Upper Back Pain
(A Complete Guide with Relief Exercises)

Written by: Nurudeen Tijani (Wellness and Pain Relief Fitness Coach)

Article Summary

• Individuals involved in strenuous work, physical activities, sedentary routines, or active lifestyles may experience discomfort or pain in the upper back.
• The primary causes include magnesium deficiency, muscle restriction, subluxation, and chronic inflammation.
• Why it becomes chronic: Even when the painful area is treated, symptoms often return due to muscle stiffness, how muscles and tendons absorb stress, and compensation patterns that develop over time.
• This article explores these causes and outlines effective non-surgical self-treatment and prevention strategies for managing upper back pain.

Key Points

• Root Causes: Magnesium deficiency, muscle restriction, subluxation, and chronic inflammation are the primary causes of upper back pain.
• Symptoms: Discomfort or pain when breathing, lying down, or coughing; pain when turning the head, sleeping, or between the shoulder blades and mid-back; pinching sensations along the spine during shoulder movements.
• Non-Surgical Treatment: Use self-myofascial release (SMR) exercises to massage and keep the upper back muscles pliable. SMR is an effective and reliable way to relieve upper back pain.

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Causes of Upper Back Pain

In this section, we'll cover the root causes, spine, muscles, and general factors that lead to discomfort.

Root Causes

Root Cause #1: Magnesium Deficiency

Approximately 70 to 80% of the population in the U.S. is magnesium deficient, which can have significant implications for muscle health.

Magnesium is essential for muscle relaxation, while calcium promotes muscle contraction. When magnesium levels are low, muscles are more likely to remain tense, which can strain tendons, overburden ligaments, and lead to inflammation and discomfort in the upper back.

Around 40% of the body’s magnesium is stored in muscles. Low magnesium levels can manifest as muscle twitching, cramps, and spasms, all of which indicate an imbalance that can contribute to upper back issues.

Magnesium also dissolves excess calcium, preventing the calcification of soft tissues, which can otherwise lead to hardened muscles, tendons, and ligaments. A lack of magnesium directly contributes to inflammation, as conditions ending in "itis" (like tendonitis) are often linked to an inflammatory process that magnesium can help mitigate.

According to The Magnesium Miracle by Carolyn Dean, MD, ND, heavy exercise, physical occupations, caffeine, stimulants, diuretics, stress, and dehydration all contribute to magnesium depletion.

For individuals engaged in strenuous activities or physical occupations, it’s crucial to actively replenish magnesium in the body.

Root Cause #2: Muscle Restriction

With the body deficient in magnesium, muscles in the upper back—such as the trapezius, rhomboid major and minor, serratus posterior, and spinal erectors—are more likely to contract, become tense, and lose elasticity over time.

This creates a condition known as muscle restriction, where muscle fibers become inelastic, tight, shortened, knotted, or tender, and are unable to fully relax back to their normal state.

Muscle restriction commonly results from upper body activities involving lifting, pulling, pushing, or supporting heavy loads, which overstretch and overload these muscles.

When restricted, these muscles shorten and tighten, placing excess tension on tendons and joints in the thoracic spine. This tension ultimately leads to inflammation, strain, and pain in the upper back.

Root Cause #3: Subluxation

Restricted muscles pull tighter on the joints, and over time, this can cause the joints to shift out of their normal position. This condition is known as subluxation, which affects both joint alignment and the nervous system.

In the case of upper back pain, restricted muscles in the thoracic region exert pressure on the vertebrae, leading to misalignment in the thoracic spine. This shift causes discomfort and can even result in sharp nerve pain, as the misaligned vertebrae stretch and compress nerves.

Misaligned vertebrae also contribute to inflammation in the surrounding ligaments and spinal discs, creating ongoing pain and discomfort in the upper back.

If left uncorrected, subluxation can lead to chronic upper back pain and may develop into a long-term inflammatory condition.

Root Cause #4: Chronic Inflammation

As mentioned earlier, muscle restriction and subluxation cause inflammation in the muscles, vertebrae, and thoracic spine, leading to upper back pain. Initially, this inflammation is acute, meaning the pain and condition are temporary.

