Upper back pain after sleeping: causes, treatments, and exercises

Sleep is essential for recovery and overall health. It also helps your muscles relax. But if you sometimes wake up with upper back pain, you’re not alone. “Upper back pain after sleeping is pretty common, especially for people who spend most of their day sitting at a desk,” says Katie Schaner, PT, DPT, a physical therapist at Hinge Health. “When you sit for long periods, your upper back and neck muscles can become tense.” 

Then, if your pillow isn’t comfortable or supportive for your neck, or if you sleep in a position that you aren’t used to, that can further contribute to tension in your upper back and neck muscles. As a result, you may wake up feeling stiff and uncomfortable. 

Fortunately, there are simple and effective ways to alleviate and prevent upper back pain after sleeping, such as gentle stretches, strengthening exercises, and adjusting your sleep setup. Read on to learn more and get tips and recommended exercises from Hinge Health physical therapists.

What is upper back pain?

Upper back pain refers to discomfort or tightness in the muscles, joints, or tissues of your upper spine, shoulders, and surrounding areas. “It occurs when these muscles and tissues are tight and don’t move as well as they could,” says Dr. Schaner. While it’s typically not a serious issue, it can interfere with your ability to perform daily tasks or enjoy restful sleep. Upper back pain often feels like stiffness or soreness and can sometimes radiate to your neck, shoulders, or arms, depending on the underlying cause.

Causes of upper back pain while sleeping

Waking up with upper back pain can happen for a variety of reasons, many of which are tied to the activities you do during the day. “When we sleep, we don’t move around much, and movement is key to loosening tense muscles,” says Dr. Schaner. If you go to bed with tight or overworked upper back muscles, you will probably wake up with some of that tension still intact. Here’s more on the common causes of upper back pain after sleeping. 

• Muscle strains. Strains can occur from repetitive movements and overexertion, such as lifting heavy objects or doing an intense workout. They can also occur when you’ve been in the same position for a long time and then abruptly move. 

• Previous injuries. Lingering effects from past sports injuries, car accidents, or other trauma — especially without rehabilitation like physical therapy — can make your upper back more sensitive to stiffness and pain.

• Arthritis. Osteoarthritis, the most common type, affects the cartilage surrounding your joints, including your spinal joints. This can lead to stiffness, especially in the morning, but symptoms may improve as you move throughout the day.

• Stress and anxiety. Stress doesn’t just affect your mind. Research shows that it can also impact your muscles, including those in your upper back. “If you’re stressed or anxious, your body may tense up more during the night,” says Dr. Schaner. 

• Sitting all day. Spending hours in the same position, such as sitting at a desk, can cause your upper back and neck muscles to tighten — and can remain tight as you sleep.

• Tight shoulder or chest muscles. Muscle imbalances, such as tightness in your shoulders or chest, can cause compensations in your upper back, making those muscles more prone to stiffness and pain after sleeping.

• Your mattress or pillow. An unfamiliar or unsupportive mattress and pillow setup can contribute to strain on your back. While the best mattress is the one that feels most comfortable to you, research shows that many people prone to upper back pain prefer a medium-firm mattress.

These exercises and stretches recommended by Hinge Health physical therapists help treat and prevent upper back pain after sleeping. Regularly practicing these exercises can improve muscle flexibility and alleviate tension where you feel stiff. For best results, try incorporating these moves into your routine both before bed and right after you wake up. This helps ease muscle tightness from the previous day and prepares your body to move during the day ahead.

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.

Treatments for upper back pain after sleeping

Upper back pain after sleeping can often be relieved with a few straightforward strategies. Here are tips from Hinge Health physical therapists to help you ease discomfort and start your day feeling better. 

• Targeted exercises and physical therapy. If you notice mild upper back pain after sleeping, try the exercises mentioned above. But if you don’t find relief after a week or two, consider seeing a physical therapist. “They can help identify which muscles are contributing most to your pain and provide specific exercises and stretches for that exact area,” says Dr. Schaner. A common culprit is the upper trapezius muscles, which run from your skull to the top of your shoulder blades. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Gentle movement. Light activity, such as taking a short walk or doing gentle stretches, can help ease upper back stiffness. Moving your body increases blood flow and loosens tight muscles, making it easier to start your day feeling better.

