The Surprising Causes of Upper Back Pain

The Surprising Causes of Upper Back Pain

What Are the Causes of Upper Back Pain?

According to the Journal of Rheumatic Diseases and Treatment, upper back pain only constitutes 15% of spinal pain cases. If you’re wondering why it’s less common than lower back pain, the answer lies in the structure and function of the upper back.

The thoracic spine holds the upper and middle back. It is composed of 12 vertebrae connected to each other through discs that also serve as shock absorbers.

The spine is also connected to the rib cage, together forming a structural shield that protects your lungs and other internal organs.

Its structure is what makes the upper back stable and less vulnerable to injuries. However, it’s also the same reason why it’s not as flexible as your neck or lower back.

Upper back pain can be felt in your neck, shoulders, in-between your shoulder blades, or ribs. Depending on its severity, upper back pain can last anywhere from less than four weeks (acute) to more than 12 weeks (chronic).

Successful treatment isn’t possible unless you first identify the cause. For some, it can be as simple as poor lifestyle choices while for others, the culprit is a much more serious medical condition.

What Causes Upper Back Pain?

Dealing with upper back pain is not a clear-cut approach. Different variables can contribute to the pain, and each case can be more complicated than the next.

Whereas some cases can be easily explained, others–like nonspecific upper back pain–can’t be attributed to any medical condition. Upper back pain also varies regarding location.

Most one-sided upper back pain is caused by poor postural habits exacerbated by an individual’s right- or left-handedness.

For example, a driver or a sedentary worker who is right-handed is more likely to suffer from right-sided upper back pain. The imbalance causes the overworked muscles on his dominant side to tighten while leaving the other side weaker.

Left-sided upper back pain, meanwhile, can be a symptom of a failing heart. Especially if pain or numbness appear on the left chest and arm, this one-sided back pain should never be taken for granted.

Central upper back pain may also be a manifestation of a critical illness, usually of the spinal column. This type of upper back pain should prompt you to visit the doctor, most importantly if the pain doesn’t go away.

It can be a sign of spinal irritation caused by a variety of conditions ranging from osteomyelitis and compression fracture to epidural abscess and cancer.

What are the most common causes of upper back pain? Living an unhealthy lifestyle, poor posture, psychological issues, and other risk factors.

1. Unhealthy Lifestyle

Slacking off, smoking, and chowing down on greasy fast food may feel good at the moment, but they can backfire on your upper back if you don’t take control.

Once you become overweight, your back will be burdened by all the extra pounds you’ve gained. In a 2011 study in the Pain Research and Management journal, middle-aged British women who are overweight and have diets rich in fatty food and chips reported of chronic pain involving the upper back.

In contrast, exercise or regular physical activity improves the muscle tone and reduces one’s likelihood of developing upper back pain. A study in Preventive Medicine, for instance, found that regular sporting activities for ten months a year can decrease pain and sickness absence related to upper limb symptoms.

Smoking is another underrated factor that can double your risk of having upper back pain. Chemicals from the cigarettes irritate the nerves and eventually lead to weakened muscles.

Case in point: A 2009 study in the Journal of Chiropractic Medicine found that nonsmoking participants demonstrated higher mobility of the thoracic spines than smokers.

2. Poor Posture

A report in The Spine Journal reveals that our habit of looking down at our phones has led to a rising number of patients suffering from neck and upper back pain.

We can also see the same bad habit at home or workplace. Whether it’s watching TV or working in front of the computer, people tend to hunch.

Getting up from your chair regularly to do some stretching and keeping a good posture can go a long way in preventing upper back pain.

The same goes for phone addicts out there: Putting your device at eye level and taking regular breaks from your browsing can lift the weight off your neck and upper back muscles.

3. Psychological Issues

The more you hide your psychological issues, the more these pent-up emotions will overpower you.

One theory explains that internalizing your stress or depression only triggers an inner tension. This tension causes the blood vessels to constrict and cut blood supply to essential muscles and body organs.

Eventually, the lack of oxygenated blood causes muscles to produce metabolic byproducts which then contribute to back pain.

In addition to that, the negative emotions can crush your motivation, preventing you from doing things like exercise and meditation that would have helped you cope.

Several studies have verified the link between mental health and back pain.

In a study published in BMC Public Health, researchers found a prevalence of back and neck pain among Australian adolescents with mental health issues. A similar link between depression and back pain was found in a 2016 study in General Hospital Psychiatry involving more than 190,000 participants from different countries.

4. Muscular Irritation and Joint Dysfunction

Muscle irritation or myofascial pain is common among sports and fitness enthusiasts who push their bodies to the limit. When overstimulated, their muscle fibers tend to stick to each other and remain in a constant state of contraction.

The overuse injuries are usually amenable to physical therapy, massage, and chiropractic therapy.

Dysfunction in the joints can also result in upper back pain. The inflammation usually occurs in the joints that connect both sides of the ribs to the thoracic spine.

Joint disruption is usually managed through manual manipulation complemented by stretching and strengthening exercises.

5. Other Causes of Upper Back Pain

Anything, no matter how harmless it appears, can lead to upper back pain if it disrupts your spinal curvature.

Other causes of upper back pain may include:

  • Ill-fitting shoes that affect your gait
  • A bra that isn’t compatible with your breast size
  • Bags that are heavier than what your back can tolerate–regardless if it’s a backpack or shoulder bag

Although less common, there are also serious medical conditions that can cause upper back pain, all of which require careful evaluation of a physician. These include osteoarthritis, spinal stenosis, herniated discs, fibromyalgia, and degenerative disc disease.

When Should You Go to the Doctor for Upper Back Pain?

Mild to moderate back pain, as long as not caused by an underlying medical condition, usually disappears after a few weeks with little or no treatment. Limited bed rest, heating pads, and over-the-counter painkillers will usually relieve upper back pain.

However, as mentioned previously, upper back pain is also one of the telltale signs of an impending heart attack.

Consider it as an emergency if the back pain is accompanied by:

  • A fast or irregular heartbeat
  • Lightheadedness
  • Sweating
  • Shortness of breath
  • Chest pain
  • Nausea and vomiting
  • Numbness and/or tingling sensation that runs through your neck, shoulders, arms, and upper jaw

Schedule an appointment with your doctor if the upper back pain doesn’t improve after a week and instead worsens, especially at night when you lie down. Take note of any swelling on your back, sudden weight loss, and pain or numbness that extends on one or both of your legs.

Immediately call 911 if the upper back pain is a result of a car crash or sports injury and occurs with loss of bladder and/or bowel control, numbness and/or weakness of legs, fever, and painful urination.


BMC Public Health (Back and neck pain are related to mental health problems in adolescence)

General Hospital Psychiatry (The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries)

Journal of Chiropractic Medicine (The effects of smoking on intersegmental motion in the upper thoracic spine)

Journal of Rheumatic Diseases and Treatment (Differential Diagnosis in Upper Back Pain)

Pain Research and Management (Diet, lifestyle and chronic widespread pain: Results from the 1958 British Birth Cohort Study)

Preventive Medicine (The effect of physical activity in leisure time on neck and upper limb symptoms) (All About Upper Back Pain)

The Irish Times (Why our social media habits are a pain in the neck)

WebMD (Upper and Middle Back Pain – Topic Overview)

WebMD (Upper and Middle Back Pain – When to Call a Doctor)

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A “hunched over” posture causes muscles to shorten and become tight overtime, causing back pain. Better posture and exercises can help alleviate this pain.
by Jeremy Ethier on June 12, 2017
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