Last Updated: October 26, 2026
Quick Summary
Causes of upper back pain are most commonly a result of muscle strain and overuse, followed by poor posture and prolonged sitting. Heavy lifting, thoracic facet joint and disc problems, neck and shoulder referred pain, one-sided strain patterns, and underlying medical conditions are the other potential causes. Most cases trace back to everyday habits rather than serious disease.
- Muscle strain is the most common cause of upper back pain and is usually manageable at home.
- Stand and move every 30 to 45 minutes to break up prolonged sitting at your desk.
- Lift with your legs, not your back, and keep the load close to your body.
- Most muscular upper back pain improves substantially within two to six weeks with activity modification.
- Seek emergency care for upper back pain with chest pressure, shortness of breath, or pain spreading to the jaw or arm.
Table of Contents
- What Causes Upper Back Pain: The Seven Most Common Reasons
- Muscle Strain and Overuse Injuries
- Poor Posture and Prolonged Sitting
- Heavy Lifting and Sudden Movement
- How the Thoracic Spine and Supporting Structures Create Pain
- Causes of Middle Back Pain and How They Differ From Upper Back Pain
- Upper Right Back Pain Causes: Why One Side Hurts More
- Neck, Shoulder and Referred Pain: When the Problem Is Elsewhere
- Exercises for Mid Back Pain You Can Start This Week
- When to See a Chiropractor for Back Pain
- Book an Assessment at Strudwick Chiropractic
- Frequently Asked Questions
What Causes Upper Back Pain: The Seven Most Common Reasons
Upper back pain is discomfort in the thoracic spine, between your neck and lower back. At Strudwick Chiropractic, we see it often, and most cases trace back to everyday habits rather than serious disease.
The seven most common reasons are:
- Muscle strain and overuse
- Poor posture and prolonged sitting
- Heavy lifting or sudden movement
- Joint dysfunction in the thoracic spine and disc problems
- Neck and shoulder referred pain
- One-sided strain patterns
- Underlying medical conditions
Most people can manage the first three at home; the last four deserve a closer look.
Here are the seven most common reasons upper back pain shows up, and how often they can be managed at home.
| Cause | Notes |
|---|---|
| Muscle strain and overuse | Most common cause; usually manageable at home |
| Poor posture and prolonged sitting | Second big driver; usually manageable at home |
| Heavy lifting or sudden movement | Usually manageable at home |
| Thoracic spine and disc problems | Deserves a closer look |
| Neck and shoulder referred pain | Deserves a closer look |
| One-sided strain patterns | Deserves a closer look |
| Underlying medical conditions | Deserves a closer look |
Muscle Strain and Overuse Injuries
Muscle strain is the most common cause of upper back pain, occurring when muscles or ligaments in the thoracic region are stretched or torn by repeated use or a sudden load.
A strain doesn’t require a dramatic moment. Hours at a keyboard, a heavy bag on one shoulder, or a new gym routine can overload the same muscles day after day.
Signs of a strain include:
- Aching or tightness between the shoulder blades
- Pain that worsens with certain movements
- Tenderness when you press on the area
Overuse injuries respond well to relative rest, not complete bed rest. Keep moving gently. If pain lingers past a couple of weeks, get it checked.
Poor Posture and Prolonged Sitting
Slouching at a desk is the second big driver of upper back pain. Sitting rounded forward for hours leaves the muscles supporting your thoracic spine stretched and the ones holding you upright weak.
The problem is accumulation, not one bad afternoon. Many office workers find pain builds through the workweek and eases on weekends, a strong clue the desk setup is involved.
Simple fixes worth trying:
- Raise your screen to eye level
- Keep your feet flat and your chair supportive
- Stand and move every 30 to 45 minutes
If your pain keeps returning despite these changes, the workstation itself may need a proper look. You can learn more about office ergonomic consultations in Victoria, BC and how an assessment of your work station can address the cause.
Heavy Lifting and Sudden Movement
Lifting with a rounded back or twisting under load can strain the thoracic region in a single moment, as can an awkward reach into the back seat of a car.
The mistake we see most is lifting with the back instead of the legs, then ignoring the warning twinge that says the load was too much for the position.
To protect your upper back:
- Keep the load close to your body
- Bend at the knees, not the waist
- Avoid twisting while carrying something heavy
If pain follows a lift and doesn’t settle within a few days, or if it comes with numbness or weakness, seek an assessment.
How the Thoracic Spine and Supporting Structures Create Pain
The thoracic spine is built for stability: each vertebra connects to a rib, making this region stiffer than your neck or lower back.
That stiffness is protective but has a downside: when joints between vertebrae or ribs lose movement, nearby muscles tighten to compensate, producing that familiar ache between the shoulder blades.
