Upper Back Pain: Why It Happens and How It’s Treated

Author: MAPS Centers For Pain Control

Published: March 19, 2026

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Back Pain Treatment | Pain Management

Upper Back Pain: Why It Happens and How It's Treated

Table of Contents hide

1 The Thoracic Spine: Why It’s Different

2 Common Causes of Upper Back Pain

3 Recognizing Upper Back Pain Symptoms

4 When to Seek Care for Upper Back Pain

5 Non-Surgical Treatment Options for Upper Back Pain

6 The Recovery Reality: Why Commitment Matters

7 FAQs: Upper Back Pain

8 Don’t Write Off Upper Back Pain

Summary

Upper back pain — pain in the thoracic spine, between the base of the neck and the bottom of the rib cage — is less common than lower back pain but can be equally disabling. It most often results from postural strain, muscle imbalance, disc or joint degeneration, and sometimes nerve compression. Chicago’s desk workers, commuters, and healthcare professionals are disproportionately affected. Non-surgical treatments including physical therapy, targeted injections, and interventional procedures are effective for most patients. MAPS pain specialist Adarsh Shukla, MD, LCP-C emphasizes that any persistent back pain — upper or lower — deserves prompt evaluation and a structured recovery plan.

When most people picture back pain, they think of the lower back. And for good reason — the lumbar spine is the most common pain site, accounting for the overwhelming majority of back pain cases nationwide. But the upper back is not exempt. Thoracic spine pain — pain in the mid and upper back, between the base of the neck and the bottom of the rib cage — affects a meaningful portion of back pain patients, and in the Chicagoland area, where desk work, long commutes, and physically demanding jobs are all part of daily life, it’s a complaint MAPS physicians see regularly.

“When we think of the back, generally we split it into three different segments,” explains Adarsh Shukla, MD, a double-board-certified pain management specialist at MAPS Centers for Pain Control. “Cervical being the neck, thoracic is that mid-back, and then the lumbar is your lower back.” While most back pain conversations center on the lumbar region, the thoracic spine has its own set of vulnerabilities, causes, and treatment considerations — and they’re worth understanding.

The Thoracic Spine: Why It’s Different

The thoracic spine consists of twelve vertebrae (T1 through T12), running from the base of the neck to the bottom of the rib cage. Each thoracic vertebra connects to a pair of ribs, forming the structural framework of the chest wall. This attachment is what gives the thoracic spine one of its defining characteristics: it is the least mobile segment of the spine.

That relative rigidity is by design. The thoracic spine’s primary job is to protect the heart, lungs, and other vital organs housed within the rib cage, not to flex and extend the way the lumbar spine does. But this same stability comes at a cost. When the thoracic spine is forced out of its natural position, through prolonged poor posture, muscle imbalance, or trauma, the surrounding muscles, joints, and nerves can become irritated in ways that are difficult to self-correct and often resistant to rest alone.

Understanding why the thoracic spine hurts requires understanding the difference between the role it’s designed to play and the role modern daily life often forces it into.

Common Causes of Upper Back Pain

Postural Strain — The Dominant Driver

If there is a single leading cause of upper back pain in the Chicago population, it is postural strain — the chronic, accumulated load placed on the thoracic spine and its surrounding muscles by poor positioning during work, commuting, and daily activity.

The thoracic spine is particularly sensitive to forward-head and rounded-shoulder postures. When the head drifts forward of the shoulders — as it does when looking at a screen at the wrong height, hunching over a phone, or slumping in a car or CTA seat — the muscles of the upper and mid-back must work continuously to counteract that forward pull. Over time, these muscles fatigue, tighten, and develop persistent pain.

Dr. Shukla regularly addresses the relationship between mechanics and back pain across all spine regions. “Poor posture, poor positioning when lifting, just poor mechanics overall with anything from sitting to walking” are among the most common contributors to musculoskeletal back pain he sees. In the upper back specifically, forward head posture and thoracic rounding are the mechanical culprits behind an enormous share of patient complaints.

Chicagoland’s workforce — analysts, developers, healthcare professionals, educators, and tradespeople — spends significant portions of the day in positions that load the thoracic spine unfavorably. The result is a cycle of muscle tension, restricted mobility, and pain that worsens without targeted intervention.

Muscle Strain and Overuse

Acute muscle strain in the upper back occurs when the muscles between and around the shoulder blades — the rhomboids, trapezius, and erector spinae — are overloaded beyond what they can handle. This can happen during a single event (lifting something heavy with poor form, a sudden awkward movement) or develop gradually through repetitive overuse.

Athletes, manual laborers, and patients who perform overhead work are particularly prone to upper back muscle strain. Even non-athletic activities — carrying a heavy bag on one shoulder, sleeping in an awkward position, sitting for an extended flight — can trigger acute thoracic muscle pain. Unlike lower back strain, upper back muscle injuries are often strongly linked to shoulder and scapular mechanics, making a thorough physical evaluation important for identifying which structures are actually involved.

