What are the most likely causes of upper back pain?
The upper back is the area between the base of the neck and the bottom of the ribcage. There are 12 bones that make up the upper back, which doctors call the thoracic spine.
The first bone of the upper back begins at the base of the neck, and the 12th bone ends just below the ribcage. Upper back pain can appear anywhere between these bones.
Most people describe upper back pain as a burning or pulling sensation in one place, which may be the location of injury or strain.
Common causes of upper back pain
Though it is less common than lower back pain or neck pain, a study posted to Occupational Medicine indicated that 1 in 10 men and 1 in 5 women might suffer from upper back pain.
Doctors call upper back pain thoracic spine pain or TSP. Common causes include the following:
1. Muscle deconditioning and poor posture
Using the muscles infrequently or incorrectly can cause back pain.
People can condition their muscles over time to be stronger or more enduring through exercises and weight training.
The reverse is also true. Humans may decondition their muscles over time by not using them correctly.
In some muscles, including back muscles, deconditioning is as easy as sitting at a desk with incorrect posture for too long. A person may do this while at work.
Slouching in a chair over a desk may cause a loss of strength in the muscles. Over time, the weakening of muscles may lead to pain in the area as they experience strains or irritation.
When a person slouches, pressure from gravity and the body itself pushes on the spine, neck, discs, and ligaments. Over time, this pressure can lead to pain and other complications.
It is possible to condition the muscles to be stronger and more durable in most cases. This process starts with correcting the posture while sitting, and taking regular breaks from the desk to move around and stretch.
Exercises may also improve strength in the back, and using a standing desk can help, too.
Conditioning the muscle requires patience, however, and anyone with chronic upper back pain from weak muscles might benefit from seeing a physical therapist to find an exercise routine for their specific needs.
2. Muscle overuse
Overusing back muscles is another common cause of upper back pain. This typically occurs due to repeating the same motions over time. This can be a cause of:
- muscle strain
The classic example of how this occurs is a pitcher in baseball, who does a similar motion every time they pitch, which can often take a toll on their shoulder.
Other repetitive activities may cause similar pain. Someone who has to make the same motion all day, or lifts things above their head throughout the day, for example, may start to experience muscle irritation, tightness, or strain. This could turn into chronic pain if they ignore these signs.
Treatment for muscle overuse typically begins with resting the area, as well as using heat or ice packs to promote blood circulation to the muscle tissues. It may help to find ways to avoid the repeated motion where possible or to take breaks between activities.
A physical therapist may recommend exercises to promote flexibility and strength in the area.
3. Traumatic injury
A traumatic injury can also lead to back pain. This may be the result of situations that include:
- car accidents
- slipping and falling
- work-related accidents
- lifting incorrectly
- working out too hard
The injury is sometimes obvious, and pain appears just after the incident. At other times, the pain may not develop until later or the next day.
Traumatic injuries can be severe, and issues from injuries, for example, fractured vertebrae, put a person at risk of lasting complications, including chronic pain, nerve damage, and paralysis.
A doctor should look at all potential back injuries as it is vital that they heal properly to avoid long-term pain.
A doctor may refer the person to a physiologist or physical therapist to help muscle injuries heal properly. Severe injuries may require surgery.
4. Herniated disc
Discs in the spine prevent the vertebrae from rubbing against each other.
Herniated discs are more common in the lower back but may sometimes happen in the upper back too.
Discs are the soft, rubbery cushions between each vertebra. Herniated discs occur when a piece of this cushion pokes through and puts pressure on the spine.
Even a small amount of pressure can result in significant pain in the middle of the back, as well as other symptoms, including numbness or weakness in the arms or legs.
Most people do not need surgery for herniated discs and will recover with rest or by taking anti-inflammatory medications.
5. Pinched nerve
A herniated disc can slip far enough out that it compresses the nearby nerve. A pinched nerve in the middle back may cause:
- numbness and pain in the arms or legs
- problems with controlling urination
- weakness or loss of control in the legs
When a pinched nerve comes from a herniated disc, the treatment is similar to treating the herniated disc. A pinched nerve does not usually need surgery, though doctors may recommend spinal steroid injections in some cases.
The source of back pain is sometimes not the muscles, but a problem in the bones and joints.
The cartilage that cushions and protects the bones may wear down as a person ages. The term for this is osteoarthritis. It is the most common form of arthritis among older adults, according to the United States National Institute on Aging.
Osteoarthritis may eventually lead to cartilage between the bones completely wearing away, causing the bones to rub together. This can also put pressure on the nerves in the spine, causing numbness or tingling in the arms and legs.
Anyone who suspects they have osteoarthritis should see a doctor for a diagnosis and treatment plan. Treatment typically focuses on managing pain and keeping the joints functioning.
7. Myofascial pain
Pain may also stem from problems in the connective tissue in the back, which doctors call the fascia.
Myofascial pain may begin after an injury or overuse, but chronic myofascial pain may last long after the initial injury.
It is still uncertain why myofascial pain continues in some cases. Doctors may recommend physical therapy and myofascial release therapy to enable a person to work the fascia and relieve the pain.
8. Spinal infection
In some cases, surgery may be necessary to treat a spinal infection.
Rarely, an infection may be the cause of upper back pain. A spinal epidural abscess is a collection of germs and pus that form between the spinal cord and bones of the spine.
The abscess can grow and swell, leading to pain. Early diagnosis is critical, and doctors will treat a spinal abscess quickly to avoid serious complications.
Antibiotics may help, and surgery may be necessary to clear the abscess and reduce the risk of complications.
A study posted to BioMed Research International notes that mortality can vary from 2 to 25 percent in people with spinal epidural abscess, typically, because it may take too long to diagnose their condition.
9. Lung cancer
Back pain may be due to lung cancer in very rare cases.
A case study in the Journal of the Advanced Practitioner in Oncology highlights one such case. The study notes that complications can cause the cancer to spread to the bones in about 30 to 40 percent of people with non-small cell lung cancer.
Specific conditions affecting the spine or muscles may also lead to upper back pain. These include:
Treatment for each condition varies and will have varying degrees of success.
Preventing upper back pain
It may not be possible to prevent all causes of upper back pain, but there are some easy steps people can take that may avoid some of the more common causes. These include:
- Take regular breaks from sitting or lying down to stretch and move different muscle groups.
- Take frequent breaks when working at a desk to stretch, so the muscles stay loose and strong.
- Take a few minutes to stretch the muscles or warm up the body before any activities.
- People who lift heavy objects should avoid twisting or lifting with their back.
- Have regular massages to help work out the tension of the muscles.
- Work with a physical therapist to strengthen weak muscles and keep pressure off the joints.
- Avoid wearing heavy backpacks or purses.
- Be conscious of posture at all times, walking upright and sitting correctly, using back supports if necessary.
Most cases of back pain appear because of lifestyle issues, such as weak or overused muscles from repetitive behaviors. In these cases, lifestyle changes, such as regular exercise and stretching, may help relieve pain.
In cases of trauma or chronic back pain, people should see a doctor for a proper diagnosis. Anyone who is uncertain where to begin should ask their doctor about their pain and treatment options. They may recommend specific exercises or refer a person to a physical therapist.