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Upper Spine Pain

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Last updated May 19, 2023

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Upper spine pain is pain in the upper back below the neck. It can affect the muscles, ligaments, nerves, or vertebrae of the back, and cause pain and stiffness.

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What is upper spine pain?

Upper spine pain is usually felt anywhere in the back between the neck and the lower back. This part of the back is called the thoracic spine. It is made up of 12 vertebrae (backbones).

Upper spine pain can be caused by problems with the vertebrae themselves or with back muscles, ligaments, nerves, or the cushiony discs between the vertebrae. Or it could be “referred” pain, meaning the pain starts in another part of your body, like organs in the chest or abdomen.

Pain in the upper spine is often caused by an injury, but sometimes it develops more gradually from poor posture or a slightly curved spine. Issues related to aging, like osteoarthritis or osteoporosis, are also common causes.

What upper spine pain feels like

You may have pain in just one spot or in a larger area. It may feel like aching, burning, a muscle spasm, or a sharp pain. Upper spine pain often occurs with back stiffness. It may be worse when you bend or twist, or when breathing deeply. You may also have neck pain or lower back pain.

When to worry about upper back pain

Pain in the upper spine is not as common as pain in the neck or lower back, so it’s important to talk to your doctor if you can’t figure out a reason for your pain (like lifting heavy boxes or a minor injury). Call your doctor if you have pain that doesn’t improve after about 2 weeks, or if it starts to get worse instead of better.

You should also let your doctor know if you develop upper spine pain and:

  • Have a suppressed immune system
  • Have a history of cancer
  • Use intravenous drugs
  • Have lost a significant amount of weight

Go to the ER if the pain is related to an injury or if you can’t control the pain with OTC medications. You should also go to the ER if you have upper spine pain with:

  • Fever
  • Chest pain
  • Breathing problems
  • Severe abdominal pain
  • Numbness or weakness in your arms or legs
  • Trouble with coordination or walking
  • Loss of bowel or bladder control

Pro Tip

Many people expect to have imaging tests right away when they develop back pain, but it’s often not necessary. A doctor can ask you about your symptoms and do a thorough physical exam, and then let you know if X-rays or other tests are needed. —Dr. Anne Jacobsen


1. Poor posture

Slouching or prolonged staring at a handheld device can eventually lead to upper spine pain. These positions, when held for a long time, can cause muscle strain or wear on your discs or vertebrae. After a while, you may have aching pain or stiffness even when standing upright.

Very common. 76% of people who work in a sitting position experience back pain, and over half of them believe that poor posture or ergonomics contribute to their symptoms [Source: International Journal of Health Sciences and Research].

Other symptoms:

  • Neck pain
  • Stiffness
  • Pain with movement

Treatment and urgency: Try to change the habits that are causing your pain. Sit in a supportive chair, sit and walk upright, hold your shoulders back, and frequently change positions. When looking at your devices, hold your head and neck in a neutral position to avoid slouching.

You can treat the pain at home with OTC pain medications, heat or ice, and gentle stretching. You usually don’t need to see a doctor unless the pain keeps you from doing everyday activities.

2. Upper back strain or sprain

An upper back strain is a stretch or tear to the muscles or tendons of the upper back, while a sprain is a stretching or tearing of a ligament. Tendons connect muscle to bone, and ligaments connect two bones at a joint. These injuries are usually what people are describing when they say they have “thrown their back out.”

These injuries often occur suddenly during sports, heavy lifting, or a car accident. But they can also happen over time from repetitive movements or other overuse injuries.

Very common. Over the course of 3 years, 1 in 10 men and 1 in 5 women have upper back strain or sprain [Source: Occupational Medicine].

Other symptoms:

  • Stiffness
  • Decreased range of motion
  • Pain that worsens with movement
  • Muscle spasms
  • Pain in neck or lower back

Treatment and urgency: Strains and sprains can often be treated at home with OTC pain medications, ice or heat, and gentle stretching. Call your doctor if your pain doesn’t improve in about 2 weeks, you can’t manage the pain at home, or you start to feel worse instead of better. Other treatments might include prescription muscle relaxers or pain medications, physical therapy, or a back brace.

