29 min read
Sam North
Upper back pain refers to pain felt through the thoracic region of the spine, between the neck and the lower back.
Upper back pain behaves a little differently from pain elsewhere in the spine. Neck pain and lower back pain are just as common, but neck pain is more likely to come with headaches or symptoms that travel into the arms. Lower back pain is more often caused by sudden injury through bending and/or lifting under load, or pain that spreads into the legs.
Upper back pain usually stays more localised and is more often linked to repeated loading rather than nerve involvement or a single clear injury, although both of those triggers are also possible.
Contents
The entire upper back is built around the ‘thoracic’ region of the spine, which is made up of 12 vertebrae (T1-T12). It sits under the ‘cervical’ spine (the neck) and above the ‘lumbar’ spine (the lower back). Each of the 12 vertebrae in the upper back attaches to the ribs on either side, forming the rib cage and giving the upper back much of its strength and stability.
The fact that this area of the spine is so securely attached to the rib cage is one of the main reasons that the upper back moves less freely than the neck and lower back, making it less prone to sudden injury, but also more likely to become stiff, tight, and just generally less mobile as we age.
And it is not just the muscles specifically located in the upper back that are responsible for this. While the rhomboids, trapezius, and paraspinal muscles play a key role in supporting the thoracic spine, the upper back does not work in isolation. Muscles in the shoulders, chest, and even the hips all influence how this area moves and how much load it takes on.
That is a tough question to answer, as there are many different types of upper back pain, but let’s run through the most common.
Some people notice their upper back pain as a background tightness that never fully settles. Others only become aware of it at certain points in the day, like after sitting hunched over a computer for hours, or at the end of a physically taxing day when they finally stop moving.
You may have no upper back pain issues at all, but then notice a deep ache or more acute niggle start to creep in during (or after) you play some type of sporting activity, which lingers long after you put down the basketball, golf club, or pool cue. Even a low-impact activity, such as throwing darts, can cause upper back issues through repetitive movement concentrated on one side.
Again, there is no one clear answer, as the upper back is such a complex area of the body that takes on much of the load of everyday life. Most cases are influenced by a combination of posture, repeated loading, and how well the area is allowed to recover.
|
Cause category |
Typical symptoms |
Common contributors |
|
Postural strain |
Dull ache, stiffness between the shoulder blades, discomfort after sitting |
Prolonged desk work, screen use, slouched posture |
|
Muscle overuse and fatigue |
Tightness, soreness, pain with movement |
Repetitive lifting, sustained arm use, poor ergonomics |
|
Joint irritation |
Localised pain, reduced movement, stiffness |
Thoracic joint loading, repetitive twisting, age-related changes |
|
Stress-related muscle tension |
Tight, band-like pain, aching that fluctuates |
Chronic stress, anxiety, shallow breathing patterns |
|
Less common or serious injury |
Persistent pain, pain following trauma, pain not linked to posture or activity |
Falls, car accidents, direct impact, underlying inflammatory or structural conditions |
Upper back pain is one of the more common issues faced in the modern age, mostly thanks to the fact that so many of us work in roles that involve long periods of sitting, screen use, and limited movement.
When your work role demands that you sit in front of a desk for eight hours a day, five days a week, it should really come as no surprise that the upper back is going to suffer. 40 hours a week of sitting in mostly the same position with very limited movement, other than your fingers flying across the keyboard and the occasional wander to the bathroom, places a steady, almost unrelenting load on your upper back and shoulders. The muscles lose mobility, which leads to your posture changing, which feeds back into more stiffness.
A true vicious cycle, but one that can be easily broken through some pretty basic and easy-to-implement movements (more on this later).
Your sleeping position can also have quite a heavy effect on upper back pain. People who sleep on their side or stomach have a much higher chance of experiencing upper back pain, simply due to the way these positions can and do put pressure on the shoulders, ribs, scapulae, and upper spine for long periods without movement.
It’s not just a lack of movement, leading to a gradual loss of mobility and an increase in bad posture, that contributes to all upper back pain.
