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Upper Back Pain - How to Narrow Down Causes

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Common Causes

The most common causes of upper back pain are bad posture due to prolonged sitting, carrying heavy bags and muscle overstretching due to hard exercise or physical work.

Other causes include disorders of the spine, spinal nerves, lungs, heart, gallbladder and stomach.

Remember that overstretched or injured muscles cause tenderness in the back muscles, while disorders of the internal organs usually do not.

You may be able to narrow down the causes of back pain by being aware of all symptoms you have: pain in the back or arms, headache, nausea, heartburn, etc.

Muscle or Tendon Pain


  • Muscle strain
  • Direct hit
  • Bad posture
  • Muscle spasm as a reaction to a painful condition in the spine


  • Pain is aggravated by movements of the upper back, neck and arms.
  • The back is sensitive to touch.
  • Visible muscle knots or bruises can be present.
  • The pain can radiate along the inner side of one or both arms.

Icing and relative rest help relieve the pain. Symptoms usually resolve in few weeks.

Herniated Disc in the Neck Spine


  • Repeated bending and twisting of the neck
  • Whiplash injury during a car or motorbike accident
  • Blunt trauma


  • The pain in the neck and over the upper back spine can spread down the outer side of one or both arms [2].
  • You may feel tingling in the fingers.
  • If you bend the neck backwards or tilt the head to the affected side, you may feel pain in the neck, shoulder or upper arm.
  • If you place a hand of the affected arm on the top of your head, the pain can temporarily disappear.

A small disc herniation can resolve on its own within several weeks or few months. In severe cases, a surgical decompression of the affected spinal nerves can help. 

Heart-Related Pain

Ischemic heart disease can cause pain called angina pectoris.


  • Pain behind the breastbone is triggered by exercise or stress and lasts for less than 5 minutes [3]. In heart attack, the pain can last for more than 15 minutes, though.
  • Pain can radiate into the left shoulder blade or down the inside of the left arm.
  • The back and chest are not tender to touch.

The pain is relieved by rest and taking the vasodilator drug nitroglycerin. In severe cases, a bypass surgery of the coronary arteries is needed.


Pleurisy is an inflammation of the lung membranes, most commonly as a complication of pneumonia [1].


  • Knife-like pain in the middle or upper back is triggered by deep breathing and coughing.
  • The pain is not aggravated by touching the back or by body movements.
  • Cough
  • Fever

Treatment includes antibiotics or other drugs for pneumonia. Recovery time in otherwise healthy individuals is about 1-3 weeks. 


Pneumothorax is a collapse of one part or the entire lung wing. Spontaneous pneumothorax occurs from no apparent reason, while traumatic pneumothorax is usually caused by a puncture of the lung membrane by a fractured rib or knife stab.

The main symptom is sudden pain in the chest followed by vague aches around the shoulder girdle. Surgical treatment is usually needed.


Shingles refers to reactivation of the Herpes zoster virus in a spinal nerve.

The initial symptom is burning pain on one side of the back. After a week or two, an itchy rash that travels around the trunk as a stripe can develop.

Shingles can heal on its own in about a month. A cream containing the antiviral drug acyclovir can speed up recovery.


Credit: https://rbssinfectiousdiseases.wikispaces.com/Shingles

Other Causes of Upper Back Pain

Gastroesophageal reflux disease (GERD) causes burning behind the breastbone and in the middle of the upper back, and metallic taste in mouth. You may be able to ease heartburn by avoiding smoking, alcohol, caffeine, chocolate and large meals, especially ones that contain fried foods. Antacids, H2 blockers, such as ranitidine, and proton pump inhibitors, such as omeprazole, can help.

Rib fracture after a fall from a height or direct hit causes a sudden, sharp pain on the side of the rib cage. Recovery time is about six weeks.

Osteoporosis can result in a fracture of the vertebra with dull aches between the shoulder blades or in the lower back [4]. Older women are at the greatest risk. Surgical reconstruction of the fractured vertebra may be necessary.

The following can help you or your doctor to figure out the cause of your back pain:

  • Try to recall when did the pain appear for the first time and was it related to exercise, injury or lifting a heavy object.
  • Do back aches change with body position or movements?
  • Does your back feels sore to touch?
  • Is the pain better or worse at night?
  • Do you have any other symptoms, such as pain in the chest, neck or arms, cough, fever, nausea, headache or fatigue?

Referred Pain

Referred Pain
Credit: https://en.wikipedia.org/wiki/Referred_pain

What a doctor can do?

A doctor can help you the cause of upper back pain if you tell him or her your exact symptoms:

  • Try to recall when did the pain appear for the first time and was it related to exercise, injury or lifting a heavy object.
  • Do back aches change with body position or movements?
  • Does your back feels sore to touch?
  • Is the pain better or worse at night?
  • Do you have any other symptoms, such as pain in the chest, neck or arms, cough, fever, nausea, headache or fatigue?

During physical examination a doctor can find bruises, tender points, muscle knots, numb areas and changes in muscle weakness.

An X-ray can reveal pneumonia, collapsed spinal disc or fractured vertebra and gallstones, but not stretched muscles or herniated disc.

An MRI can reveal a herniated disc in the neck spine.

Treatment options:

  • Relative rest is practically always necessary.
  • Painkillers can help, but you should avoid long-term use.
  • Trigger point injections (steroids) can provide only temporary relief.
  • When the pain subsides, you can try stretching and strengthening exercises for back muscles.
  • Arrange your working desk and chair in the way that your forearms, thighs and feet will rest horizontally, your back will be straight and you won't poke your chin.


Do not do any exercise until you are certain about the cause of your pain. Exercises are meant as prevention rather than treatment of back pain, so you do them when you are relatively pain free.

Stretching Exercise for Shoulder Blade Muscles

Upper back muscle stretching
Credit: http://www.wikihow.com/Massage-for-Shoulder-Blade-Pain
Shoulder blade stretch
Credit: http://www.housegymnastics.com/howto/preparation/back.shtml


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  1. "Understanding Pleurisy -- the Basics." WebMD. 10/03/2016 <Web >
  2. "Bulging, Herniated Disc and Pinched Nerve in Neck and Lower Back." eHealthStar. 10/03/2016 <Web >
  3. "Angina Pectoris (Stable Angina)." Heart.org. 10/03/2016 <Web >
  4. "Compression fractures of the back." MedlinePlus. 10/03/2016 <Web >

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