Your upper and middle back area runs from the base of your neck to the bottom of your rib cage. Many issues can cause pain in this area, such as overuse, poor posture, or a pinched nerve. In most cases, it's nothing to worry about and can be treated at home. But if the pain comes with other symptoms or it's long-lasting, you'll need to see your doctor.
Your back’s structure
Your spine is divided into three sections: cervical, thoracic, and lumbar. Your cervical spine is in your neck, and your lumbar spine is in your lower back. If you have upper and middle back pain, that involves your thoracic spine.
There are 12 vertebrae in your thoracic spine. You may hear your doctor refer to them as T1 through T12. Between these vertebrae are spongy disks that act a lot like shock absorbers, cushioning the bones when you move around. Ligaments and muscles hold the spine together. Your thoracic spine is also surrounded by nerves that send messages throughout your body.
The thoracic spine works with your ribs to keep your body stable and to protect vital organs such as your heart and lungs.
Upper and Middle Back Pain Symptoms
The symptoms of upper and middle back pain vary, depending on what’s causing your discomfort. Some common symptoms include:
- Aches that may affect one part of your spine or spread to other parts
- Stabbing, knife-like pain in one area, which may also spread up and down your spine
- A burning or tingling sensation
- Stiffness that can keep you from being active
Causes
There are many reasons your upper and middle back can hurt. Some of these are:
- Strain or injury to the muscles and ligaments that support your spine, such as from overuse or lifting incorrectly
- Poor posture
- A pinched nerve
- A fractured vertebra
Other causes include:
Degenerated (worn-out) disk. Your disks can have normal wear and tear as you age. It's more common for this to happen in your lower back, but it's possible to have it in your thoracic spine as well.
Herniated disk. A degenerated disk can herniate, or slip out of place, and put pressure on nerves in your thoracic spine.
Osteoarthritis. Joint tissues – bone, cartilage, tendons, and ligaments – can start to break down as you age, leading to pain, swelling, and stiffness. This condition is more common in the lower back, but your middle and upper back could also be affected.
Myofascial pain syndrome. This is an ongoing (or “chronic”) pain disorder. It’s usually triggered after a muscle has contracted over and over. Sometimes, it’s related to your job or a hobby that requires the same repeated motion.
Gallbladder issues. Gallstones are pieces of hardened digestive fluids that can form in your gallbladder. The don't always cause pain, but if one gets stuck in the duct that empties wastes from your gallbladder, it can cause pain between your shoulder blades.
Spine deformities. Conditions such as scoliosis, which cause the spine to curve, can place strain on muscles and ligaments, resulting in pain.
Fibromyalgia. This chronic condition can cause pain all over the body, including the upper and middle back.
Spinal stenosis. This condition happens when the inside of your spine narrows and puts pressure on nerves.
Cancer. Some forms of cancer begin in the spine, and some forms of cancer can spread to the backbone and cause pain.
Upper and Middle Back Pain When Breathing
If the simple act of taking a breath brings on pain in your upper or middle back, see a doctor. The problem may not be serious, but back pain brought on by breathing can be a sign of a medical condition that needs prompt attention. Some possible causes of upper and middle back pain while breathing include:
- Anxiety
- Asthma
- Chest infection
- Chronic obstructive pulmonary disease (COPD)
- Lung cancer
- Pleurisy, an inflammation of the lungs’ lining, though this more commonly causes chest pain
- Pneumonia
- Pneumothorax, better known as collapsed lung
- Scoliosis
Upper and Middle Back Pain After Eating
You might have back pain after eating if you have gastroesophageal reflux disease (GERD). GERD is a a chronic condition in which stomach acid often flows back into your esophagus, the tube that carries food from the throat to the stomach. This causes irritation and symptoms like heartburn. Swelling and irritation in the esophagus can affect the surrounding nerves and cause referred pain – which means pain that is distant from the source. In this case, you can often feel the pain in your middle back.
Pancreatitis is another condition that could cause you to have pain after eating. Pancreatitis is inflammation of the pancreas, an organ that plays roles in digestion and blood sugar balance. It commonly causes pain in the upper left side of your belly, but it can spread around to your back. The pain is often worse shortly after you eat, especially if your meal was high in fat.
Upper Middle Back Pain Causes in People AFAB
People assigned female at birth (AFAB) may have a higher risk of upper and middle back pain. Research shows that up to 72% of women may have upper back pain at some time in their lives. Some reasons include:
Breast size. A 2020 study in the journal Women’s Health found that each one-size increase in bra size raises the risk of upper back pain by 13%.
Pregnancy. The hormonal and anatomical changes your body goes through during pregnancy can cause upper back pain, especially in the third trimester. The stress and anxiety of carrying a pregnancy can make the pain feel worse.
Menopause. Some studies show that upper back pain becomes more common after menopause due to poor posture, loss of flexibility in the spine, loss of muscle strength, decreased bone density, and other anatomical changes.
You may reduce your risk of upper back pain with the right workout. A 2019 study in the journal PLOS One found that weak upper back muscles were one of the most common causes of pain in that part of the spine among postmenopausal women. A fitness trainer or physical therapist can recommend exercise to strengthen those muscles.
Back Pain Risk Factors
Several things can increase your chances of having upper and middle back pain. Among them:
Age. Back pain starts for most people in their 30s or 40s, and it’s more common the older you get.
Being out of shape. The stronger the muscles in your back, shoulder, and abdomen, the lower your chance of injury.
Weight. If you carry extra pounds, you put more strain on your back.
Medical conditions. Diseases such as arthritis and cancer can cause back pain.