The upper back plays a central role in many everyday movements, especially those involving the shoulders and arms. Sports (think the bowling action in cricket, lifting weights, swinging a golf club or tennis racquet, paddling a surfboard or kayak, or swimming) and even just repeated work-related movements that require the arms to be used in front or above the body can quickly place the upper back under more strain than it is used to, or it can handle.
So, yes, while movement is important, so is making sure that the muscles in this area aren't overloaded for prolonged periods without having enough time to recover. Easier said than done, especially for those among us who work physically demanding jobs, but there are ways to lessen the impact…
Pain between or under the shoulder blades (scapula) is surprisingly common, but also often misunderstood, at least by the person suffering through it. This is an extremely complex area of the body, where the upper spine, rib cage, shoulder joints, and multiple layers of muscle all overlap and interact.
This can make pinpointing and interpreting the true cause of the pain a little difficult, even if the issue itself is quite straightforward and not overly complicated to manage.
That area between your shoulder blades is integral in supporting everything you do with your arms. It helps control shoulder movement, stabilise the upper spine, and manage load as your arms move in front of or away from your body. Because of this, pain here is usually less about a single injury and more about endurance, fatigue, and stiffness building up over time.
By this point in the guide, the underlying causes such as posture, repeated loading, and recovery are already clear. This section is about why the pain so often shows up between the shoulder blades.
The muscles that lie between the shoulder blades (the rhomboids and the middle portion of the trapezius) play the role of ‘endurance stabilisers’. For the most part, they don't have to worry about holding up huge loads, but instead have to make sure the shoulder blades stay in a safe and controlled position while your arms move. That means they are often working at a low level for long periods rather than switching fully on and off.
Over time, this constant low level of load leads to high-level fatigue, and if you don’t give the muscle groups the time they need to rest and recover, you may have already started to do some damage.
Instead of a sharp, acute strain that causes a very noticeable and sudden pain, the tension builds gradually. You will have probably noticed a dull ache starting to grow, along with extra tightness and a feeling that the muscles here need to be massaged and stretched. Even when the overall load is spread across the upper back and shoulders, discomfort often feels most noticeable between the shoulder blades because these muscles are doing a lot of background work.
And while the most common area for upper back pain is around the shoulder blades, the pain isn't always spread evenly across or under both shoulder blades…
It is actually more common for upper back pain to be more concentrated on one side than the other, either left or right. Small asymmetries in load and how the body deals with them add up over time, often resulting in certain muscles being expected to do more than they are used to or properly capable of, without pain sneaking in.
Both upper left back pain and upper right side back pain are usually mechanical. They reflect how everyday load is being managed rather than pointing to a specific injury or structural problem. Importantly, pain being worse on one side is not, on its own, a reliable sign that something serious is wrong.
We all move through life in slightly uneven ways. We favour one hand, one leg, one side of the body when we sit, stand, carry things, or rest. Over time, these small preferences influence where fatigue sets in first, and pain can start to appear.
While the vast majority of us are right-hand dominant (and right-foot dominant, for that matter), it is not uncommon for pain to show up on the non-dominant side of your upper back. This may sound a little counterintuitive at first, but as we have already discussed, the muscles in the upper back are most often used in a supportive and stabilising role, sharing the load across both sides of the back.
For right-handers, the left-hand side of the upper back often provides the steadiness and stabilisation needed while the right hand does the heavy lifting, helping balance the load and keep movement controlled (and vice versa, for all the left-handers out there).
Every day, almost unconscious habits can and do reinforce this pattern, often without you ever noticing until the pain kicks in. Carrying items on the same side, leaning slightly one way at a desk, or consistently favouring one sleeping position can all take a toll.
Upper right side back pain more often reflects dominant-side use and repetition. With so many of us leaning heavily on our right side to do the majority of strength and fine motor work, it’s obvious that the right arm leads most daily tasks.