With time, the body can often heal minor strains, allowing the pain to subside. However, when restricted muscles and subluxation in the thoracic spine do not heal and the pain persists for three months or more, it becomes a chronic inflammatory condition.

Chronic inflammation is a state in which the body's natural healing response is impaired. This condition prevents the inflammatory process from effectively repairing injured muscles, tendons, and ligaments, which in turn, leads to persistent upper back pain.

If left untreated, chronic inflammation in the thoracic spine can become degenerative, potentially causing irreversible deterioration of the spinal structures in this area.

Note: Beside muscle strain, various health condition can cause back problems. Here is an article from the National Institute of Health (NIH) on medical conditions that cause back pain.

Spine and Muscle Issues

Thoracic Spine:

The thoracic spine is the middle segment of the spinal column, extending from the base of the neck to the lower back. It consists of 12 vertebrae (T1–T12) and is connected to the ribcage, providing stability to the upper body and protecting vital organs.

The thoracic spine’s structure is designed for support rather than mobility, making it susceptible to strain, particularly when influenced by restricted muscles.

A photo of the spine anatomy is available below.

Upper Back Muscles:

The following muscles are listed in order of their significance and contribution to upper back pain. When these muscles become restricted, they can lead to tension, strain, and pain in the upper back.

• Rhomboid Major and Minor: These muscles are located between the spine and the shoulder blades. They originate from the upper thoracic vertebrae and insert onto the scapula. Their primary function is to retract the shoulder blades, stabilizing the upper back and supporting shoulder movement. When the rhomboids are tight or restricted, they can alter shoulder positioning, contributing to pain and strain in the upper back.
• Trapezius: The trapezius is a large, diamond-shaped muscle that extends from the upper back to the neck and shoulders. It originates from the base of the skull and the cervical and thoracic vertebrae and inserts onto the scapula and clavicle. Responsible for supporting shoulder and head movements, the trapezius, when restricted, can lead to significant upper back tension and strain, especially under stress or physical strain.
• Serratus Posterior Superior: The serratus posterior superior lies underneath the rhomboids and assists with rib movement and stabilization. Originating from the upper thoracic vertebrae, it attaches to the upper ribs. When tight, this muscle can create a pulling sensation in the upper back and contribute to discomfort, particularly during breathing.
• Erector Muscles: The erector muscles run along the spine and play a key role in maintaining an upright posture. Originating along the vertebrae, they extend down the spine and attach at various points along the ribs and pelvis. When these muscles are tight or restricted, they limit flexibility in the upper back, contributing to strain and discomfort, especially after long periods of sitting or poor posture.

General Causes

1. Sudden Impact to the Spine: Events such as car accidents or sports injuries can exert significant force on the spine, leading to trauma in the upper back muscles, ligaments, and vertebrae. This impact can cause acute pain, muscle strain, and long-term discomfort if not properly treated.
2. Lifestyle Factors: A person’s occupation or daily activities play a major role in upper back health. Jobs that involve prolonged sitting or heavy lifting can place strain on the upper back muscles and spine, often resulting in persistent pain.
3. Neck Issues: Injuries or conditions in the neck can contribute to pain in the upper or mid-back. Misalignments or tension in the cervical spine often affect the thoracic spine, spreading discomfort throughout the upper back.
4. Lower Back Issues: Similarly, lower back injuries or misalignments can lead to compensatory strain in the upper or mid-back, as the entire spine works together to support posture and movement.
5. Sleeping Position and Pillow: Sleeping in positions that don’t support spinal alignment can strain the upper back muscles. Poor pillow support may lead to improper neck and back posture, resulting in pain or strain upon waking.
6. Chronic Stress: Prolonged stress can cause increased muscle tension throughout the body, particularly in the shoulders and upper back. Over time, this tension can contribute to pain and discomfort.
7. Tension in the Body: General body tension, whether from physical exertion or emotional factors, can cause upper back muscles to tighten and restrict movement.
8. Bad Posture: Poor posture, especially while sitting or using electronic devices, can lead to forward head and rounded shoulder posture, straining the upper back muscles. Over time, this strain can cause pain and fatigue in the upper back.

The images below illustrate the thoracic spine and muscles mentioned earlier.