• Heat or ice. Both heat and ice can be effective for relieving upper back pain, so choose the option that feels best for you, or alternate between the two. Heat increases blood flow to the affected area, helping to relax tight muscles and promote overall relaxation. Ice reduces inflammation and numbs the area, which can be especially helpful if your upper back pain feels sharp. 

• Foam rolling. Foam rolling is a great way to give yourself a self-massage and loosen stiff muscles. Using a cylindrical foam roller, gently roll over your upper back for a few minutes. A 2020 review in the Journal of Bodywork and Movement Therapies found that this can effectively improve muscle flexibility and reduce tension.

• Over-the-counter (OTC) medication. 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.

When to see a doctor

Upper back pain after sleeping is usually not serious. However, Dr. Schaner recommends seeing a doctor if you’ve tried physical therapy for about a month without improvement or if you experience:

• Pain so intense it disrupts your morning activities. 

• Pain that wakes you up at night. 

• Numbness, weakness, or tingling in your arms or legs. 

• Pain following an injury, like a car accident or fall. 

• Other concerning symptoms, such as fever, difficulty walking, or loss of bladder or bowel control. 

These signs may indicate a more serious issue that requires medical attention. 

How to prevent upper back pain after sleeping

You can help prevent upper back pain after sleeping with these suggestions from Hinge Health physical therapists. 

• Move regularly. Staying active with a mix of aerobic exercise and strength training helps build resilience in your muscles, including those in your upper back. “Whether it’s walking, lifting weights, doing yoga, or cycling, movement is key to keeping your upper back muscles strong and flexible,” says Dr. Schaner. 

• Make your workspace work for you. If you spend a lot of your day at a computer, simple ergonomic adjustments can reduce strain on your upper back. “The most impactful change is keeping your screen at eye level to avoid looking down for long periods,” says Dr. Schaner. Remember to take regular breaks to stand up, stretch, or move around.

• Experiment with your sleeping position. Your sleeping position plays a role in how your body feels when you wake up. If you often wake up sore, try adjusting how you sleep. For instance, some people find that sleeping on their back with a pillow under their knees eases strain on their spine, while others prefer sleeping on their side with a supportive neck pillow and a small pillow between their knees. Find what feels best for your body.

• Adjust your pillow to your sleep style. Your pillow should support your preferred sleep position for maximum comfort. “Stomach sleepers often prefer a smaller pillow, while side sleepers may prefer something that supports their neck and keeps their spine in a comfortable position,” says Dr. Schaner. For back sleepers, a pillow that’s not too high can help reduce strain on your upper back. Experiment with different pillow heights and firmness levels to find what works best for you.

• Prioritize relaxation before bed. Relaxation techniques not only relax tight muscles but can also improve the quality of your sleep, according to research. A simple and very effective technique is diaphragmatic (or belly) breathing. Other techniques that help include establishing consistent sleep habits, limiting screen time before bed, and making your room as quiet and dark as possible to help your body unwind. “When you’re relaxed, your muscles are, too,” says Dr. Schaner. 

PT tip: Loosen up

If you wake up with a stiff, achy upper back, try this quick stretch: Take a deep breath and reach your arms overhead for about two minutes. “This simple movement can help you loosen up your upper back quickly,” advises Dr. Schaner.

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 

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2. Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology, 22(1). doi:10.1186/s10195-021-00616-5

3. Hendricks, S., Hill, H., Hollander, S. den, Lombard, W., & Parker, R. (2019). Effects of Foam Rolling on Performance and Recovery: A Systematic Review of the Literature to Guide Practitioners on the use of Foam Rolling. Journal of Bodywork and Movement Therapies, 24(2). https://doi.org/10.1016/j.jbmt.2019.10.019

4. Martin, J. L., & Benca, R. (2024, October 17). Patient education: Insomnia treatments (Beyond the Basics). UpToDate. Retrieved from https://www.uptodate.com/contents/insomnia-treatments-beyond-the-basics

5. Fouquet, N., Bodin, J., Descatha, A., Petit, A., Ramond, A., Ha, C., & Roquelaure, Y. (2014). Prevalence of thoracic spine pain in a surveillance network. Occupational Medicine, 65(2), 122–125. doi:10.1093/occmed/kqu151

6. Spencer, L., McKenna, L., Fary, R., Jacques, A., & Briffa, K. (2019). Upper back pain in postmenopausal women and associated physical characteristics. PloS One, 14(7), e0220452. doi:10.1371/journal.pone.0220452