Go to the ER if the pain is from a forceful injury (like a sports injury, car accident, or fall) and you have severe back or neck pain or a head injury. Also, see a doctor right away for a back injury with numbness or weakness in your arms or legs.

3. Herniated disc & pinched nerve

The spinal vertebrae are separated by shock-absorbing “cushions” called discs. A back injury from falling, a minor injury, or wear-and-tear can damage discs, allowing their jelly-like contents to leak into the spinal canal (this is referred to as a herniated disc). It can put pressure on nerves, leading to a pinched nerve. The pain is usually felt close to the damaged disc.

Herniated discs and pinched nerves are most common in young and middle-aged adults. Men are more likely to get them.

Common. There are about 5–20 cases of herniated disc per 1,000 adults each year [Source: National Institutes of Health].

Other symptoms:

  • Pain that radiates to the front of the chest
  • Numbness or muscle weakness on one side of the body
  • Increased reflexes
  • Muscle tightness

Treatment and urgency: If you have any nerve symptoms—numbness or weakness, problems with bowel or bladder function—go to the ER right away. They will check for conditions that may need to be treated with emergency surgery.

When you first feel pain, you might not know if you have a disc problem or just a strain or sprain. If your symptoms are not severe, you can treat spinal pain with OTC pain relievers, ice or heat, and gentle stretching.

Call your doctor if your pain doesn’t improve within about 2 weeks, is too severe to manage with OTC medicines, or you start to feel worse instead of better. In these situations, you may need an MRI, which is the most reliable way to diagnose a herniated disc.

4. Thoracic spine fracture

A “broken back” is a fracture, or broken bone, affecting one or more vertebrae in the spine. The most common location is where the thoracic spine meets the lumbar (lower back) spine, since it lacks the added support of the rib cage.

Thoracic spine fractures are most often caused by a car accident, fall, or sports injury that puts a lot of pressure on the vertebrae. This type of injury can be serious because the broken bones can injure the spinal cord (causing paralysis or other nerve problems), and the impact can also cause injuries to other nearby organs and structures. Thoracic spine fractures are most common in young people, athletes, and males.

Uncommon: About 6.9% of people who have a car accident or fall will have a thoracic spine fracture, but about 25% of these people will have a spinal cord injury [Source: Journal of Orthopaedics].

Other symptoms:

  • Numbness or muscle weakness in arms or legs
  • Pain that radiates to the arms or legs

Treatment and urgency: If you think you have a spinal fracture, go to the ER. You will need to be examined by a doctor and have imaging tests (X-ray, CT scan, or MRI). Some injuries that cause nerve damage, a spinal cord injury, an unstable spine, or severe spinal deformity will need surgery.

If surgery is not needed, treatment might include pain medications, a back brace, and physical therapy.

Pro Tip

Be sure to ask your doctor when you need to return if you aren’t getting better. While many people will get better with time and supportive care at home, it’s important to know when to get checked out again if your symptoms continue. —Dr. Jacobsen

5. Osteoarthritis

Spine osteoarthritis is an age-related breakdown of the cartilage in the joints that connect the vertebrae. This causes inflammation and upper back pain, though you may have osteoarthritis without the pain. A previous injury to the spine can increase the risk of developing it. Osteoarthritis is most common in older adults.

Common. 95% of men and 70% of women over age 60 showed at least one X-ray finding that indicates spinal arthritis [Source: National Institutes of Health].

Other symptoms:

  • Stiffness
  • Decreased range of motion
  • Pain that gets worse with movement and may improve when lying flat on your back

Treatment and urgency: Osteoarthritis can be treated at home with OTC pain medications, applying ice or heat, and wearing a back brace. Strengthening and range-of-motion exercises can help. A doctor may recommend losing weight and physical therapy, and may give you a steroid injection for the pain. Some people may need surgery if there are nerve symptoms or if the pain is not well controlled with other treatments.