Because our bodies have been conditioned over the years, this right-hand-dominant work usually feels normal, familiar, and easier than if done by the left. It also rarely causes discomfort or pain in the moment. Symptoms tend to appear later, once activity slows down, and the cumulative load becomes more apparent.
The pain often has nothing to do with a specific strain and more to do with how much work that side has been doing overall. As with left-sided pain, discomfort on the right side of the upper back is common and usually mechanical. On its own, it does not reliably point to anything serious, but it can be a useful clue about how load is being shared across the upper back over time.
With all that said, it is possible that upper back pain, whether left-sided, right-sided, or felt across the upper back, may be caused by an injury, strain or minor soft tissue injury. This is more likely if the pain immediately follows a clear incident or movement where something changes suddenly, rather than developing gradually over time.
|
Pain location |
What it may be linked to |
Common triggers |
|
Between the shoulder blades |
Postural strain, muscle fatigue |
Prolonged sitting, desk work, driving |
|
Upper back with neck stiffness |
Muscle tension, postural overload |
Screen use, stress, poor sleep posture |
|
Upper back with shoulder discomfort |
Muscular overload, movement compensation |
Reaching, lifting, overhead activity |
|
One-sided upper back pain |
Asymmetrical loading, muscle imbalance |
Carrying bags on one side, repetitive tasks |
|
Widespread upper back tightness |
Sustained muscle tension |
Stress, reduced movement variety |
Upper back pain often follows a pattern of flare-ups from certain, not always obvious, triggers rather than a level of pain that always stays constant. In most cases, a flare-up does not mean new damage, although this isn't always the case.
It is often just a sign that your upper back is being asked to cope with more than it is ready for at that point. That might be a change in routine, an increase in activity, longer time spentsittingt at your desk in a slightly less than ideal position, or less opportunity to recover. And remember, upper back pain doesn’t always hit straight away. There may be a good hour or so between what you did earlier in the day and when the discomfort starts to make itself known.
Understanding your upper back pain triggers, whether that be an awkward sleeping position, a particularly stressful day, or a heavier-than-usual workload, can make flare-ups feel less a little confusing and scary, and easier to manage when they do happen.
There is a big difference between a decent night’s sleep in a restful position and one where your upper back is twisted or has a load placed on it.
Sleep is our most important recovery period, the time when our body and mind reset after the demands of the day. When sleep is disrupted, or your upper back is held in an awkward position for long periods, stiffness and discomfort are more likely to be noticeable the following day.
Stress can have a similar effect.
Higher stress levels often increase muscle tension in the upper back and shoulders, which reduces how well the area unwinds. When sleep and stress overlap, flare-ups are far more likely, even without any clear change in activity.
Pain in the upper back area is so common among desk workers that it has been labelled an epidemic from time to time.
It might not seem like a lot for the muscles to handle: sitting in the same position for hours on end, typing furiously, and barely moving beyond small hand and arm motions. But, in reality, this creates a steady static load through the upper back and shoulders, especially when the arms are unsupported, or your head and neck creep forward into a somewhat dangerous posture.
This lack of movement, especially when coupled with bad posture, slowly but surely causes heavy fatigue to set in in the upper back region. This is usually followed by pain, but not always straight away.
Do you notice that your shoulders and upper back get sore later in the day, just as you are getting ready to pack up for the day? Maybe try changing position and breaking up long periods of sitting with some short walks - this usually matters more than trying to hold a perfect posture all day.
Upper back pain after physical activity can be a real annoyance. You are doing your best to be active and healthy, and then the pain hits. Everything feels fine at the time, and then hours later, or even the next day, your upper back lets you know it was doing more work than you realised.
This usually happens when the volume or intensity of activity jumps up without your body being ready for it. That might be a longer session than usual, a return to training after time off, or a busy day of lifting and carrying. The upper back often copes in the moment, then struggles once things slow down and fatigue has time to settle in. When pain appears later like this, it is more often about accumulated load than a single strain or mistake.
But again, with that said, injuries are more likely to strike when you have been doing heavy exercise or pushing well beyond what your body is used to, particularly if pain comes on suddenly during the movement itself rather than building up later on.
