Upper back pain is pain felt anywhere between the base of the neck and the bottom of the ribcage, often between the shoulder blades. In most cases it comes from the muscles, joints and ligaments of the thoracic spine and ribs rather than serious disease. It usually improves with time, staying active and a gradual return to normal activity.
Also known as mid-back pain, thoracic spine pain, pain between the shoulder blades
Symptoms
- Aching, stiffness or tightness in the middle of the back or between the shoulder blades
- Pain that changes with posture, twisting, reaching or deep breaths
- Muscle tenderness or spasm alongside the spine
- Stiffness after sitting or sleeping in one position
- Pain that sometimes wraps around towards the side of the chest
Causes and risk factors
- Prolonged sitting, desk work or repeated reaching and lifting
- A sudden increase in activity, sport or gardening
- Muscle strain or minor joint sprain, sometimes after a cough or awkward movement
- Pain elsewhere, such as neck or low back pain, which often occurs alongside it
- Higher workload, stress and low mood, which are linked with more spinal pain
- In young people: adolescence, being female and carrying heavy school bags
What the evidence says helps
- Understanding that most upper back pain is not caused by serious damage, and staying as active as you can, is a sensible starting point. High-quality research specific to the upper back is limited, so advice is largely drawn from wider spinal pain evidence.13
- Strengthening exercises for the upper back muscles are commonly used. In one trial, people with thoracic pain improved with an exercise programme, and the benefits of exercise lasted at follow-up.4
- Spinal manipulation or mobilisation may give a small, short-term reduction in pain. A systematic review found this effect was modest, so hands-on care is best used alongside exercise and advice rather than on its own.34
- Combining exercise with education about how pain works has been shown to reduce pain and worry about movement in people with longer-lasting spinal pain, though the evidence is of low certainty.5
- Acupuncture has not been shown to work better than a placebo treatment for recent upper back pain.3
Things you can try at home
- Keep moving: short, regular walks and gentle back and shoulder movements usually help more than rest
- Break up long periods of sitting every 30–45 minutes with a stand, stretch or short walk
- Try heat (a warm shower or heat pack) to ease muscle tightness
- Return gradually to sport, lifting and gardening rather than all at once
- Simple pain relief from a pharmacist may help you keep active
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Call 999 if upper back or chest pain comes with breathlessness, sweating, feeling sick, or pain spreading to the arm, jaw or neck
- Call 999 for sudden, severe, tearing pain between the shoulder blades
- See a GP urgently or call NHS 111 if you have a history of cancer, unexplained weight loss, fever or night sweats with back pain
- Seek urgent help for numbness, weakness or pins and needles in both legs, unsteady walking, or problems with bladder or bowel control
- See a GP urgently for back pain after a fall or minor injury if you have osteoporosis or take long-term steroids
- See a GP if pain is constant, getting worse, or does not ease with rest or position changes
How Apollo can help
Our osteopaths start with a thorough assessment, including screening for any signs that need medical review, and explain what is likely to be driving your pain. Care may include hands-on treatment where appropriate, a tailored exercise programme for strength and mobility, and practical advice on work set-up and activity. If anything suggests your pain is not musculoskeletal, we will refer you to your GP or urgent care.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Why does my upper back hurt between my shoulder blades?
Pain between the shoulder blades most often comes from tired or strained muscles and stiff spinal or rib joints, especially after long periods of sitting or a sudden increase in activity. It is rarely serious. However, pain here with breathlessness, sweating or a tearing feeling needs urgent medical attention.
How long does upper back pain last?
Many episodes improve within a few days to a few weeks, particularly if you stay active. Some people have pain that comes and goes. If it lasts more than a few weeks or keeps returning, an assessment can help identify what is keeping it going.
Is bad posture the cause of upper back pain?
Research does not show that one posture is the single cause of upper back pain. Staying in any position for a long time can make you stiff and sore. Changing position often and building strength tends to help more than trying to hold a 'perfect' posture.
References
- Briggs AM, et al. (2009). Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskeletal Disorders. View source
- Fouquet N, et al. (2015). Prevalence of thoracic spine pain in a surveillance network. Occupational Medicine. View source
- Southerst D, et al. (2015). The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the OPTIMa collaboration. Journal of Manipulative and Physiological Therapeutics. View source
- Waqas MS, et al. (2023). The effects of spinal manipulation added to exercise on pain and quality of life in patients with thoracic spinal pain: a randomized controlled trial. BioMed Research International. View source
- Bonatesta L, et al. (2021). Pain science education plus exercise therapy in chronic nonspecific spinal pain: a systematic review and meta-analyses of randomized clinical trials. The Journal of Pain. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