The "X" indicated in the images are where trigger points in the tissue tend to occur. Trigger points, known as muscle knots, are small, hyperirritable spots within a muscle. They cause tenderness and discomfort.

Jump to a specific section of the article:

1. Symptoms
2. Non-surgical Treatment
3. Relief Exercises
4. Next Step & Getting Started

Symptoms of Acute vs. Chronic Pain

Acute Pain of the Vertebrae, Joint, and Disc:

Acute upper back pain often results from subluxation caused by sudden strain, which may be triggered by strenuous physical activities, poor posture, or an unexpected impact.

Subluxation occurs when restricted muscles pull on the thoracic vertebrae, causing them to move out of alignment and leading to sharp, localized pain in the upper back.

Common symptoms of acute upper back pain include:

• Sharp pain between the shoulder blades, particularly when moving or lifting
• Pain when lying down, breathing, or coughing, as these actions can create additional pressure on the affected area
• A burning sensation in the upper back area
• Heat, redness, and tenderness around the affected region
• Throbbing or pulsating discomfort

This type of pain is typically an inflammatory response as the body attempts to repair the misalignment and strain. Acute inflammation usually lasts from a few days to a few weeks, during which rest and proper care can help alleviate the pain and support healing.

Chronic Pain:

Chronic upper back pain is characterized by ongoing tension, strain, and a dull ache, often resulting from prolonged muscle restriction and poor posture.

Over time, muscles like the trapezius, rhomboids, serratus posterior superior, and erector muscles become restricted, contributing to persistent discomfort and limited mobility in the upper back.

Key symptoms of chronic upper back pain include:

• Tension: Chronic tension in the trapezius muscle creates a feeling of tightness and heaviness in the upper back and shoulders. This tension can worsen with stress or physical strain.
• Strain and Discomfort: Restricted muscles, particularly the rhomboids, trapezius, and erector muscles, lead to strain and discomfort in the upper back. Poor posture, strenuous activities, and improper sleeping positions can intensify this strain, making it difficult to move freely. Pain is often noticeable when performing overhead movements or lifting.
• Pain When Turning the Head or Sleeping: Chronic muscle restriction can cause discomfort during head movements or while sleeping, as restricted muscles may pull on the vertebrae and joints.
• Dull and Persistent Ache: Unlike acute pain, chronic pain is less intense but more persistent, with a constant, dull ache that doesn’t easily subside. This ache may extend into the middle section of the spine, affecting posture and movement.

Chronic upper back pain develops when inflammation and muscle restriction persist for three months or more, creating a cycle of discomfort that becomes harder to resolve without addressing the root causes.

Non-Surgical Treatment and Prevention

Summary of Treatments

1. Heat Therapy: Applying heat can relax tight muscles, improve circulation, and reduce discomfort in the upper back.
2. Short-Term Relief Options: Supplements, pain relievers, and supportive tools like kinesiology tape can provide temporary relief but may not address the root causes of the injury.
3. Self-Myofascial Release (SMR) Relief Exercises: SMR exercises can keep upper back muscles pliable, releasing restrictions and easing tension in spine and shoulder blades.

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Heat Therapy

Heat therapy is effective for relaxing tight muscles in the upper back, promoting blood flow, and reducing pain. This approach is particularly beneficial for managing chronic tension and discomfort in the upper back.

To apply heat therapy:

• Use a heating pad, warm towel, or hot water bottle on the affected area of the upper back.
• Apply heat for 15-20 minutes, two to three times a day.
• Avoid applying heat directly on the skin, for extended periods, to reduce the risk of skin irritation.

By increasing blood circulation to the upper back muscles, heat therapy can help alleviate muscle tension, ease tightness, and provide relief from discomfort.

However, while heat can temporarily reduce muscle tension, it may not fully address the underlying causes of chronically restricted muscles.

Short-Term Options: Pros and Cons

Joint Supplements & Health Vitamins

• Pros: Joint supplements containing Methylsulfonylmethane (MSM) and Chondroitin can support joint health. When taken consistently, they may help promote overall health of the spine and upper back.
• Cons: In many cases, supplements like MSM, Chondroitin, Turmeric, and Fish Oil do not significantly relieve chronic upper back issues. These supplements also don’t address the root causes of muscle restriction. A study published in Arthritis & Rheumatology found that MSM and Chondroitin did not significantly reduce chronic joint pain.