While the symptoms of upper back pain can be just as uncomfortable and equally persistent as other back or neck pain issues, they are usually manageable and tend to respond well to the right balance of movement, rest, and (most importantly) a gradual strengthening routine through gentle physiotherapy.
Are scans or injections needed straight away?
No, not for most upper back pain treatment situations anyway. If you are in very bad and acute pain, then a scan and potentially some type of steroid or pain-relieving injection may be required, but for the overwhelming majority of people, this is not the route things need to go down. Upper back pain that has come on gradually, or that tends to flare and settle, is very unlikely to benefit from early imaging or injections.
Scans are usually reserved for situations where pain is linked to a clear injury, neurological symptoms, or when things are not improving over time despite appropriate care. In the same way, injections are generally considered later on, not as a first step, and only when pain is significantly limiting daily life.
For most people, focusing on movement, recovery, and gradual strengthening achieves far more than jumping straight to invasive options. But the last thing you want to do is over-rest a sore upper back.
Keeping the area gently moving, even when it feels uncomfortable, usually helps prevent stiffness from building up and supports recovery over time. That does not mean that you should push through heavy/sharp pain when moving or ignore what your body is telling you. But keeping the area mobile and gently moving it through the soreness helps prevent stiffness from building up and supports recovery over time.
Physiotherapy is a great starting point for upper back pain treatment. The aim is not to fix one sore spot, but to get the entire upper back moving more comfortably, improve the overall strength and how effectively the shoulder blades are being supported by the surrounding muscles, and slowly build up your tolerance to the normal load being placed on your upper back.
A lot of this work is guided by how your pain responds. A simple rule many physios use is the pain scale. If discomfort stays at or below around 4 out of 10 during or after movement, it is unlikely you are harming yourself. That level of pain usually reflects effort and fatigue rather than damage. If pain shoots well past that or lingers longer than expected, it is often a sign to dial things back slightly rather than stop altogether.
Over time, working within those limits helps rebuild strength and confidence without constantly triggering symptoms.
Yes, medical cannabis for chronic pain (including upper back pain) has been a fully legal treatment option since 2018 in the UK. That said, it is not as simple as popping down to your local GP's office, picking up a prescription, and then heading to the chemist to get the script filled…
So, how do you go about getting a UK medical cannabis prescription for chronic upper back pain?
The simplest first step is to head to Releaf’s medical cannabis eligibility checker. It’s free, takes less than 20 seconds, and will give you a clear indication of your potential eligibility moving forward.
If you are found to be potentially eligible, the next steps will usually look something like this:
In late 2025, Releaf conducted the largest ever medical cannabis patient survey in the UK.
Of the 1,669 respondents, almost half (792 or 47.5%) are being treated for chronic pain as their primary condition, which includes long-standing musculoskeletal pain such as persistent upper back pain.
The results were overwhelmingly positive:
(If any of the terminology feels unfamiliar, the Releaf medical cannabis glossary breaks down common terms in plain, patient-friendly language.)
Physiotherapy/strengthening routines should be seen as one part of a holistic treatment plan. There are also plenty of practical ways that you can help ease your upper back pain in the moment while also working to strengthen the area through a physio programme.
Certain over-the-counter medications can help in times of heavy flare-ups, but keep in mind that they can come with some unwanted side effects and won’t fix the root cause. That said, if you are currently battling through an upper back pain flare up, you may find some relief from:
Think of these options as tools to help you stay active enough to continue your mobility and strengthening exercises.
Heat and cold pack options are often overlooked for upper back pain soreness, but they can have a surprisingly hefty impact in terms of short-term pain relief. That said, they work best when applied in the right area and at the right time, and knowing when to use one or the other can make all the difference.
Seating and desk setups get a lot of attention when it comes to upper back pain, and rightfully so. While they are not a cure, they can make a noticeable difference to how quickly fatigue builds up through the day if you spend hours at a desk.