6. Compression fracture/osteoporosis

This is a fracture (broken bone) in which a vertebra of the thoracic spine is compressed, causing the bone to collapse. It most commonly occurs as a complication of osteoporosis, which causes bone loss that weakens the vertebrae. It can also happen suddenly from an injury or be caused by a spinal tumor.

Men and women can get compression fractures. But they are more common in women because osteoporosis is 4 times as common in women, according to a study in the Journal of Clinical Medicine Research. The condition is also more common in older people.

Common. About 10 million Americans over age 50 have been diagnosed with osteoporosis. Approximately 1.5 million vertebral compression fractures are diagnosed each year in the U.S., and 25% of postmenopausal American women will develop a compression fracture during their lifetime [Sources: U.S. Department of Health and Human Services; The Permanente Journal].

Other symptoms:

  • Decreased range of motion
  • Pain that worsens with movement and may be relieved by lying flat on your back
  • Loss of height

Treatment and urgency: Go to the ER for any back pain that causes numbness or muscle weakness or problems with your bowel or bladder. Also, you should be examined by a doctor if you have an injury that causes severe back pain.

You’ll need to be seen by your doctor for imaging tests, like an MRI, to confirm you have a compression fracture. It can be treated with pain medications, a back brace, or physical therapy. Surgery may be needed if the pain doesn’t improve.


In many cases of minor upper back pain, you may not know the exact cause of your symptoms. That’s okay because the basic treatments are the same, regardless of the cause.

  • First, try to rest but don’t stay in bed all day. Avoid strenuous activity or anything that causes any pain, but try to move about gently so you don’t become stiff from inactivity.
  • Apply ice or heat. Use either one for 15–20 minutes. Then take a break for a couple hours. Gentle stretches may also help. Stop immediately if any movement causes sharp or severe pain or numbness or weakness in your arms or legs.
  • Anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can treat pain and reduce inflammation. Acetaminophen (Tylenol) can help with pain.

Some people with severe pain may need to see a doctor to be examined and treated.  Muscle relaxers or prescription pain medications may be prescribed. Cortisone injections may be recommended when other treatments aren’t helping.

Less commonly, imaging tests will show a fracture or a disc problem that requires surgery.

Dr. Rx

Ask your doctor what you can do now to prevent upper spine problems in the future. Women are particularly at risk for osteoporosis as they age, so it’s important to eat a healthy diet including calcium and vitamin D, and get regular weight-bearing exercise. —Dr. Jacobsen

Frequently asked questions

How do you know if back pain is from muscles or your spine?

Usually the location is the best clue. Pain from the spine can usually be detected by pressing on the backbones. Sometimes pain related to the spine itself will also cause some muscle pain, especially if both were injured in a fall or other injury. But pain from the muscles should not cause bony spine pain.

What organ makes your upper back hurt?

Organs in the chest and abdomen can cause “referred” pain to the upper back. This is from shared nerve pathways in the area. Heart, lung, and blood vessel problems can all cause pain in the upper back, as can diseases of the gallbladder, pancreas, and kidneys. It’s very important to be evaluated in the ER if you have chest pain that radiates to the upper back or upper back pain that causes a tearing sensation.

How should I sleep with upper back and neck pain?

It can be hard to find a comfortable position for sleeping with upper back pain.

The best positions keep your spine in a straight line, so try to sleep on your back or on your side with pillows supporting any areas that aren’t in contact with the mattress. Overall you’ll get the best sleep in a familiar position. Try to modify your normal position without completely changing it. Keep in mind that you’ll probably reposition yourself while you’re sleeping.

This is also a good time to make sure that your mattress and pillows offer enough support. If the ones you have give you back or neck pain even on a good day, it’s probably time to replace them!

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medic...
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