Thoracic Pain

Upper back pain

A less common presentation

The thoracic spine is often time overshadowed by the more common and dramatic presentation of lower back and cervical spine pain. Low back pain and neck pain often lead to pain in the extremities (radiculopathies), but this is way less common in the TX spine mainly for two reasons: the thorax has restricted movement due to the attachments of the ribs; and also because disc herniations are way less common here. This is such an important part of the spine because is the home of the cell bodies of the sympathetic nervous system. 

Sometimes there may be an age-related occurence or objective deformity: for example, in children and teenagers scoliosis and hyperkyphosis are concerns.  In the second case, it is important to distinguish between simply bad posture (so common nowadays, especially with the use of smartphones) or abnormalities such as Scheuermann’s disease. 

With senior clients, the main concern is compression fracture, often the result of low bone density (osteoporosis). 

Anatomy of the Upper Back

The upper back, also known as the thoracic region, is located between the base of the neck and the lower back. It consists of 12 vertebrae (T1 to T12) that are attached to the rib cage, forming the thoracic spine. This region plays a crucial role in supporting the body’s framework, protecting the vital organs within the chest, and facilitating essential movements like bending, twisting, and extending.

The thoracic spine has a natural curvature called kyphosis, which helps maintain balance and posture. The upper back also comprises several muscles, ligaments, and other structures that work in harmony to support the spine and allow smooth movement.

Muscles in the upper back include the trapezius, rhomboids, levator scapulae, and latissimus dorsi, among others. These muscles help stabilize and move the shoulder blades and arms. Ligaments connect the vertebrae and stabilize the spine, and intervertebral discs act as shock absorbers between the vertebrae, enabling flexibility and preventing bone-to-bone contact.

Most common causes of upper back pain

Upper back pain can arise from various sources, and identifying the underlying cause is crucial for effective treatment. Some of the most common causes include:

Muscular Strain and Tension

Poor posture, overuse, or excessive strain on the upper back muscles can lead to tension and inflammation, resulting in pain. Activities that involve repetitive movements, such as long hours of sitting at a desk or lifting heavy objects, can contribute to muscular strain.

Poor Posture

Sustaining a hunched posture, especially while working on computers or using smartphones for prolonged periods, can strain the muscles and ligaments in the upper back.

Trauma and Injuries

Accidents, falls, or sports-related injuries can cause damage to the bones, muscles, ligaments, or intervertebral discs in the upper back, leading to pain.

Herniated or Bulging Discs

Discs act as cushions between the vertebrae. When a disc’s outer layer weakens or ruptures, it can press on nearby nerves, causing upper back pain.


As people age, the cartilage that cushions the joints may deteriorate, leading to a condition called osteoarthritis. This can affect the facet joints in the thoracic spine, resulting in pain and stiffness.


Excessive curvature of the upper back (kyphosis) can cause strain on the muscles and lead to discomfort.


A sideways curvature of the spine can affect the alignment of the upper back and contribute to pain. Read more about scoliosis here.

Degenerative Disc Disease

The natural aging process can cause wear and tear on the intervertebral discs, leading to degenerative disc disease, which may result in upper back pain.

Poor Sleeping Positions

Sleeping in awkward positions or on an unsupportive mattress can strain the muscles and lead to upper back pain.

Underlying Medical Conditions

Certain medical conditions like fibromyalgia, osteoporosis, and spinal infections can also manifest as upper back pain.

Remedies for upper back pain

Finding relief from upper back pain often involves a combination of self-care strategies, lifestyle adjustments, and professional treatments. If you are experiencing upper back pain, please do not under estimate your symptoms and get assessed by a health care professional. Here are some effective remedies:

Rest and Ice

Giving the affected area ample rest and applying ice packs for 15-20 minutes at a time can help reduce inflammation and ease muscle tension.

Heat Therapy

Applying heat (via a warm compress or heating pad) to the upper back can improve blood circulation, promote relaxation, and alleviate pain.

Over-the-Counter Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and reduce inflammation.

Physical Therapy

A physical therapist can design exercises to strengthen the upper back muscles, improve flexibility, and correct posture issues.

Correcting Posture

Consciously maintaining good posture throughout the day can prevent further strain on the upper back. Ergonomic adjustments in the workplace, such as using an ergonomic chair and setting up a proper computer workstation, can also help.

Stretching and Strengthening Exercises

Regular stretching exercises can improve flexibility, while specific strengthening exercises can target the upper back muscles and reduce pain.

Massage Therapy

Professional massage therapy can help relax tense muscles, improve circulation, and provide pain relief.


Acupuncture, a traditional Chinese therapy involving the insertion of fine needles into specific points on the body, is believed to help reduce pain and promote healing.

Chiropractic Care

Chiropractic adjustments may be beneficial for certain upper back pain conditions, particularly those related to spinal misalignments.

Weight Management

Maintaining a healthy weight can reduce strain on the spine and alleviate upper back pain.

Ergonomic Accessories

Using proper lumbar support in chairs and ergonomic pillows for sleeping can help improve posture and reduce pain.

Stress Reduction Techniques

Chronic stress can exacerbate pain, so practicing relaxation techniques like yoga, meditation, and deep breathing can be helpful.

Topical Analgesics

Creams or ointments containing pain-relieving ingredients like menthol or capsaicin can provide temporary relief when applied to the affected area.

When to seek medical attention

While many cases of upper back pain can be managed with self-care measures, there are instances when medical attention is necessary. You should seek medical evaluation if:

  • The pain is severe and persists for more than a few days.
  • The pain is accompanied by numbness, tingling, or weakness in the arms or legs.
  • The pain is the result of a traumatic injury or accident.
  • The pain is associated with difficulty breathing or other concerning symptoms.

In such cases, a healthcare professional can conduct a thorough examination, order diagnostic tests (e.g., X-rays, MRI), and provide appropriate medical advice or treatment.

Upper back pain is a common issue that can result from various causes, including muscular strain, poor posture, injuries, and underlying medical conditions. Fortunately, many cases of upper back pain can be managed and alleviated with self-care measures, lifestyle adjustments, and professional treatments like physical therapy or chiropractic care. Understanding the anatomy and common causes of upper back pain empowers individuals to take proactive steps to prevent and manage this discomfort effectively. If you experience persistent or severe upper back pain, it is essential to consult a healthcare professional for a proper diagnosis and personalized treatment plan.

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