Your back is a complex structure that includes a stack of bones called vertebrae, separated and cushioned by spongy discs. Pain can arise from compressed or herniated discs, pinched nerves, or strained muscles.

As a rule, upper back pain is unusual, since the upper back is structurally stronger than the lower back and also isn’t as mobile, due to being connected to the rib cage. This lack of motion affords it some protection against the bending-twisting types of injury you might sustain in your lower back, which is significantly more mobile, and also against degenerative conditions like those that can cause spinal stenosis symptoms.

You can ease your upper back pain with over-the-counter painkillers, such as acetaminophen and ibuprofen. Alternative approaches such as acupuncture and spinal manipulation therapies such as chiropractic and osteopathy also may help relieve upper back pain.

6 Causes of Upper Back Pain

Specific types of pain in upper back may respond to self-help measures and to targeted treatment approaches. Be wary of:

1. Poor posture: This is a major risk factor for upper back pain, particularly if your job involves computer use and you tend to hunch your shoulders when sitting at your desk. Constantly looking down at a cell phone while texting also can cause upper back pain. It’s vital to maintain proper alignment from your head down through your body, because if your head juts forward, its weight pulls on the muscles in the upper back and neck, which get weak and overstretched. If you also have weak bones, your spine will curve forward, creating a structural change, so take steps to correct this when it’s still a postural problem, and not the way your spine is set. When you’re standing and walking, keep your head lined up over your shoulders and your shoulders lined up with your hips. Also try to avoid hunching at your desk—make a point of taking computer breaks, and also set a timer that reminds you to do simple shoulder rolls that can help loosen the muscles of your upper back and avert pain.
2. Muscle strain: This often happens if you don’t use the correct lifting technique. Always bend at the knees when lifting things, and carry heavy objects close to your body to lessen the strain on your back muscles that can result in pain.
3. Vertebral compression fractures: These are especially common in older adults, due to the bone-thinning disease osteoporosis. These fractures can occur in the upper spine as a result of falls, but if osteoporosis is severe, even coughing or sneezing can result in a fracture that could cause upper back pain, and a hunched posture known as “dowager’s hump.” If you have osteoporosis, be sure to follow your doctor’s advice when it comes to taking osteoporosis medications, eating plenty of calcium-rich foods, and taking a vitamin D supplement if necessary.
4. Herniated spinal disk: This problem typically occurs in the lower back, but can also be a cause of upper back pain. A herniated disk bulges out from between the vertebrae and may press on the spinal nerves, causing upper back pain. In some cases, surgery may be advised to remove a herniated disk.
5. Myofascial pain: This condition affects the fascia, which is the connective tissue in and between muscles. Myofascial pain is characterized by hardened or knotted “trigger points” that hurt if pressed, and the pain tends to present as a burning, tingling sensation. You’re at risk for chronic myofascial if you play sports (such as tennis) involving the large shoulder muscles, or if your job involves constant use of these muscles. Myofascial pain often responds well to stretching exercises (see a qualified physical therapist, who can show you a range of exercises to stretch and strengthen your upper back muscles) and also to massage therapy and trigger-point therapy (pressure applied to hardened, knotted muscle in order to soften it). Your doctor also may suggest trigger point injections, which are lidocaine shots directly into the trigger points.
6. Spondylosis: This is a form of arthritis that can affect the upper and lower back, as well as the neck. It causes bone spurs to develop, and these narrow the bony channel that houses the spinal cord. If the spinal nerves are pinched, you may experience numbness and a feeling of weakness in your legs that may interfere with walking. You’re more at risk for spondylosis in the upper back and neck (called cervical spondylosis) if you had a previous neck injury, or have a job that includes (or included) sustained awkward neck positions, such as looking above you.

Upper Back Pain Red Flags

Rarely, upper back pain can herald a serious underlying condition, so always mention the pain to your doctor, particularly if it comes on suddenly, has no obvious cause, or is preceded or accompanied by chest pain that could signal the following:

• Heart attack: Women in particular may develop referred upper back pain from a heart attack. Call your doctor immediately if your pain is accompanied by a feeling of tightness or pressure in your chest. Other heart attack symptoms include pain that radiates from the chest to the shoulders and arms, shortness of breath, dizziness, nausea, and vomiting.
• Aortic aneurysm: The aorta, your largest artery, carries oxygenated blood and vital nutrients to all parts of your body, including the heart. A healthy aorta has elastic walls that expand and contract with the ebb and flow of blood, but if any part of the aorta is rendered fragile by disease, the abnormal tissue can bulge or balloon out to form an aneurysm. If the aneurysm is in the chest area, pain in upper back can be one of the symptoms.
• Pleurisy develops if the pleura—the lining surrounding the lungs—becomes inflamed. The inflammation causes sharp, stabbing chest pain that can radiate to cause pleurisy back pain. While pleurisy itself is not serious, it can be a symptom for more serious conditions like pneumonia, or even lung cancer.

Originally published in 2016 and updated.