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Causes of Upper Back Pain

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In order to get the best, most effective treatment for your upper back pain (also known as mid-back pain), you should know what's causing it. Your doctor can help you figure that out, but here are some common causes:

  • muscle or soft tissue problem: Muscles, tendons, and ligaments—the soft tissues that support the spine—can be sprained or strained by misuse or overuse. It's possible to get an upper back muscle sprain or a strain through:
      • poor posture: Sitting with a rounded back, shoulders hunched forward, can put too much stress on the back muscles. Poor posture is one of the leading causes of upper back pain because so many office workers spend their work days at the computer. It's easy to fall into bad habits of not sitting properly, especially when you're at your desk for so many hours a day.
      • improper lifting: When picking something up, you should also use good body mechanics so that you protect your spine. Not using the proper form can cause injury and pain.
      • carrying a heavy backpack: Kids are obviously more in danger of getting an upper back injury because of a backpack. An overly loaded backpack is dangerous to the spine, but so is not wearing the backpack correctly (eg, just using one strap).
  • trauma/injury: Traumatic events, such as car accidents, can cause upper back pain for various reasons. It's possible to fracture a vertebra (spinal bone). Or part of your vertebra(e) can press on a spinal nerve, which can cause pain.
  • other spinal conditions: Upper back pain can be a symptom associated with other spinal conditions. For example:
      • infections: A spinal epidural abscess or a paraspinal abscess can compress the spinal cord or spinal nerves in the thoracic spine, causing pain and other symptoms.
      • osteoporosis: This is a condition affecting the bones. It weakens them, making them more likely to fracture and less likely to carry your weight well. If you have osteoporosis in your thoracic spine, you may develop upper back pain. Weakened vertebrae don't support your body's weight as well, so your muscles, ligaments, and tendons have to work harder to make up for the vertebrae. That can lead to sprain, strain, or muscle fatigue.

        If you have a vertebral fracture or fractures because of osteoporosis, you will probably develop a rounded back—that's poor posture, which can lead to upper back pain.
      • problematic kyphosis: When looked at from the side, your spine is supposed to curve outwards in your upper back (thoracic spine) region; that curve is called kyphosis or a kyphotic curve. However, it can start to curve outward too much, and that's problematic kyphosis. Various conditions, such as osteoporosis, can cause problematic kyphosis in the thoracic spine, leading to upper back pain.
      • scoliosis: Scoliosis causes an unusual curve or curves in the spine. It can make your spine look like an "S"or a "C" when viewed from the back. If your spine is curving to the left or to the right in the upper back (thoracic spine), you may have pain because of how the curve affects spinal nerves, muscles, and other soft tissues.
      • other conditions: Upper back pain can develop in conjunction with other medical conditions not related to the spine. For example:
        • acid reflux (GERD)
        • ulcers
        • cardiac conditions, such as angina

The upper back (thoracic spine) is much more stable than the neck (cervical spine) and low back (lumbar spine). It doesn't move as much as they do because one of its main jobs is to protect the internal organs in the chest. It does this in conjunction with the ribs, which are attached to the thoracic vertebrae.

Because the thoracic spine doesn't move as much, it's less prone to the joint and disc problems that more commonly affect the neck and low back. That doesn't mean that you can't have a herniated disc causing your upper back pain, but it is much less common.

It's also less common to have degenerative problems in the thoracic spine. The neck and low back move more, so the joints and discs may wear out sooner from use, overuse, and misuse.

Updated on: 07/10/12

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Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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