Thoracic Disc Problems

Although far less common than lumbar disc herniations, disc problems in the thoracic spine do occur — and when they do, they can be particularly significant. A herniated thoracic disc can compress the spinal cord itself (not just a nerve root, as in the lumbar spine), which means thoracic disc pathology has the potential to produce symptoms well beyond back pain, including pain that wraps around the chest wall, numbness or weakness in the legs, or, in serious cases, symptoms of myelopathy.

For most patients with thoracic disc issues, the presentation is more localized — pain in the mid-back, sometimes radiating around the ribs — and responds well to conservative management. But the unique anatomy of the thoracic spine means that symptoms extending into the legs or affecting balance and coordination warrant prompt evaluation rather than watchful waiting.

Facet Joint Irritation and Degeneration

Like the lumbar spine, the thoracic spine contains facet joints — small paired joints at the back of each vertebral level that guide movement and bear a portion of the spine’s mechanical load. These joints can become inflamed, arthritic, or irritated, producing pain that is typically felt in the mid-back and often described as a deep aching or stiffness rather than a sharp or shooting pain.

Thoracic facet pain tends to worsen with certain movements — particularly rotation and extension — and is often worst after prolonged static positions like sitting or sleeping. It is one of the more common sources of chronic mid-back pain in patients over 40 and is addressable with targeted injection-based treatments when conservative care alone isn’t sufficient.

Trauma and Vertebral Fractures

The thoracic spine is the most common site for osteoporotic vertebral compression fractures — fractures that occur when bone density has declined enough that normal daily loading causes a vertebra to collapse partially. In older adults, particularly post-menopausal women, this can happen without any significant traumatic event, producing sudden, severe mid-back pain that is often initially attributed to muscle strain.

Traumatic injuries from car accidents, falls, and contact sports can also fracture or dislocate thoracic vertebrae. Any upper back pain following a significant trauma, or any sudden severe mid-back pain in an older adult, warrants imaging to rule out fracture before any physical treatment is initiated.

Referred Pain from Other Structures

One feature of thoracic back pain that makes it diagnostically interesting is that it is sometimes not originating from the spine at all. The thoracic region overlaps with referral patterns from several internal structures — the heart, lungs, gallbladder, kidneys, and aorta can all produce pain that is felt in the back between the shoulder blades or around the mid-back.

This is one reason that new or unusual upper back pain — particularly pain that is accompanied by shortness of breath, chest tightness, fever, or pain that radiates into the arm or jaw — should be evaluated medically without delay. A trained pain specialist will always screen for non-spinal causes before assuming a musculoskeletal origin.

Recognizing Upper Back Pain Symptoms

Upper back pain presents differently depending on its source. Key symptom patterns include:

Localized mid-back aching or stiffness — a dull, persistent discomfort between the shoulder blades or along the thoracic spine, often worse after sitting or sleeping; typically muscular, facet-related, or postural in origin
Pain with deep breathing or rib movement — a sharp or catching sensation with inhale, cough, or twist; can indicate costovertebral joint irritation (where the rib meets the spine) or, less commonly, a thoracic disc issue
Radiating pain around the rib cage — pain that wraps from the mid-back around the chest wall, sometimes mistaken for cardiac or pulmonary symptoms; often nerve-related when present
Muscle spasm and restricted rotation — the thoracic spine’s mobility (especially rotation) is often the first thing lost when the surrounding muscles are in protective spasm; patients describe difficulty turning to look over their shoulder or twisting at the waist
Headaches or neck pain accompanying mid-back pain — the cervical and thoracic spines are mechanically interdependent; upper thoracic dysfunction frequently contributes to neck stiffness and tension-type headaches

When to Seek Care for Upper Back Pain

The same principle that applies to lower back pain applies here: don’t wait. “My advice is always address it sooner rather than later,” says Dr. Shukla. “We know that with back pain, the longer you wait to address it, the more likely it is that that pain becomes chronic and long lasting.”

For upper back pain specifically, certain features should prompt immediate evaluation rather than watchful waiting: pain following trauma, pain severe enough to interfere with breathing, any neurological symptoms in the legs, sudden severe pain in an older adult, or pain accompanied by systemic symptoms like fever, unexplained weight loss, or chest symptoms.

For pain that is clearly musculoskeletal in character but has persisted for more than a few weeks, a pain management consultation can identify the specific source and the most effective treatment path.

Non-Surgical Treatment Options for Upper Back Pain

At MAPS, treatment for upper back pain follows the same individualized, non-surgical philosophy that guides all pain care. The goal is not just to reduce pain, but to address the underlying mechanical and structural factors that caused it.

Physical Therapy

Physical therapy is the cornerstone of upper back pain treatment and the intervention with the most significant long-term impact. For thoracic pain driven by postural strain and muscle imbalance — which describes the majority of cases — PT directly targets the root cause.

