you wrap this in a towel and don’t apply it directly to your skin. You can also take over-the-counter painkillers such as ibuprofen or paracetamol as pain relief for upper back pain. Ask your pharmacist for advice.

If the pain is caused by a particular condition, your treatment will vary depending on the underlying problem that’s causing the pain.

Treatments may include medicines, physiotherapy, injections and manual therapies.

Prevention of upper back pain

The following tips may help to prevent you from developing upper back pain.

• Lift objects safely and correctly by bending at your knees and not from the waist.
• Make sure your back is properly supported when sitting.
• If you wake up with back pain, a more supportive mattress that adjusts to your back and supports its various curves and hollows may help.
• Take regular breaks from sitting for long periods of time and from doing repetitive tasks.
• Practise good posture – see our section on causes of back pain.
• Exercise regularly – see our FAQ on some specific exercises for upper back strength.
• Learn and practise good technique for any sports you’re doing.
• Stop doing any activity that you know is causing your back pain.
• Stop smoking – it can speed up the degeneration of the discs between your vertebrae that act as shock absorbers.
• If you are overweight, losing weight may help to reduce the risk of back pain.

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