Patient education: Upper back pain (The Basics)

What is upper back pain? — Upper back pain is felt anywhere from the base of the neck to the middle part of the back. This is called the "thoracic" spine (figure 1). It is the part of the back where the ribs connect to the spine.

The upper back and ribs help keep the back stable and protect the organs in the chest. The upper back does not have as much movement as the neck or lower back.

With upper back pain, you might also have pain in your neck, arms, and shoulders.

What are the parts of the back? — The back is made up of (figure 2):

●Vertebrae – These are the bones of the spine. Each has a hole in the center. The vertebrae are stacked to form a hollow tube called the "spinal canal." The spinal cord passes through this tube and is protected by the vertebrae.

●Spinal cord and nerves – The spinal cord is the bundle of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, the legs, and the organs.

●Discs – Rubbery discs sit in between each of the vertebrae. These add cushion and allow movement.

●Muscles, tendons, and ligaments – These support the vertebrae. They are used to move the head and neck, stand upright, and bend and flex the body. They are also called the "soft tissues" of the neck and back.

What causes upper back pain? — Many different things can cause upper back pain. Most of the time, doctors do not know the exact cause.

Upper back pain can happen if you strain a muscle. Sometimes, it starts suddenly after physical activity. For example, you might have pain after throwing, lifting something heavy, twisting, or bending over.

Upper back pain can also happen if you have:

●Bad posture

●Damaged, bulging, or torn discs

●Arthritis affecting the joints of the spine

●Bony growths on the vertebrae that press on nearby nerves

●A vertebra or rib out of place

●Narrowing in the spinal canal

●An accident or injury

●A problem with an organ in the upper abdomen or chest

●A tumor or infection (but this is very rare)

How is upper back pain diagnosed? — Your doctor or nurse will do an exam and ask about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. They will see how you move and bend. They might also check your muscle strength and reflexes.

Most people do not need an imaging test like an X-ray, CT scan, or MRI. Most of the time, upper back pain goes away within a few weeks. Doctors usually do not order imaging tests unless there are signs of something unusual.

If your doctor does not order an imaging test, do not worry. They can still learn a lot about your pain just from looking you over and talking with you.

How is upper back pain treated? — Most people with an episode of upper back pain do not have a serious medical problem and can try simple treatments. These include:

●Staying active – Try to stay as active as possible without causing too much pain. People with mild back pain recover faster if they stay active and avoid bedrest. If your pain is severe, you might need to rest for a day or 2. But it's important to get back to walking and moving as soon as possible. You should avoid heavy lifting, twisting, reaching, and sports while your back hurts, but try to keep doing your normal daily activities.

●Heat – Some people find that it helps to use a heating pad or heated wrap for short periods of time. Put a heating pad (on the low setting) on your upper back for 20 minutes at a time a few times each day. Be careful to avoid high heat settings to prevent skin burns.

●Medicines – Take a medicine like ibuprofen (sample brand names: Advil, Motrin) or naproxen (brand name: Aleve) for pain, if needed. These are nonsteroidal anti-inflammatory drugs ("NSAIDs"). You can also take acetaminophen (sample brand name: Tylenol).

●Treatments to help with symptoms – Some treatments might help you feel better for a little while. They include:

•Spinal manipulation – This is when a chiropractor, physical therapist, or other professional moves or "adjusts" the joints of your back. If you want to try this, talk to your doctor or nurse first.

•Acupuncture – This is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals.

•Massage – A massage therapist massages the muscles and other soft tissues in your back.

•Physical therapy – In some cases, your doctor might suggest learning exercises or stretches to help with your pain.

Can upper back pain be prevented? — It's important to stay active and stretch your muscles. Other tips to help prevent upper back pain include:

●Use good posture.

●Do not sit or stand in 1 position for a long time.

●Avoid wearing heavy backpacks or purses.

●If you have a desk job, keep your computer at eye level and use a supportive chair.

●If you wear a bra, make sure it has good support.

●Use a supportive pillow when sleeping. Avoid sleeping on your stomach.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

●You have trouble breathing.

●Your pain becomes severe.

●You develop new weakness in 1 or both arms, or you cannot move your arm.

Call your doctor for advice if:

●Your arms are numb, weak, or tingly.

●You have a fever of 100.4°F (38°C) or higher or chills, or are coughing up mucus that looks green or yellow.

●Your pain is getting worse, even with medicines and rest.

●You cannot do your daily activities or sleep because of the pain.

More on this topic

Patient education: Herniated disc (The Basics)
Patient education: Lumbar spinal stenosis (The Basics)
Patient education: Radiculopathy of the neck and back (including sciatica) (The Basics)
Patient education: Scoliosis (The Basics)
Patient education: Vertebral compression fracture (The Basics)
Patient education: Low back pain in adults (The Basics)

Patient education: Back pain in children and adolescents (Beyond the Basics)
Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)
Patient education: Low back pain in adults (Beyond the Basics)