How to Prevent and Treat Upper Back Pain, According to Physical Therapists

Upper back pain may be common, but it can also take a major toll on your well-being. Occurring anywhere along your thoracic spine — which is everything between the bottom of your neck and the bottom of your rib cage — upper back pain can have several different contributors, resulting in stiffness, tension, or aching that can make everyday activities more challenging. 

While upper back pain can be frustrating to deal with, in most cases, it’s manageable with lifestyle tweaks and simple-but-effective home remedies. In this article, learn more about what causes upper back pain symptoms, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

Common Causes of Upper Back Pain

Your upper back, also known as your thoracic spine, can develop tension or pain from several causes, such as: 

• Back strains and sprains. Acute injury to muscles, tendons, or ligaments is a common cause of upper back pain. Strains and sprains to the upper back can happen from lifting, reaching, or sports injuries. 

• Staying in the same position for long periods. While there’s no such thing as “perfect” posture, staying in the same position for a long time can overwork your muscles, says Nicole Stavale, PT, DPT, a physical therapist at Hinge Health. “This can cause stiffness and tension over time, especially between the shoulder blades.” 

• Muscle overuse. Similarly, if you’re holding your spine in a certain position for a long time, your muscles can tighten, which reduces their range of motion. “If you’re not able to put your muscles through their whole range of motion due to fatigue, then they lose some strength,” says Dr. Stavale. 

• Neck tension. It’s common to experience neck tension or nerve irritation that refers down to the upper back, especially if you look down at a screen frequently. “That kind of pain often feels achy and dull in the upper back,” says Dr. Stavale. 

• Pinched nerve. Though it’s much more common to experience a pinched nerve in the neck or lower back, Dr. Stavale says it can also occur in the upper back, causing pain that wraps around the rib cage. 

Symptoms of Upper Back Pain

The upper back pain symptoms you experience can depend on what’s causing it. Some of the most common symptoms include: 

• Burning 

• Aching

• Throbbing

• Tension

• Stiffness

• Limited range of motion 

While Dr. Stavale says most incidences of upper back pain can be managed at home and with exercise, rarely, certain symptoms can be a sign of another more serious medical condition. Touch base with your medical provider if your pain increases in severity even with at-home interventions (see below), or if you experience red-flag symptoms such as a fever, bowel or bladder issues, or unexplained weight loss. 

Upper Back Pain Treatment Options 

Mild and moderate upper back pain can usually be treated at home or with conservative measures, such as:

• Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for upper back pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Medical massage. Massage from a licensed therapist can help relieve tension and promote blood flow in the upper back muscles, which may reduce pain and improve mobility. 

• Heat or ice. Both heat and ice can stave off discomfort in the upper back, says Dr. Stavale. “I generally tell people to do whatever feels good to them,” she says. 

• Activity modification. Movement is one of the best ways to treat upper back pain, but temporarily adjusting your activity level, or how you do certain activities, may help. This might mean walking instead of running for a short period of time until you start to feel better, or decreasing the length of your typical bike ride by 15-20 minutes. Regardless, don’t stop activity altogether, recommends Dr. Stavale. “Movement is medicine. It promotes blood flow and oxygenation to your tissues, which can help you heal and feel better,” she says.

Tips for Upper Back Pain Relief and Prevention

A few other lifestyle adjustments can help reduce (and prevent) pain in your upper back, including:

• Prioritize gentle movement. Exercises that stretch and strengthen your upper back muscles can help relieve muscle tension and promote better support of your spine.

• Switch positions frequently. “One thing we like to say is your best position is your next position,” says Dr. Stavale. In other words, keep moving. “If you sit for work, change up your position frequently and get up to move every hour or so to prevent or manage upper back pain.”

• Reduce stress levels. Although we recognize how difficult this can be, stress can create tension in the neck and upper back, resulting in pain and stiffness over time. Dr. Stavale recommends deep breathing, meditation, and other relaxation techniques to relieve stress and, in turn, prevent pain. 

• Work with a physical therapist. If changes to your routines aren’t cutting it, a physical therapist can help you determine the cause of your pain and manage it with exercises to improve flexibility and strength. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

While it may seem counterintuitive to move when you’re hurting, Dr. Stavale says exercise is one of the most important components of improving upper back pain. “Exercise is life changing,” says one Hinge Health member. “Back pain sent me into a dark place. Moving and learning about pain and exercise has made my life so much better.”

If you’re just getting started with exercise, or are returning to it after some time away, these exercises recommended by Hinge Health physical therapists are a great place to start. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Check In With Yourself 

Whenever you start feeling tension or discomfort increasing in your upper back, check in and see if you are holding tension anywhere in your body. Take three big belly breaths in and out. “This will help you relax any place you were holding tension subconsciously,” says Dr. Stavale.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Casiano, Vincent E., and Nikhilesh K. De. “Back Pain.” PubMed, StatPearls Publishing, 2020, www.ncbi.nlm.nih.gov/books/NBK538173/.

2. Touma, Jeffrey, et al. “Cervical Myofascial Pain.” PubMed, StatPearls Publishing, 2020, www.ncbi.nlm.nih.gov/books/NBK507825/. Accessed 27 Jan. 2021.

3. Isaac, Z. & Kelly, H. R. (2023, May 31). Evaluation of the adult patient with neck pain. UpToDate. https://www.uptodate.com/contents/evaluation-of-the-adult-patient-with-neck-pain

4. Briggs, Andrew M, et al. “Thoracic Spine Pain in the General Population: Prevalence, Incidence and Associated Factors in Children, Adolescents and Adults. A Systematic Review.” BMC Musculoskeletal Disorders, vol. 10, no. 1, 29 June 2009, doi:10.1186/1471-2474-10-77.