“Physical therapy is ultimately where the patient will learn to correct a lot of the things that may have led to their back pain — strengthen the areas that may be weak, improve the range of motion or flexibility in the areas that are not moving properly,” explains Dr. Shukla.

For upper back pain specifically, therapy typically focuses on thoracic mobility exercises, scapular stabilization, postural retraining, and strengthening of the deep cervicothoracic muscles that support proper head and shoulder positioning. These are not changes that happen in a few sessions — they require consistent practice, including home exercises that continue well beyond the formal PT program.

Trigger Point and Injection-Based Treatments

For patients with persistent muscular pain in the upper back — particularly those with identifiable trigger points (knots of hyperactive muscle tissue) in the rhomboids, trapezius, or paraspinal muscles — targeted injections can provide meaningful relief that allows more effective participation in therapy.

Facet joint injections and medial branch nerve blocks in the thoracic spine address pain from arthritic or irritated thoracic facet joints. And for patients with confirmed thoracic facet-mediated pain that responds to diagnostic blocks, radiofrequency ablation (nerve ablation) can provide extended relief lasting a year or more.

Medications

Anti-inflammatory medications and muscle relaxants play a supportive role in managing upper back pain, particularly during acute flares when muscle spasm is prominent and mobility is severely limited. As with all pain care at MAPS, medication management is evidence-based and always coordinated with the broader rehabilitation plan rather than used as a standalone long-term strategy.

Advanced Interventional Procedures

For a smaller subset of upper back pain patients — those with chronic, treatment-resistant thoracic pain — more advanced options including spinal cord stimulation may be appropriate and are available through MAPS. These are typically considered after conservative and injection-based treatments have been adequately trialed.

The Recovery Reality: Why Commitment Matters

Regardless of whether the back pain is upper, lower, or both, Dr. Shukla is consistent in the message he delivers to every patient: recovery takes time, it requires active patient participation, and it doesn’t end when the formal treatment program does.

“Something that developed over years and years of wear and tear or improper mechanics can’t just be fixed in a short amount of time,” he says. “When I’m establishing a doctor-patient relationship, I’ll counsel my patients on that — this might be a longer process than you initially thought, but there is a clear path to recovery. And if you are committed to it and you’re willing to put the effort in along with myself, we can certainly get you on the path to recovery.”

For upper back pain — where postural habits and workplace ergonomics are so central to the cause — this commitment to lasting change is especially important. Getting out of pain is one milestone. Changing the patterns that caused it is what determines whether it comes back.

FAQs: Upper Back Pain

Q: Is upper back pain less serious than lower back pain? A: Not necessarily. While upper back pain is less common, it can be equally disabling and — in cases involving the thoracic spinal cord or referred pain from internal organs — potentially more medically significant. Any persistent or unusual upper back pain warrants evaluation by a trained specialist.

Q: Can upper back pain cause headaches? A: Yes. The upper thoracic and lower cervical spine are closely related mechanically. Dysfunction or muscle tension in the upper back can contribute to neck stiffness and tension-type headaches. Patients who notice their headaches coincide with periods of worsened upper back pain should mention this to their physician — it can be an important diagnostic clue.

Q: Why does my upper back hurt more after sitting at my desk all day? A: Prolonged sitting — especially with a forward-head or rounded-shoulder posture — places sustained, uneven load on the thoracic spine and its surrounding muscles. Over the course of a workday, the muscles responsible for maintaining upright posture fatigue progressively, leading to increasing pain and stiffness by late afternoon. This is one of the most common presentations of mechanical thoracic pain in Chicago’s office workforce.

Q: Can upper back pain go away on its own? A: Mild, acute muscular upper back pain from a specific incident (a strain, an awkward sleeping position) often resolves within a few weeks with rest and gentle movement. But pain that persists beyond that window, recurs frequently, or is accompanied by any neurological symptoms should be evaluated rather than waited out. The underlying mechanical or structural cause is unlikely to resolve without targeted treatment.

Q: Does MAPS treat upper back pain as well as lower back pain? A: Yes. MAPS treats pain across all regions of the spine — cervical, thoracic, and lumbar — as well as hips, knees, shoulders, and other areas. Upper back pain is evaluated and treated with the same individualized, team-based approach as any other pain condition.

Don’t Write Off Upper Back Pain

Upper back pain is often undertreated — patients chalk it up to stress, a bad night’s sleep, or something that will eventually work itself out. Sometimes it does. But persistent thoracic pain almost always has an addressable cause, and the longer it goes without being properly diagnosed and treated, the more entrenched the pain patterns become.

MAPS Centers for Pain Control offers Chicagoland patients a comprehensive, non-surgical path to relief — from thorough diagnosis through physical therapy, targeted injections, and advanced interventional options when needed. With eight locations across the region, expert care is always close to home.

Call MAPS at 773-917-8400 or schedule your consultation online at mwpain.com.

Reviewed by Adarsh Shukla, MD — Board-Certified Pain Management Specialist, MAPS Centers for Pain Control. This content is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for diagnosis and treatment.