Pain in the upper back

Pain in the upper back is felt in the area extending from the neck to the lower back, in other words, the area between or below the shoulder blades. Pain in the upper portion of the back can affect other parts of the body, which in turn may cause additional symptoms.

Anatomy of the upper back

The upper back consists of 12 vertebrae and 12 pairs of ribs. These ribs are attached to the vertebrae of the upper back. Due to the ribs, the upper back is much less flexible than the neck and lower back.

The vertebrae of the upper back together form the thoracic spine. The muscles of the thoracic spine are supplied from the neck. The nerves exiting the upper back supply the organs in the chest cavity.

The ribs, the alignment of the spine, the muscles, and the organs can all play a role in upper back pain complaints. Normally, everything works together harmoniously, but when there is an issue somewhere, other parts can also be affected.

When breathing in, the ribs spread slightly apart, and when breathing out, they move back together again. This means many small joints are activated with each breath. The spreading of the ribs allows the lungs to expand with each inhalation.

The shoulder blades glide over the upper back. However, since the shoulder blade is part of the shoulder, it does not belong to the upper back but to the shoulder. This shows how interconnected everything is.

Pain symptoms

For upper back pain, heart problems must first be ruled out, as these can cause pain between the shoulder blades combined with chest pain. Heart-related problems are often provoked by physical activity.

Pain between the shoulder blades more often indicates a problem with the ribs, vertebrae, breathing, or pain coming from muscles controlled by the neck.

If the ribs or vertebrae lack proper mobility, strain can develop in the upper back because movement has to be forced. A physiotherapist can help improve mobility in such cases.

Posture is also very important for the upper back. The curvature of the upper back directly affects the neck, and the neck, in turn, supplies the muscles of the upper back.

The posture of the upper back also determines the position of the shoulder blades, which in turn form the base of the shoulder and arm. Poor posture can thus cause upper back pain, as well as pain radiating to the shoulders.

Acute pain can be caused by trauma (an accident or fall), in which a rib may be bruised or broken. A broken or bruised rib often causes severe pain while (deep) breathing or coughing.

What causes your upper back complaints?

Do you have pain in your upper back and want to know what’s going on? It’s advisable to have a physiotherapist examine your upper back. In our overview of physiotherapists you can find a physiotherapy practice that can help you further.

Would you prefer to investigate on your own first? You can get an initial indication of your complaints by doing the online physiotherapy check. Indicate where you feel the pain in your back and answer the questions. You will then receive an overview of back problems that may correspond to your symptoms.

Upper back conditions

The overview below shows the main conditions that can cause pain in the upper back. Click on a condition name to read more about the cause, symptoms, treatment, and underlying anatomy.