None of these need to be perfect, and experimentation is key, as what works for one person may not be right for you. If something helps you change position more often or feel less tense by the end of the day, it is probably useful. If it makes you feel rigid or locked into one setup, it is likely doing more harm than good.
The first question most people have when upper back pain flares up is…
“What can I do right now?”
Relieving upper back pain is unglamorous work. As we just touched on above, physiotherapy is the first port of call for most people searching for upper back pain relief.
Is it a quick fix?
No, not usually.
Oftentimes, physio will need to become a part of your everyday routine for weeks, months, or maybe even for the rest of your life. Think of it as maintenance, movements to keep that machine of yours moving pain-free. The more strength you slowly build, the less likely you are to experience regular flare-ups.
Most physio programmes take less than 10 to 20 minutes a day, and can have a huge impact on your ongoing upper back pain.
Pain between the shoulder blades (or on one side) usually responds very well to gentle, controlled movements. The last thing you want is for the muscles to tighten up, so think of these movements as a reset rather than a solution.
Thoracic mobility exercises usually involve rotation and extension through the upper spine and are often part of most physio programmes for upper back pain.
None of this should be forced or cause heavy pain.
All we are looking for is that the area moves a little more freely afterwards. They work best when they are short and repeatable. A few minutes three or four times a day is more helpful than one long session.
Mild discomfort is normal, but don’t ever push through sharp pain. Upper back pain relief can take time, but the last thing you want to do is constantly re-aggrivate it.
|
Treatment option |
What it may help with |
When it is commonly used |
|
Medical cannabis treatment |
Managing ongoing upper back pain alongside disrupted sleep, muscle tension, stress, and reduced quality of life |
When at least 2 conventional treatments have not provided adequate symptom relief, under specialist doctor oversight |
|
Physiotherapy |
Improving movement confidence, posture, strength, and flexibility |
Early support and longer-term management |
|
Activity modification |
Settling flare-ups and reducing strain |
During acute pain phases or symptom spikes |
|
Exercise and movement |
Supporting mobility, resilience, and long-term recovery |
Once pain begins to settle, guided by symptoms |
|
Pain relief medications |
Short-term symptom relief |
Acute flare-ups, used cautiously and under guidance |
Without a long-term strengthening and mobility treatment plan, combined with other treatment options as part of a holistic approach, upper back pain symptoms usually return. ort-term relief can settle symptoms, but if the muscles and joints are still being asked to handle the same loads with the same tolerance, flare-ups are likely to repeat.
No, but without the proper support and management, it can become persistent and frustrating. Most upper back pain is mechanical and related to how the area is being used and loaded over time, rather than anything dangerous.
Yes, stress can cause the upper body to ‘lock up’, even when there are no acutal physical issues.
If you are suffering from heavy upper back pain, sleeping on your back with a fully supportive pillow can be the difference between a pain-free day and not. A pillow placed under your kness is also suggested, as it can help you stay in the ‘back to the mattress’ position.
If you have been dealing with upper back pain for more than a few weeks, while also implementing a strengthening and mobility programme, then it is recommended to go see your GP and see what the next steps may be.
Missing data is something that researchers always plan for, and while it can have an impact on the final results a single study, well designed studies and trials take this into acccount and explain and shortcomings. It usually isn't a big factor in the overall findings, especially in areas where there is much research to pull from.
It is fair to say that almost every one of us will encounter a period of upper back pain at some point in our lives, it is literally that common. But as common as it is, it is also most often not related to any serious injury.
That said, if you have been dealing with ongoing upper back pain issues, and conventional treatment options (including physiotherapy, strengthening routines, and short-term pain relief) havent brought the symptom control you need, it may be worth considering other options. For many UK patients dealing with long term chronic pain issues, medical cannabis has already helped reduce persistent pain, improve sleep quality, ease muscle tension, and make life easier more generally.
If you are interested to find out more, head to our medical cannabis eligibility checker. It’s free, takes less than 20 seconds, and gives you a clearer idea of your potential eligibility.
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