Supporting structures that can cause pain include:
- Muscles and ligaments: the most common source
- Facet joints: small joints between vertebrae that can stiffen
- Discs: cushions that can bulge or, rarely, herniate in this region
Disc problems are far less common in the thoracic spine than the lower back, but when they happen, pain can wrap around the ribcage and be mistaken for other problems.
Causes of Middle Back Pain and How They Differ From Upper Back Pain
Middle back pain and upper back pain overlap heavily because the thoracic spine runs from the base of the neck to the bottom of the ribcage, so the terms are often used interchangeably.
The difference is mostly one of location and pattern:
- Upper back pain sits between the shoulder blades and toward the neck
- Middle back pain sits lower, near the bottom of the ribcage
Causes of middle back pain follow the same list, strain, posture, lifting, joint stiffness, though the lower thoracic spine carries more load, so prolonged standing or carrying weight can irritate it more.
If your pain moves around or shifts sides, that pattern often points to a muscular cause rather than a structural one.
Upper Right Back Pain Causes: Why One Side Hurts More
One-sided pain usually means one-sided strain. Upper right back pain causes include:
- Carrying a bag or child on the same shoulder
- Sleeping on one side without support
- A desk setup where the mouse arm reaches forward
There is one important exception. Pain on the right side under the shoulder blade, especially if it comes with abdominal symptoms, can sometimes be referred from the gallbladder or liver. This is uncommon, but it is why persistent right-sided pain that doesn’t respond to movement deserves a proper look.
Most one-sided upper back pain, though, is muscular and responds to balancing your daily habits.
Neck, Shoulder and Referred Pain: When the Problem Is Elsewhere
Sometimes the upper back isn’t the problem at all. The neck, shoulder, and thoracic spine share muscles, fascia, and nerve pathways, so a problem in one area can be felt in another, referred pain. Recognizing its patterns is one of the most useful skills you can build as a patient.
How referred pain works
Referred pain happens when nerve signals from one structure converge on the same spinal cord segment as signals from another, and the brain misattributes the source. That’s why a stiff lower neck joint can produce a deep ache between the shoulder blades, or a rotator cuff problem can refer pain toward the upper thoracic region.
Three broad patterns are worth knowing:
- Neck-driven pain: ache or tightness that worsens with neck rotation, extension, or sustained head positions, often with headaches or stiffness at the base of the skull.
- Shoulder-driven pain: pain that tracks toward the shoulder top or upper arm and worsens with overhead reaching, lifting, or lying on that side.
- Thoracic-driven pain: pain that stays between or just beside the shoulder blades and changes with trunk movement, breathing, or prolonged sitting.
Clues that the source is elsewhere
- Pain that reliably worsens with neck movement points toward the cervical spine.
- Headaches alongside upper back pain suggest a neck component.
- Shoulder weakness or a limited range of motion suggests the shoulder joint or rotator cuff.
Non-spinal referred causes: when to think beyond the back
A small share of upper back pain is referred from organs inside the chest or abdomen.
Seek emergency care or call emergency services if upper back pain comes with any of the following: chest pressure or squeezing, pain spreading to the jaw, neck, or arm, shortness of breath, cold sweat, nausea, fainting, or a sudden tearing sensation between the shoulder blades. These can signal a heart or aortic event and are not a wait-and-see situation.
Other non-spinal patterns to discuss promptly with a clinician:
- Lung-related: pain that worsens with deep breathing or coughing, especially with fever, cough, or shortness of breath.
- Digestive-related: right-sided pain under the shoulder blade with abdominal symptoms, nausea, or pain after fatty meals, sometimes gallbladder-related.
- Kidney-related: pain that wraps from the back toward the flank, often with urinary changes or fever.
None of these is common, and most upper back pain is muscular. The point is to know which patterns don’t fit the muscular story and should be checked rather than stretched.
If neck movement clearly triggers your upper back pain, the neck is worth examining first. We cover the common patterns in our guide to neck pain when turning your head.
Exercises for Mid Back Pain You Can Start This Week
Gentle movement is one of the best things you can do for mid back pain. These exercises are low risk for most people and easy to do at home.
Try these four moves:
- Thoracic extension: lie over a rolled towel or foam roller, arms crossed, and breathe slowly for 30 seconds
- Cat-cow: on hands and knees, alternate arching and rounding your spine for 10 slow reps
- Wall angels: stand with your back to a wall and slide your arms up and down for 10 reps
Do these once or twice a day. If you want a wider set of desk-friendly options, our guide to stretches for back pain from sitting has seven moves you can do without leaving your chair.