Painkillers (NSAIDs)

• Pros: Nonsteroidal anti-inflammatory drugs (NSAIDs) or painkillers can reduce inflammation and provide temporary relief from upper back pain, especially when dealing with acute flare-ups.
• Cons: Painkillers primarily address pain symptoms without targeting underlying causes of upper back discomfort. Long-term NSAID use may lead to side effects, including gastrointestinal and kidney issues, making it an unsuitable option for chronic management.

Topical Anti-Inflammatory Remedies (Oil, Cream, Spray, Gel, Poultices)

• Pros: Topical solutions like oils, creams, and gels containing anti-inflammatory ingredients (such as MSM or menthol) can offer temporary relief from aches. These remedies can be applied directly to sore areas to provide localized relief.
• Cons: For chronic upper back issues lasting three months or more, these topical solutions may offer limited relief and do not address underlying muscle restriction. Additionally, they typically require frequent reapplication to maintain their effects.

Strength and Physical Therapy

• Pros: Strengthening exercises can improve overall stability, mobility, and the health of the spine and upper back, aiding in recovery from strain and reducing the risk of recurring pain. Physical therapy may also help correct posture and alignment issues that contribute to pain.
• Cons: Without addressing chronic muscle restriction, physical therapy alone may be insufficient for preventing or managing persistent upper back pain. Additionally, some exercises may increase discomfort if underlying issues, like restricted muscles, are not first resolved.

Manual Therapy (Massage, Cupping, Dry Needling)

• Pros: Manual therapies, such as massage, cupping, and dry needling, can effectively relieve upper back tension by targeting tight muscles and knots. These techniques help release muscle restrictions, improve blood flow, and reduce pain, providing relief for individuals dealing with muscle strain.
• Cons: To achieve lasting results, multiple sessions over an extended period may be required, which can be costly. Some individuals find deep-tissue massage uncomfortable, and for chronic upper back tension, frequent treatments are often necessary to maintain relief.

Vibrating Massagers

• Pros: Vibrating massagers can provide temporary relaxation for tight muscles in the upper back, potentially offering short-term relief from tension and discomfort. These devices are convenient for at-home use and can be applied directly to sore areas.
• Cons: Vigorous vibration on chronically tight muscles may cause them to tense up further, as restricted muscles often cannot absorb the shock effectively. For many, vibrating massagers may exacerbate upper back tightness, making this option unsuitable for chronically tense and magnesium-deficient muscles.

Kinesiology Tape Therapy

• Pros: Kinesiology tape provides support and stability to the upper back, potentially reducing strain on overworked muscles. This can be especially helpful for individuals involved in physical activities who are recovering from an injury. Kinesiology tape is also beneficial for improving posture.
• Cons: Taping alone does not address the underlying causes of the condition and may only mask symptoms temporarily. Over-reliance on tape for extended periods could lead to reduced muscle strength or dependence on external support.

Pain Relief Patches

• Pros: Medicated patches containing anti-inflammatory ingredients offer temporary relief for upper back pain by targeting the affected area directly. Some non-medicated options also provide support by promoting natural pain relief mechanisms.
• Cons: These patches primarily address symptoms rather than the underlying causes of chronic upper back tension. Long-term use of medicated patches may lead to side effects, and over-reliance on patches could delay addressing the root issues.

Stretching Therapy

• Pros: Stretching the upper back muscles helps improve flexibility, relieve tension, and increase blood flow. Regular stretching can be effective in reducing pain and promoting better posture over time.
• Cons: While stretching can provide temporary relief, it doesn’t directly address the root causes of chronic upper back pain if used alone. Without proper technique, overstretching can also worsen muscle strain, particularly in already tense or restricted muscles.

Chiropractic and Spine Health

If you experience sharp pain or restricted movement in the upper back, consulting a chiropractor for an adjustment may help to correct subluxations in the thoracic spine.