Smoking. Smoker’s cough can strain your back. And if you smoke, you may be slower to heal, which can make your back pain last longer.
Upper and Middle Back Pain Relief
When you’re coping with upper or middle back pain, simply taking it easy for a few days may help you feel better. You can also try:
Heat or cold therapy. Both can help ease pain. A heating pad can relax stiff muscles, and an ice pack can reduce swelling.
Over-the-counter pain medications. These include ibuprofen and acetaminophen. Ask your doctor which one you should take and for how long.
Massage. Ease stress and relieve tight muscles – just be sure to choose a licensed therapist who has experience with back pain. Ask your doctor for a referral.
Exercise. Staying active with cardio and strength training exercises can help keep your muscles strong and flexible. It will also help you manage your weight.
Lower stress: Stress can make your muscles tense up and make back pain worse. Practice deep breathing and meditation, or just find some quiet time to relax and unplug.
Stretches for Upper and Middle Back Pain
Doing the right forms of stretching not only feels great, but it can help you prevent and recover from upper and middle back pain. Working with a physical therapist or fitness trainer familiar with spinal conditions can help you develop the right technique. A few effective stretches for upper and middle back pain include:
Child's pose
To perform this classic yoga pose, kneel on a yoga mat or rug and rest your bottom on your ankles. Extend your arms forward and place your palms on the floor. Place your head between your arms and slowly lower your chest toward the ground while reaching forward as much as you can. Hold this pose for 30 seconds, relax, and repeat four times.
Upper back stretch
Stand or sit with your spine straight. Raise your arms to shoulder height, bring them together, and clasp your hands. Lower your chin. Now reach forward so that your upper back becomes rounded. You should feel like your shoulder blades are spreading apart. Hold for up to 30 seconds, relax, and repeat up four times.
Shoulder roll
Stand or sit with your spine straight. Keep your arms relaxed at your sides. Tuck your chin slightly. Now roll your shoulders in a circular motion so that they move up, back, down and forward. Do four cycles, then reverse direction for four cycles.
Resisted shoulder-blade squeeze
This stretch requires an exercise band, which you can pick up at a sporting goods store or online. While standing or sitting, grab the band with two hands about shoulders’ width apart, elbow bent to about 90 degrees and palms up. With your elbows tucked at your side, squeeze your shoulder blades and stretch the band by spreading your hands apart. Return to your starting position and repeat up to 12 times.
When to See a Doctor
If you’re like most people with upper and middle back pain, you’ll be able to manage your symptoms at home. Over-the-counter pain relievers, heat, or ice may be enough to ease your condition.
You should call your doctor, though, if your pain becomes too intense or starts to keep you away from your daily activities.
Certain symptoms require fast attention. They include:
- Losing control of your bowels or bladder
- Fever along with pain
- Pain that starts after a fall, an accident, or a sports injury
- Weakness or pain in your arms or legs
- Chest pain
Upper and middle back pain red flags
Sometimes, upper and middle back pain can be a warning that you have a serious condition. Some red flags that your doctor might look for are:
- Signs of neurological disorders, such as numbness, tingling, muscle weakness or paralysis, or loss of balance
- Past trauma, such as an accident
- Pain that’s worse at night
- Unplanned weight loss
- Loss of bladder or bowel control
- A recent infection
- A personal or family history of heart or lung disease
Upper and Middle Back Pain and Chest Pain
If you have pain in the upper or middle back at the same time as you’re dealing with chest pain, it’s wise to see a doctor soon. The combination of chest pain and back pain may be a coincidence, but it can be a sign of a condition that needs to be identified and treated quickly, such as:
Angina. A potential sign that a heart attack is coming, angina happens when not enough blood is getting to your heart, depriving it of oxygen and nutrients. Angina causes pain that people describe as tightness or a crushing sensation in their chest.
Chest infections. Common chest infections such as bronchitis and pneumonia can cause pain in your upper torso that radiates to the back. You may also cough a lot, which makes the pain feel worse.
Gallstones. Your biliary system distributes bile and other digestive juices throughout your body. If a gallstone blocks one of the ducts that carries these juices, severe pain that comes and goes can result. The pain is usually in your belly, but it may travel to other parts of the body.
Muscle, bone, and joint conditions. Any conditions or trauma affecting the muscles, bones, and joints that form your chest and back, such as bone fractures and muscle strains, can cause pain in both regions.
Pericarditis. Your heart is wrapped in a protective liner called the pericardium. Pericarditis is an infection of this lining, which often causes chest pain that spreads to other parts of your body, including the back.
Pulmonary embolism (PE). This serious condition, which requires medical attention right away, happens when blood clots form in your lungs. PE causes stabbing pain in the chest, which often comes with back pain and other symptoms, including shortness of breath.
Takeaways
Upper and middle back pain are less common than lower back pain, but no less troubling if you injure or have a problem in those parts of the spine. Women, who are particularly vulnerable to this type of spine pain, may want to add upper back stretches and exercises to their workout routines. Upper and middle back pain usually eases over time, but if it’s persistent or comes with other symptoms, see a doctor.
Upper and Middle Back Pain FAQs
What organs can cause upper back pain?
Conditions affecting the pancreas, kidneys, and gallbladder can all cause upper back pain.
What is a red flag for upper back pain?
If you have chest pain at the same time as upper back pain, you should see a doctor soon. Other red flags for upper back pain include numbness and tingling, loss of bowel control, unintentional weight loss, and others.
How can you tell if back pain is muscular or something else?
The best way to find the source of back pain is to see your primary care doctor, who can refer you to a back specialist.