When to See a Chiropractor for Back Pain
Most upper back pain is self-limiting. Knowing what to do in the first days, what to expect over the first weeks, and which symptoms change the plan beats a single “see someone if it lasts” rule.
A practical decision path
Days 0-3: calm it down, keep moving.
- Modify, don’t stop. Reduce loads and avoid positions that sharply reproduce pain, but keep gentle daily movement.
- Use heat for muscle tightness and ice for a recent, localized strain if that feels better to you.
- Over-the-counter pain relief may be appropriate for some people; check with a pharmacist or clinician about what is safe for you, especially with other medications or health conditions.
Days 3-14: rebuild tolerance.
- Gradually return to normal activity as pain allows.
- Add gentle thoracic mobility and postural endurance work (see the exercise section above).
- Address the obvious driver: desk setup, bag-carrying side, training load, or sleep position.
Weeks 2-6: reassess.
- Most muscular upper back pain improves substantially within two to six weeks with activity modification and gentle loading.
- If pain is unchanged, worsening, or spreading at this point, an assessment is reasonable.
When to book an assessment
Consider a chiropractor when:
- Pain lasts more than two weeks despite sensible self-care.
- Pain keeps returning in the same spot, suggesting an unresolved driver.
- Pain limits work, sleep, or daily activity.
When to seek urgent medical care instead
Go to emergency or call emergency services for upper back pain with any of the following: loss of bladder or bowel control, numbness or weakness in both legs, new inability to walk, pain after a significant fall or accident, fever with severe pain, unexplained weight loss, night pain that wakes you, a history of cancer with new back pain, or chest pain with shortness of breath, sweating, or pain radiating to the jaw or arm.
These signs are uncommon, but they matter. For a fuller list, read our guide on when to see a chiropractor for back pain.
What to expect from an assessment
A good assessment is not just an adjustment. It should include a history of when and how the pain started, what makes it better or worse, a physical exam of the neck, shoulder, and thoracic spine, and a clear explanation of the working diagnosis. Imaging isn’t routine for typical mechanical upper back pain and is usually reserved for red flags, trauma, or persistent symptoms that don’t fit a muscular pattern.
Most upper back pain improves within a few weeks with movement and habit changes. The decision rule is simple: manage the first two weeks actively, reassess at two to six weeks, and escalate sooner if any red flag appears.
Book an Assessment at Strudwick Chiropractic
If your upper back pain keeps coming back, a proper assessment beats guessing. Visit our chiropractor in Victoria, BC page to learn about our care and get started. At Strudwick Chiropractic, Dr. Mark Strudwick brings over 25 years of clinical experience and an International Certificate in Sports Chiropractic to every visit. Care is tailored to your needs, using adjustive techniques, soft tissue therapy, and rehabilitation exercises.
Frequently Asked Questions
Can poor posture cause upper back pain?
Yes. Slouching and prolonged sitting round the thoracic spine and keep the muscles between the shoulder blades working in a shortened position. Over hours and weeks that pattern creates muscle tension, stiffness and a dull ache across the upper back. Posture alone rarely causes damage, but it does load the same tissues repeatedly. Breaking up sitting every 30 to 45 minutes and adding strengthening work for the mid back usually reduces symptoms.
What are some good exercises for mid back pain?
Start with movements that open the thoracic spine and wake up the muscles that support it. Seated thoracic rotations, cat-cow, wall angels, and chest-opening stretches done for 5 to 10 slow repetitions each are a reasonable starting point. Add light rows or band pull-aparts two or three times a week to build endurance. Stop any exercise that sharply increases pain, and have a clinician check your technique if symptoms persist beyond a couple of weeks.
When should I see a chiropractor for back pain?
Book an assessment when pain lasts more than a week or two, keeps returning, limits your training or work, or comes with stiffness that does not ease with movement. A chiropractor can examine the thoracic spine, ribs and surrounding muscles, explain what is driving the pain, and build a plan that combines manual treatment with exercises. Seek urgent medical care instead if you have severe pain after trauma, numbness, weakness, or loss of bladder or bowel control.
Can stress cause upper back pain?
Stress contributes to upper back pain by increasing muscle tension in the neck, shoulders and between the shoulder blades. People under sustained pressure often hold their shoulders elevated and breathe shallowly, which fatigues those muscles over time. Stress also disrupts sleep and reduces how much people move, both of which slow recovery. Managing the load matters, but the muscular pattern still needs addressing with movement, posture changes and hands-on treatment where appropriate.
Upper back pain rarely needs to run your life. The right assessment finds the cause, and the right plan keeps it from returning. Get started with Strudwick Chiropractic and get back to moving without the ache.