Most individuals require 2-3 chiropractic sessions to address acute subluxation issues effectively, though the exact number of adjustments will depend on personal needs and assessment results.

For prevention, regular chiropractic check-ups can help maintain spine health, as the body is constantly affected by stress, posture, and physical activity.

Chiropractic care can support spine alignment, which is essential for preventing chronic upper back pain and promoting long-term musculoskeletal health.

The images below illustrates some of the non-surgical treatment options referenced above, including heat therapy, sport taping, and stretching.

SMR Exercises for Upper Back Pain (exercise photos below)

Self-myofascial release (SMR) is an effective technique for relieving chronically tight muscles in the upper back, helping to reduce strain, increase mobility, and improve overall upper back function.

By applying targeted pressure to specific points in the fascia—the connective tissue around muscles—SMR encourages restricted muscles to relax, reducing discomfort and enhancing flexibility.

Recommended Tools:

• A Theracane is ideal for targeting the trapezius and upper back muscles.
• The PSO-Rite is effective for reaching deeper muscles, such as the rhomboids and serratus posterior superior.
• A foam roller works well for the erector muscles along the spine, providing relief along the thoracic area.

These tools are durable, affordable, and offer an accessible solution for ongoing pain management in the upper back.

Relief Exercises (Step-by-Step Instructions)

Performing specific SMR exercises can help relieve upper back pain by targeting and releasing tension in the upper back muscles.

These exercises focus on areas prone to restriction, such as the trapezius, rhomboids, and erector muscles.

For best results, use a holistic approach and massage the entire upper back and supporting muscles.

Exercise #1 — Massage the Trapezius and Erector Muscles

Massage the Trapezius and Erector Muscles with an Acumobility Roller:

1. Setup: Lie on your back with the Acumobility Roller positioned under the trapezius and erector muscles, between the shoulder blades.
2. Apply Pressure: Gently relax your body weight onto the roller, allowing it to press into the muscles. Hold this position for 2-3 minutes, breathing deeply to help release tension.
3. Roll Slowly: Gradually roll the Acumobility Roller along the trapezius and erector muscles, focusing on any tight or tender areas.
4. Target Trigger Points: Pause and hold pressure on any areas where you feel significant tightness or tenderness, allowing the muscles to relax. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the trapezius.
5. Routine: Perform this exercise once a day to relieve tension in the trapezius and erector muscles. For faster results, increase to twice a day, morning and evening.

In the photo below, I demonstrate how to massage the trapezius and erector muscles using an Acumobility Roller.

Exercise #2 — Massage the Rhomboid Muscles

Massage the Rhomboid Muscles with a PSO-Rite:

1. Setup: Lie on your back with the PSO-Rite positioned under the rhomboid muscles, between the shoulder blades.
2. Apply Pressure: Relax your body weight onto the PSO-Rite, allowing it to press into the rhomboids. Hold this position for 2-3 minutes, breathing deeply to encourage muscle relaxation.
3. Shift and Adjust: Slowly shift your position slightly to target different points along the rhomboid muscles. Focus on any tight or tender areas as you move.
4. Target Trigger Points: Pause and apply additional pressure to any areas with significant tension. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the rhomboid muscles.
5. Routine: Perform this exercise once a day to relieve tension in the rhomboids. For faster results, increase to twice a day, morning and evening.

In the photo below, I demonstrate how to massage the rhomboid muscles using a PSO-Rite.

Exercise #3 — Massage the Trapezius

Massage the Upper Trapezius with a Theracane:

1. Setup: Stand upright, holding the Theracane in one hand.
2. Position the Theracane: Place the hook of the Theracane over your shoulder, positioning it against the upper trapezius muscle at the top of the shoulder, extending from the neck to the shoulder joint.
3. Apply Pressure: Gently apply pressure to the trapezius muscle and hold for 2-3 minutes, breathing deeply to allow the muscle to relax.
4. Move Along the Muscle: Slowly slide the Theracane along the upper trapezius, focusing on tight or tender areas. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the upper trapezius.
5. Routine: Perform this exercise once a day to relieve tension in the upper trapezius. For faster results, increase to twice a day, morning and evening.

In the photo below, I demonstrate how to massage the upper trapezius using a Theracane.

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